瞬时弹性波：受转氨酶主要变化影响的新型肝纤维化替代指标

B. Coco; F. Oliveri; A. M. Maina; P. Ciccorossi; R. Sacco; P. Colombatto; F. Bonino; M. R. Brunetto
UO Gastroenterologia ed Epatologia Ospedaliera, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
摘要：
对228名慢性病毒性肝炎病人（115名有肝硬化，113名无肝硬化），使用瞬时弹性波（FibroScan）测量肝脏硬度，从而研究瞬时弹性波与血清转氨酶（丙氨酸转移酶），肝纤维化分级和无创替代指标（APRI,FORNS, FibroTest和透明质酸）之间的关系。对31名病人进行6个月随访，通过多重测试比较血清转氨酶和肝脏硬度动态变化的数据。我们将8.3kPa和14kPa分别定为纤维化分级≥F2和肝硬化的临界值，敏感性分别为85.2%/78.3%，特异性分别为90.7%/98.2%，阳性预测值分别为93.9%/97.8%，阴性预测值分别为78.8%/81.6%，诊断精确率分别为87.3%/88.2%。FibroScan比其它纤维化替代指标更好的指示肝纤维化的程度（p<0.001）。对所有病人和慢性肝炎病人来说，除了纤维化之外，其它与肝脏硬度独立相关的因素有ALT（p<0.001），以及硬化病人12个持续正常的ALT（生化好转，p<0.001）。对于无论是自然好转或经抗病毒治疗后生化学指标好转的病人（228名病人中有48人，占21%），其肝脏硬度显著低于纤维化级别相同，但ALT水平升高的病人（p<0.001）。肝脏硬度的动态变化与ALT的动态变化平行，10名肝炎恶化的病人的ALT增加了1.3-3倍。21名生化学活性指标稳定的病人其肝脏硬度值也保持稳定(P = 0.001)。总之，因为与生化活性主要变化具有平行关系，瞬时弹性波作为慢性病毒性肝炎的一项可靠的纤维化替代指标，是一项新型的肝病参数。
J Viral Hepat. 2007 May;14(5):360-9.

Transient Elastography: A New Surrogate Marker of Liver Fibrosis Influenced by Major Changes of Transaminases
B. Coco; F. Oliveri; A. M. Maina; P. Ciccorossi; R. Sacco; P. Colombatto; F. Bonino; M. R. Brunetto
Summary
Liver stiffness was measured by transient elastography (FibroScan®) in 228 consecutive patients with chronic viral hepatitis, with (115) or without cirrhosis (113), to study its correlations with serum transaminases [alanine aminotransferase (ALT)], fibrosis stage and surrogate noninvasive markers of fibrosis (APRI, FORNS, FibroTest and hyaluronic acid). The dynamic profiles of serum transaminases and liver stiffness were compared by multiple testing in 31 patients during a 6-month follow-up. We identified 8.3 and 14 kPa as the fibrosis ≥F2 and cirrhosis cut-offs, respectively: their sensitivities were 85.2%/78.3%; specificities 90.7%/98.2%; positive predictive values 93.9%/97.8%; negative predictive values 78.8%/81.6%; diagnostic accuracies 87.3%/88.2%. FibroScan® performed better than the other surrogate markers of fibrosis (P < 0.001). Other than fibrosis, other factors independently associated with liver stiffness were ALT for all patients and chronic hepatitis patients (P < 0.001), and 12-month persistently normal ALT (biochemical remission, P < 0.001) in cirrhotics. In patients with biochemical remission either spontaneous or after antiviral therapy (48 of 228, 21%), liver stiffness was lower than in patients with identical fibrosis stage, but elevated ALT (P < 0.001). The liver stiffness dynamic profiles paralleled those of ALT, increasing 1.3- to 3-fold during ALT flares in 10 patients with hepatitis exacerbations. Liver stiffness remained unchanged in 21 with stable biochemical activity (P = 0.001). In conclusion, transient elastography is a new liver parameter that behaves as a reliable surrogate marker of fibrosis in chronic viral hepatitis patients, provided that its relationship with major changes of biochemical activity is taken into account.