瞬时弹性成像检查肝组织硬度诊断酒精性肝硬化效能研究*

doi:10.3969/j.issn.1672-5069.2023.04.018

摘要/Abstract

摘要： 目的探讨使用瞬时弹性成像检查肝组织硬度诊断酒精性肝病(ALD)患者肝硬化的效能。方法 2019年1月～2022年1月我院收治的ALD患者68例,均接受肝活检组织病理学检查,使用FibroScan 530 Compact诊断仪行肝硬度检测(LSM)和脾硬度检测(SSM)。采用Kappa检验两种诊断方法结果的一致性。结果以LSM诊断无或轻度肝纤维化28例(41.2%),显著性肝纤维化19例(27.9%),进展性肝纤维化13例(19.1%),肝硬化8例(11.8%);组织病理学诊断显示,S0、S1、S2、S3、S4期患者分别为15例(22.1%)、11例(16.2%)、20例(29.4%)、12例(17.6%)和10例(14.7%);以瞬时弹性成像诊断标准,8例肝硬化患者LSM和SSM分别为(18.4±5.6)kPa和(22.6±4.6)kPa,显著大于60例无肝硬化患者【分别为(10.7±3.3)kPa和(14.9±3.8)kPa,P<0.05】;以组织病理学检查结果为金标准,瞬时弹性成像诊断ALD患者存在肝硬化的灵敏度为70.0%,特异度为98.3%,准确率为94.1%,与组织病理学检查结果的一致性较好(Kappa值为0.744)。结论采用瞬时弹性成像技术检查诊断ALD患者肝硬化有较高的准确性,不失为较好的无创诊断技术而应用于临床。

关键词: 肝硬化, 酒精性肝病, 瞬时弹性成像, 肝活检, 诊断

Abstract: Objective This study was aimed to investigate the clinical utility of transient elastic (TE) imaging for the detection and quantification of liver fibrosis (LF) in patients with alcoholic liver cirrhosis diagnosed by histopathology. Methods 68 patients with alcoholic liver diseases (ALD) were encountered in our hospital between January 2019 and January 2022, and all underwent ultrasound-guided liver biopsy and TE imaging detection for liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). The consistency of diagnosis by two methods was evaluated by Kappa. Results Based on the LSM, the patients without or mild LF were found in 28 cases (41.2%), with significant LF in 19 cases (27.9%), with advanced LF in 13 cases (19.1%) and liver cirrhosis (LC) in 8 cases (11.8%); the liver histopathological examination showed LF S0, S1, S2, S3 and S4 in 15 cases(22.1%), 11 cases (16.2%), 20 cases (29.4%), 12 cases (17.6%) and 10 cases (14.7%); the LSM and SSM in 8 patients with LC proven by TE were (18.4±5.6)kPa and (22.6±4.6)kPa, significantly greater than [(10.7±3.3)kPa and (14.9±3.8)kPa, respectively, P<0.05] in 60 patients without LC; based on the gold criteria by histopathology, the sensitivity, specificity and accuracy by TE in predicting LC were 70.0%, 98.3% and 94.1%, with good consistency (Kappa=0.744). Conclusion The TE imaging technique, as a good non-invasive approach, could be utilized in clinical practice for early diagnosis of LF and/or LC, which might be helpful for clinicians making interventional strategy.

Key words: Liver cirrhosis, Alcoholic liver diseases, Transient elastic imaging, Liver biopsy, Diagnosis

陈丽, 郭明君, 操依含, 曹秀玲, 周静. 瞬时弹性成像检查肝组织硬度诊断酒精性肝硬化效能研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 524-527.

Chen Li, Guo Mingjun, Cao Yihan, et al. Clinical utility of transient elastic imaging for the detection and quantification of liver fibrosis in patients with alcoholic liver cirrhosis diagnosed by histopathology[J]. Journal of Practical Hepatology, 2023, 26(4): 524-527.

参考文献

[1] 董梦珍,林中华,刘守胜,等.AGT rs5051基因多态性增加中国汉族人群非ALD患者发生冠心病的风险.中华肝脏病杂志,2021,29(11):1095-1100.
[2] Astarini FD, Ratnasari N, Wasityastuti W , et al. Update on non-alcoholic fatty liver disease-associated single nucleotide polymorphisms and their involvement in liver steatosis, inflammation, and fibrosis: a narrative review. Iran Biomed J, 2022 ,26(4):252-268.
[3] Adalı Y, Eroğlu HA, Makav M , et al. Comparison of tru-cut biopsy and fine-needle aspiration cytology in an experimental alcoholic liver disease model. Rev Assoc Med Bras (1992), 2020,66(8):1030-1035.
[4] Steinkohl F, Barbieri F, Senoner T , et al. Coronary atherosclerosis profile in patients with end-stage liver disease prior to liver transplantation due to alcoholic fatty liver: a coronary CTA study. Eur Radiol, 2021 ,31(1):494-503.
[5] Zhuge Q, Zhang Y, Liu B , et al. Blueberry polyphenols play apreventive effect on alcoholic fatty liver disease C57BL/6 J mice by promoting autophagy to accelerate lipolysis to eliminate excessive TG accumulation in hepatocytes. Ann Palliat Med, 2020,9(3):1045-1054.
[6] Yaraş S, Sezgin O, Üçbilek E, et al. Significant decrease in liver stiffness detected by two dimensional shear-wave elastography after treatment with direct-acting antiviral agents in patients with chronic Hepatitis C. Turk J Gastroenterol, 2020 ,31(2):142-147.
[7] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会. 酒精性肝病防治指南(2018年更新版). 实用肝脏病杂志,2018,21(2):170-176.
[8] 中国肝炎防治基金会,中华医学会感染病学分会,中华医学会肝病学分会和中国研究型医院学会肝病专业委员会.瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版).中华肝脏病杂志,2019,27(3):182-191.
[9] 王琳,林雪松,丁楠.非酒精性单纯性脂肪肝与非酒精性脂肪性肝炎患者血清脂质组学比较.实用肝脏病杂志,2022,25(2):215-218.
[10] 陈永超,周旺,李岩,等.超声造影指导肝穿刺对肝脏占位性病变的诊断价值研究.实用肝脏病杂志,2021,24(4):569-572.
[11] Iwashita H, Shakado S, Yoshimaru N , et al. Clinical utility of ultrasound-guided attenuation parameter for the detection and quantification of hepatic steatosis in patients with fatty liver diagnosed by computed tomography. Ultrasound Med Biol, 2022 ,48(7):1282-1289.
[12] Saraireh H, Abdelfattah T, Hassouneh R , et al. "Wet heparin" and "wet saline" EUS-guided liver biopsy techniques both provide high rates of specimen adequacy for benign parenchymal liver disease. Dig Dis Sci, 2022,67(11):5256-5261.
[13] Bende F, Sporea I,Şirli R , et al. Ultrasound-guided attenuation parameter (UGAP) for the quantification of liver steatosis using the controlled attenuation parameter (CAP) as the reference method. Med Ultrason, 2021,23(1):7-14.
[14] Rodina AS, Shubina ME, Kurbatova IV , et al. Hepatocytic apoptosis and immune dysfunction in decompensation of alcoholic liver cirrhosis with different grades of acute-on-chronic liver failure. Bull Exp Biol Med, 2022 ,172(4):410-414.
[15] Sisman G, Barbur E, Saka D , et al. Endoscopic ultrasound-guided liver biopsy using a 20-gauge fine needle biopsy needle with the wet-heparinized suction technique. Eur J Gastroenterol Hepatol, 2020,32(11):1470-1474.
[16] Cannella R, Dasyam N, SeoSH , et al. Performance of morphologic criteria for the diagnosis of cirrhosis in patients with non-alcoholic steatohepatitis compared to other etiologies of chronic liver disease: effect of level of training and experience. Abdom Radiol (NY), 2021 ,46(3):960-968.
[17] Kim D, Cholankeril G, Loomba R, et al. Prevalence of fatty liver disease and fibrosis detected by fibroscan in adults in the united states, 2017-2018. Clin Gastroenterol Hepatol, 2020, 19(7):1499-1501.
[18] Xu Y, Liu Y, Cao Z, et al. Comparison of fibrotouch and fibroscan for staging fibrosis in chronic liver disease: single-center prospective study. Dig Liver Dis, 2019,51(9):1323-1329.
[19] Cotter TG, Charlton MR. The triumph of bacchus: the emergence of nonalcoholic steatohepatitis and alcoholic liver disease as the leading causes of mortality from cirrhosis. Hepatology, 2019,69(3):931-933.
[20] Meyer JJ, Dreyhaupt J, Schwerdel D , et al. Blood-based targeted metabolomics discriminate patients with alcoholic liver cirrhosis from those with non-cirrhotic liver damage: an explorative study. Dig Dis, 2022;40(2):223-231.

瞬时弹性成像检查肝组织硬度诊断酒精性肝硬化效能研究^*

Clinical utility of transient elastic imaging for the detection and quantification of liver fibrosis in patients with alcoholic liver cirrhosis diagnosed by histopathology

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	石莹, 吕永燕, 杨增娣, 刘波, 娄方明, 徐军, 童清平. 超声剪切波弹性成像技术评估CCl₄诱导的肝损伤大鼠肝纤维化程度效能研究[J]. 实用肝脏病杂志, 2023, 26(4): 476-479.
[2]	周克丽, 吕晓丽, 周洋, 龙浩成. 应用肝脏硬度检测联合多普勒超声检测门静脉血流动力学指标评估慢性乙型肝炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 480-483.
[3]	胡灵溪, 安薪宇, 李妹, 刘百成, 南月敏, 王荣琦. 超声衰减参数诊断体检人群脂肪肝临床应用价值分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 488-491.
[4]	赵小利, 秦博, 李东风, 王娟. 乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化^*[J]. 实用肝脏病杂志, 2023, 26(4): 528-531.
[5]	王世美, 胡玲, 伍丽萍, 刘丽. 肝硬化并发非创伤性乳糜腹水12例临床特征分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 532-535.
[6]	丁闪闪, 丁凯, 姜宁. 索磷布韦联合维帕他韦治疗丙型肝炎肝硬化患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 536-539.
[7]	吴冲, 张小丽, 邢益门, 周婷. 内镜下套扎治疗乙型肝炎肝硬化并发食管胃静脉曲张破裂出血患者1年内再出血调查及危险因素分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 540-543.
[8]	刘莹, 陈东妙, 王从容. 慢性乙型肝炎、乙型肝炎肝硬化和原发性肝癌患者血清腺苷脱氨酶、α-L-岩藻糖苷酶和AFP-L3水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2023, 26(4): 552-555.
[9]	贾芳, 尚丰, 宋涛. 良恶性胆囊占位性病变超声表现特征分析^*[J]. 实用肝脏病杂志, 2023, 26(4): 592-595.
[10]	徐林芳. 食管胃底静脉曲张破裂出血患者血清PGE2和IL-6水平及PALBI评分变化及其临床意义探讨[J]. 实用肝脏病杂志, 2023, 26(4): 596-598.
[11]	李钟浙, 廖晖, 徐小平. 肝硬化患者营养评价及饮食管理研究进展[J]. 实用肝脏病杂志, 2023, 26(4): 601-604.
[12]	张绍全, 林炳亮. 肠道菌群与肝硬化研究进展^*[J]. 实用肝脏病杂志, 2023, 26(3): 313-316.
[13]	陶贞贞, 王永莉, 孙红艳, 王慧芬. 二维剪切波弹性成像诊断慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 328-331.
[14]	赵景, 何秀波, 谌瑾寰. 肝脏剪切波弹性成像联合GGT/PLT比值诊断慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 332-335.
[15]	赵玲玲, 王贝贝, 姚勇利, 郑有花, 李亚楠. T2DM合并非酒精性脂肪性肝病伴进展性肝纤维化患者血清抵抗素和TyG指数变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2023, 26(3): 356-359.