瞬时弹性成像技术在临床实践中被越来越多的用于无损伤探查慢性肝脏疾病患者的组织纤维化，特别是慢性丙肝患者的组织纤维化。本研究目的在于为连续观察的125例不同纤维化进展水平的丙肝患者在标准化餐后肝脏硬度增加的现象做出明确描述解释。分别在前夜禁食后和进标准化流食（400ml，600 Kcal, 16.7% 蛋白, 53.8% 碳水化合物, 29.5% 脂肪）后15、30、45、60、120分钟检测肝硬度值。结果：在所有患者中可以观察到在餐后15到45分钟肝硬度值显著提高，120分钟时回落至餐前基线水平。餐后肝硬度值呈三角形增加的峰值随肝纤维化水平增大而逐渐增大，在肝硬化患者达到最大。但以标准餐后呈三角形增加变化的肝硬度值来划分肝纤维化的METAVIR分期，Ch ild-Pugh分级或者食管静脉曲张的有无的应用率则低于通行的以肝硬度基线值来划分。结论：本研究的结果为标准化餐对为预测丙肝患者肝组织纤维化水平而进行肝硬度值测量的准确度产生的令人困惑的影响提供了准确的证据，并且提示在应用瞬时弹性成像检测方法前应进行120分钟的禁食周期观察。
Transient elastography (TE) is increasingly employed in clinical practice for the noninvasive detection of tissue fibrosis in patients with chronic liverdisease (CLD), and particularly chronic hepatitis C virus (HCV)-related hepatitis. The present study was designed to provide a definitive characterization of the "confounding" increase in liver stiffness (LS) following a standardized meal in a consecutive population of 125 patients withchronic HCV infection at different stages of fibrotic evolution. LS values were obtained after overnight fasting and 15, 30, 45, 60, and 120 minutes following the onset of a standardized liquid meal (400 mL, 600 Kcal, 16.7% protein, 53.8% carbohydrates, 29.5% fat). An evident increase in LS values was observed 15 to 45 minutes after the onset of the meal with return to baseline premeal levels within 120 minutes in all patients. The peak postmeal delta increase in LS was progressively more marked with increasing stages of fibrosis (P < 0.001), becoming maximal in patients with cirrhosis. However, the probability of identifying the Metavir stage of fibrosis, the Child-Pugh class, or the presence/absence of esophageal varices with the postmeal delta increase in LS was inferior to that obtained with baseline LS values. Conclusion: The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of LS measurements for the prediction of fibrosis stage in patients with chronicHCV hepatitis and suggest that a fasting period of 120 minutes should be observed before the performance of TE. (HEPATOLOGY 2013;).
吉林大学第一医院肝病科 巴特 摘译
本文首次发表于[Hepatology,2013,58(1):65-72]
本文首次发表于[Hepatology,2013,58(1):65-72]
Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages offibrotic evolution.
AbstractTransient elastography (TE) is increasingly employed in clinical practice for the noninvasive detection of tissue fibrosis in patients with chronic liverdisease (CLD), and particularly chronic hepatitis C virus (HCV)-related hepatitis. The present study was designed to provide a definitive characterization of the "confounding" increase in liver stiffness (LS) following a standardized meal in a consecutive population of 125 patients withchronic HCV infection at different stages of fibrotic evolution. LS values were obtained after overnight fasting and 15, 30, 45, 60, and 120 minutes following the onset of a standardized liquid meal (400 mL, 600 Kcal, 16.7% protein, 53.8% carbohydrates, 29.5% fat). An evident increase in LS values was observed 15 to 45 minutes after the onset of the meal with return to baseline premeal levels within 120 minutes in all patients. The peak postmeal delta increase in LS was progressively more marked with increasing stages of fibrosis (P < 0.001), becoming maximal in patients with cirrhosis. However, the probability of identifying the Metavir stage of fibrosis, the Child-Pugh class, or the presence/absence of esophageal varices with the postmeal delta increase in LS was inferior to that obtained with baseline LS values. Conclusion: The results of the present study provide definitive evidence of the confounding effect of a meal on the accuracy of LS measurements for the prediction of fibrosis stage in patients with chronicHCV hepatitis and suggest that a fasting period of 120 minutes should be observed before the performance of TE. (HEPATOLOGY 2013;).
