Ultrasound Pulse Elastometry: Assessment of One Year’s Practice in the Hepato-Gastroenterology Department of the Saint Camille Hospital in Ouagadougou

Aims: To review one year of ultrasound impulse elastometry in a hospital in Ouagadougou. Patients and Method: This is a retrospective descriptive study of data from one year’s use of impulse ultrasound elastometry. Ultrasound impulse elastometry was performed using the FibroScan® COMPACT 530. Fibrosis was considered significant when E (hepatic elasticity) ≥ 7.2 kPa (F2 fibrosis). The test was considered valid when the IQR/Median ratio ≤ 30% and there were at least 10 valid measurements. Results: A total of 1911 patients underwent FibroScan®. There were 1079 men, giving a sex ratio of 1.3. The mean age of the patients was 37.9 ± 12.2 years. The indication for FibroScan® was hepatitis B virus infection in 89% of cases. The validation criteria for FibroScan® were met in all patients. The mean value for elasticity was 7.9 kPa and for steatosis 212 dB/m. Fibrosis was non-significant in 75.5% of cases. More than half of our patients (56.7%) didn’t have steatosis, 24.8% had mild steatosis, 12.4% had moderate steatosis and 6.1% had severe steatosis. Conclusion: Ultrasound pulse elastometry plays an important role in monitoring chronic liver disease. It allows non-invasive diagnosis of hepatic fibrosis and steatosis. In our context, however, access to the test is limited by its availability only in large urban centers, and by its cost.

不同无创肝纤维化评分指标评估2型糖尿病伴非酒精性脂肪肝病患者肝纤维化的比较

目的:比较不同无创肝纤维化评分指标对2型糖尿病(type 2 diabetes mellitus,T2DM)伴非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)患者肝纤维化的评价作用。方法:将996例明确诊断为T2DM、同时经超声诊断为NAFLD的患者(男性578例,女性418例)纳入分析,采集患者的空腹静脉血,测定血常规及肝脏相关酶。计算天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)/丙氨酸氨基转移酶(alanine aminotransferase,ALT)比值、FIB-4指数、BARD评分、AST/血小板比值指数(APRI)及NAFLD纤维化评分(NAFLD fibrosis score,NFS)。以NFS作为评价肝纤维化的标准,采用相关性分析比较其余指标与NFS的相关性,进一步采用Bland-Altman方法评价这些指标的一致性。结果:T2DM伴NAFLD的男性和女性患者中,AST/ALT比值、FIB-4指数、BARD评分及APRI均与NFS呈线性正相关,其中FIB-4指数与NFS的相关性最强(r=0.619,P<0.01)。Bland-Altman分析结果表明,AST/ALT比值及FIB-4指数与NFS一致性良好,以FIB-4指数最佳。结论:AST/ALT比值及FIB-4指数可以用来评价T2DM伴NAFLD患者是否存在肝纤维化。

恩替卡韦联用3种中药治疗慢性乙肝纤维化效益风险评价

目的评估恩替卡韦联用扶正化瘀胶囊(Fuzheng Huayu Capsules,FHC)、复方鳖甲软肝片(Fufang Biejia Ruangan Tablets,BRT)及安络化纤丸(Anluo Huaxian Pills,AHP)治疗慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化的效益与风险,指导临床合理用药。方法应用多准则决策分析模型,确定效益风险指标,建立价值树。检索筛选随机对照试验(andomized controlled trials,RCTs)与半随机对照试验(quasi-randomized controlled trials,qRCTs)。通过Meta分析生成合并值,并根据摆动权重法为各指标进行赋权,采用Hiview 3软件计算恩替卡韦联用中药的效益值、风险值和效益风险总值,利用蒙特卡洛模拟优化研究结果。应用敏感性分析检验结果稳定性。结果恩替卡韦联用FHC、BRT、AHP的效益值分别为32、27、31,风险值分别为70、56、63,效益风险总值分别为51、41、47,恩替卡韦联用FHC作为最优用药方案与BRT、AHP联用方案的差异分别为10[95%CI(3,154)],4[95%CI(-121,137)],差异大于0的概率为98.37%和54.35%。结论恩替卡韦联用3种中药治疗CHB肝纤维化的疗效显著,安全性较好;其中,联用FHC临床应用优先级最高。因此,恩替卡韦联用FHC方案值得进一步推广。