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慢性肝病肝硬化肝脏硬度检测的准确性

更新时间:2009-8-4

对于慢性肝病患者,肝硬化的准确诊断至关重要,因此,我们选取1257名不同病因的慢性肝病患者,进行前瞻性的多中心研究,通过FS检测与肝穿的对照,以验证FS检测肝脏硬度的准确性。1257名患者中,有132人肝穿标本不合格,118人肝脏硬度值不准确,剩下1007人,但有232人与之前的试验交叉,因而最终分别对775新受试者和整体1007人予以分析。诊断准确性通过ROC曲线进行分析,为防止试验偏差,肝穿标本予以重复分析。775人群体和1007人群体,其诊断ROC曲线下面积均为0.95 (95% CI, 0.93-0.96),诊断肝硬化的最优诊断准确率的cutoff14.6,阳性预测率和阴性预测率分别为74%,96%。80名患者诊断错误:(145人没有肝硬化,但肝硬度值为14.6甚至更高,45人中有27人为大面积肝纤维化,10人为窦状细胞周围明显纤维化;(235名患者患有肝硬化,但肝脏硬度值低于14.6,这35人中有10人肝脏具有较大结节,25人为非活动性肝硬化。总之:FS检测肝脏硬度是较好的诊断肝硬化的方法,14.6KPA为较准确排除肝硬化的界值,错误诊断的原因主要为非活动性肝硬化或者结节性肝硬化。

来源: Hepatology. 2006 Dec;44(6):1511-7.

原文:

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases.

Ganne-Carrié N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L, Dhumeaux D, Trinchet JC, Beaugrand M.

Hépato-Gastroenterologie, Hôpital Jean Verdier, Bondy, France. UPRES EA3409, Université Paris 13, Bobigny, France. nathalie.ganne@jvr.ap-hop-paris.fr

A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases. We assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis in 1,257 patients with chronic liver diseases of various causes enrolled in a prospective multicenter study as well as clarified causes of discrepancies between liver histology and Fibroscan. One hundred thirty-two patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements. Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population (1,007; 165 cirrhosis). Diagnostic accuracy was assessed by receiver operator curve (ROC) analysis. Liver samples were re-analyzed in case of discrepancies. The area under the ROC (AUROC) was 0.95 (95% CI, 0.93-0.96) for the diagnosis of cirrhosis in either 775 or 1,007 patients. The cutoff value with optimal diagnosis accuracy was 14.6 kPa in 1,007 patients (positive and negative predictive values, 74% and 96%) with discrepancies among the etiological groups. Eighty patients were misclassified: (1) among 45 patients without cirrhosis with liver stiffness 14.6 kPa or greater, 27 (60%) had extensive fibrosis and 10 (22%) significant perisinusoidal fibrosis; and (2) among 35 patients with cirrhosis and liver stiffness less than 14.6 kPa, 10 (29%) had a macronodular pattern and 25 (71%) either none or mild activity. In conclusion, Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases, better at excluding than at predicting cirrhosis using a threshold of 14.6 kPa. False-negatives are mainly attributable to inactive or macronodular cirrhosis.

PMID: 17133503 [PubMed - indexed for MEDLINE]

 

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