肝脏瞬时弹性超声技术评估药物性肝损伤患者肝脏纤维化程度的价值

Validation of transient elastography in assessment of hepatic fibrosis in patients with drug-induced liver injury

目的探讨肝脏瞬时弹性超声技术评估药物性肝损伤（DILI）患者肝脏纤维化程度的价值。方法 2011年7月至2013年10月昆明医科大学附属第二医院临床诊断为DILI患者64例,在肝组织穿刺活检1周内运用瞬时弹性超声技术检测肝脏平均瞬时弹性超声硬度值（Stiffness）,同时进行肝脏活组织穿刺病理检查,并采用Ishak评分进行肝纤维化分期。结果肝脏活组织穿刺病理检查结果显示,64例DILI患者中,S0期6例,S1期15例,S2期20例,S3期10例,S4期8例,S5期5例和S6期0例。肝纤维化分期与丙氨酸转氨酶、天冬氨酸转氨酶和血小板浓度无相关性（r值分别为-0.18、-0.14和0.20,均P〉0.05）,而与碱性磷酸酶和总胆红素浓度水平呈正相关（r值分别为0.46、0.37,均P〈0.05）。肝纤维化S0~S5期患者的Stiffness值分别为（6.23±1.18）、（7.24±1.86）、（8.80±2.51）、（20.36±5.73）、（23.14±7.85）和（36.60±9.87）k Pa。肝脏Stiffness值与肝纤维化分期呈正相关（r=0.633,P〈0.01）。受试者工作曲线（ROC）显示,以肝脏Stiffness值13.35 k Pa作为肝脏中重度纤维化（S3期及以上）的诊断界值,ROC曲线下面积为0.954,肝脏瞬时弹性超声技术诊断肝脏中重度纤维化的敏感度为84.2%,特异度为94.3%,阳性预测值为88.89%,阴性预测值为91.67%。结论肝脏瞬时弹性超声技术可将DILI患者肝脏无或轻度纤维化与肝脏中重度纤维化较好地予以区分。

Objective To validate transient elastography in assessment of hepatic fibrosis in patients with drug-induced liver injury（ DILI）. Methods Liver stiffness was assessed by validate transient elastography in totally 64 patients who had been clinically diagnosed with DILI and reconfirmed by liver biopsy within a week in the Second Affiliated Hospital of Kunming Medical University between July 2011 and October 2013. Liver stiffness result was compared with Ishak fibrosis score of liver biopsy in each patient.Results Among the 64 DILI patients,6 patients were staged S0,15 were staged S1,20 were staged S2,10 were staged S3,8 were staged S4,5 were staged S5,and none was staged S6 by Ishak fibrosis score. Fibrosis stage was not associated with alanine transaminase（ ALT）,aspartate aminotransferase（ AST） and platelet（ PLT） levels（ r =- 0. 18,-0. 14,0. 20,all P〉0. 05）,but was positively correlated with alkaline phosphatase（ AKP） and total bilirubin（ TBIL） levels（ r = 0. 46,0. 37,both P〈0. 05）. Average liver stiffness of patients in each stage（ S0-S5） was（ 6. 23 ± 1. 18）,（ 7. 24 ± 1. 86）,（ 8. 80 ± 2. 51）,（ 20. 36 ± 5. 73）,（ 23. 14 ± 7. 85）and（ 36. 60 ± 9. 87） k Pa,accordingly. Liver stiffness values were positively correlated with stages of liver fibrosis（ r = 0. 633,P〈0. 01）. When taking the stiffness value of 13. 35 k Pa as a cut-off for moderate and advanced fibrosis（ Ishak fibrosis stage of 3 or above） in receiver operator characteristic curve,the area under curve was 0. 954,with 84. 2% of sensitivity,94. 3% of specificity,88. 89% of positive predictive value,and91. 67% of negative predictive value. Conclusions Validate transient elastography is able to distinguish patients with no or mild liver fibrosis from those with moderate or advanced fibrosis in DILI.