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(FS)监测肝移植后复发丙肝肝纤维化进展

更新时间:2009-8-4

目的:肝脏弹性检测评估丙肝肝纤维化病变的无创手段,我们研究的目的在于验证肝脏弹性检测(FS)是否适用于肝移植后的患者,包括肝移植后复发丙肝的患者。观察对象:第三医院的95名患者,均因丙肝终末期行肝移植。在肝移植后6156个月期间,对他们实行前后两次肝穿和肝弹性检测,40名复发丙肝的患者在621个月依次予以评估。

主要结果:临床参数,实验室检查,组织学特性均影响肝脏弹性检测结果。结果:所有检测成功的90个患者肝弹性值为7.6 kPa30个肝穿结果为S0-1患者的弹性值为5.6kpa38人为S2-3,其弹性值为7.6kpa,22人为S4-6,其弹性值为16.7kpa。对于S3患者,其诊断ROC曲线下面积为0.85 (95% CI, 0.76 to 0.92)S4时,其ROC曲线下面积为0.90 (95% CI, 0.82 to 0.95),对S3S4,最优cut-off值分别为7.9 11.9 kPa,且灵敏度,特异度分别为:81% 82%88% 94%。同时,肝纤维化炎症活性和γ-谷氨酸转移酶高于200 IU/l时也影响肝弹性值。对于肝移植后的观察阶段,其炎症分期和纤维化分级均影响肝弹性值,其相关系数分别为:r = 0.63r = 0.71,提示纤维化级别改变的灵敏度为86%,特异度为92%

结论:对于肝移植后复发丙肝患者,肝弹性检测能准确诊断肝纤维化级别,对于肝移植后观察期内,如患者肝弹性值增加或稳定的患者可以免做肝穿。

来源:Gut. 2008 Jun;57(6):821-7. Epub 2008 Jan 24.

原文:

Transient elastography predicts fibrosis progression in patients with recurrent hepatitis C after liver transplantation.

Rigamonti C, Donato MF, Fraquelli M, Agnelli F, Ronchi G, Casazza G, Rossi G, Colombo M.

First Division of Gastroenterology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Sforza, 35-20122 Milano, Italy. crigamo@tin.it

OBJECTIVE: Transient elastography (TE) allows non-invasive evaluation of the severity of liver disease in patients with chronic hepatitis C. This procedure, however, warrants further validation in the setting of liver transplantation (LT), including patients under follow-up for recurrent hepatitis C. SETTING: Tertiary referral hospital. PATIENTS: 95 patients (75 males) transplanted for end-stage liver disease due to hepatitis C virus. INTERVENTIONS: Paired liver biopsy (LB) and TE were carried out 6-156 (median, 35) months after LT. 40 patients with recurrent hepatitis C sequentially evaluated 6-21 months apart. MAIN OUTCOME MEASURES: Clinical, laboratory and graft histological features influencing TE results. RESULTS: Median TE values were 7.6 kPa in the 90 patients with a successful TE examination, being 5.6 kPa in the 30 patients with Ishak fibrosis score (S) of 0-1, 7.6 kPa in the 38 with S2-3; 16.7 kPa in the 22 with S4-6, (p < 0.0001). Areas under the ROC curves were 0.85 (95% CI, 0.76 to 0.92) for S > or = 3, 0.90 (95% CI, 0.82 to 0.95) for S > or = 4 with 7.9 and 11.9 kPa optimal TE cut-off (81% and 82% sensitivity, 88% and 94% negative predictive value, respectively).Fibrosis, necroinflammatory activity and higher than 200 IU/l gamma-glutamyl transpeptidase levels independently influenced TE results. During post-LT follow-up, TE results changed in parallel with grading (r = 0.63) and staging (r = 0.71), showing 86% sensitivity and 92% specificity in predicting staging increases. CONCLUSIONS: TE accurately predicts fibrosis progression in LT patients with recurrent hepatitis C, suggesting that protocol LB might be avoided in patients with improved or stable TE values during follow-up.

PMID: 18218676 [PubMed - indexed for MEDLINE]

 

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