本研究的目的是应用实时组织弹性成像技术测量非酒精性脂肪性肝病患者的肝脏硬度，并且与临床通过肝脏组织学评估纤维化分级的结果进行比较。将181名做过肝组织弹性成像检测的患者纳入该试验，将第一部分106名患者作为实验组，剩下的75名患者作为验证组。计算肝脏和脾脏的弹性比，比较组织纤维化程度。同时评估门静脉高压程度。在实验组中将各阶段组织弹性的临界值进行划分：小于2.47为F1阶段，2.47-2.67为F2阶段，2.67-3.02为F3阶段和3.02-3.36为F4阶段。应用这些临界值对验证组进行诊断，所有组别的肝纤维化诊断准确率在82.6%-96.0%。门脉纤维化与肝脏弹性值进行多因素分析。受试者工作特征曲线下面积提示在早期和晚期纤维化阶段弹性比值均比血清学纤维化指标有更好的相关性 。通过脾脏弹性来定义的门脉高压患者只见于轻度纤维化组。而严重的门脉高压患者只见于肝硬化组。最后得到的结论实时组织弹性成像在评估非酒精性脂肪性肝病的肝纤维化及门静脉高压中是非常有用的。
吉林大学第一医院肝胆胰内科 姜翠 牛俊奇 摘译
本文首次发表于[Hepatology, 2012, 56(4): 1271-1278]
Real-time tissue elastography for evaluation of hepatic fibrosis and portal hypertension in nonalcoholic fatty liver diseases
The aim of this study was to prospectively measure liver stiffness with real-time tissue elastography in patients with nonalcoholic fatty liver diseases (NAFLD) and to compare the result with the clinical assessment of fibrosis using histological stage. One hundred and eighty-one prospectively enrolled patients underwent real-time tissue elastography, with the first 106 being analyzed as the training set and the remaining 75 being evaluated as the validation set. Hepatic and splenic elastic ratios were calculated and compared with stage of histological fibrosis. Portal hypertension (PH) was assessed. Real-time tissue elastography cut-off values by stage in the training set were 2.47 for F1, 2.67 for F2, 3.02 for F3, and 3.36 for F4. Using these cut-off values, the diagnostic accuracy of hepatic fibrosis in the validation set was 82.6%-96.0% in all stages. Only portal fibrosis correlated with the hepatic elastic ratio by multivariate analysis. The area under the receiver operating characteristic curve of elastic ratio better correlated than serum fibrosis markers in both early and advanced fibrosis stages.Patients with PH, defined by splenic elasticity, had early fibrosis. Patients with severe PH were found only in the group with cirrhosis.
Conclusion:Real-time tissue elastography is useful in evaluating hepatic fibrosis and PH in patients with NAFLD（ nonalcoholic fatty liver diseases ）.
