瞬时弹性成像检测肝硬度失败的因素及分析

Frequency and Determinants of Liver Stiffness Measurement Failure

目的探讨瞬时弹性成像(FibroScan)测量肝硬度失败率及分析失败原因。方法用FibroScan对4000例慢性肝病患者进行肝脏硬度检测,包括HBV携带者、慢性乙型肝炎、慢性丙型肝炎、酒精性肝病以及肝炎肝硬化、自身免疫性肝病、肝癌及肝移植术后患者。检测失败包括无法获得测量值,成功率<60%,以及四分位间距(IQR)≥1/3中位值3种。结果 4000例检测者中的260例检测失败,失败率为6.5%。其中无法获得测量值91例,占2.3%;成功率<60%的108例,占2.7%;IQR≥中位值1/3值61例,占1.5%。BMI≥28kg/m2者失败率明显高于BMI<28kg/m2者(39.8%vs 2.9%,P<0.01)。女性失败率高于男性(18.5%vs 2.4%,P<0.01)。老年人测量失败率高(≥50岁男性10.1%vs<50岁男性4.5%,P<0.01)。肋间隙狭窄患者失败率高(肋间隙<9mm 25.1%vs肋间隙≥9mm 2.1%,P<0.01)。合并肝脏血管瘤、结节、囊肿,肝脏缩小、腹腔积液等均为导致失败率增高的因素。对260例初次检测失败病例更换检测部位、探头方向重新检测后检测成功64例,使失败率降低至4.9%。结论 FibroScan检测的失败多由于肥胖、肋间隙狭窄引起,肝脏占位病变、老年人与女性检测失败率较高。正确的方向、体位、准确的操作可提高检测成功率。

Objective To investigate the frequency and determinants of liver stiffness measurement （LSM） with transient elastogra- phy （FibroScan） and unreliable results. Methods A total of 4000 patients, including asymptomatic carrier, chronic hepatitis B （CHB） , chronic hepatitis C （CHC） , alcoholic liver disease （ALD） , liver cirrhosis, autoimmune liver disease （AILD） , hepatocellular carcinoma （HCC） and liver transplant recipients, were enrolled. Liver fibrosis was evaluated by FibroScan detection. LSM failure was de- fined as zero valid shots, an interquartile range （IQR） greater than or equal to one third of the median value, or a success rate （SR） less than 60%. Results LSM failure occurred in 6.5% of all examinations （260 patients out of 4000）. LSM was unable to achieve the valid values in 91 cases （2.3%） , SR was less than 60% in 108 cases （2.7%） , and IQR was larger than 30% of median value in 61 cases （ 1.5% ）. LSM failure was independently associated with body mass index （BMI） greater than 28kg/m2, female sex, age greater than 50 years, intercostal spaces less than 9mm, and HCC patients. There was no significant difference among other diseases. By changing anoth- er skilled operator, success was achieved on 64 cases out of 260, which reduced the failure rate to 4.9%. Conclusion The principal reasons of LSM failure are obesity and narrow of intercostal space. For the failure rates of HCC, eider or female patients are higher. These results emphasize the need for adequate operator training and for technological improvements in specific patient subpopulations.