FibroScan

摘要： BACKGROUND Non-alcoholic fatty liver disease(NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis(NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIM To explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODS This study was conducted on NAFLD/NASH patients(n = 73) who underwent Fibroscan examinations at Saint George Hospital University Medical Center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase(AST)/alanine transaminase(ALT) ratio, AST platelet ratio index(APRI) score and Fibrosis-4 score.RESULTS A significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSION This study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.

摘要： 目的探讨脾脏硬度(SSM)联合流式细胞术(FCM)在急性髓系白血病(AML)微小残留病(MRD)监测中的意义。方法选取2016年3月-2020年3月在河北中石油中心医院就诊的33例初治AML患者,治疗前作为初诊组、治疗后作为诱导化疗后组,同时选取15例健康志愿者作为对照组,分别进行SSM检测,比较各组SSM差异,进一步根据MRD水平将诱导化疗后患者分为MRD-、MRD+组,比较各组SSM差异,分析MRD+组SSM与MRD的相关性。结果初诊组SSM高于对照组、诱导化疗后组,差异有统计学意义(P<0.05);MRD+组SSM高于MRD-组,差异有统计学意义(P<0.05);MRD+组SSM与MRD水平呈正相关(r=0.877);7例患者复发时SSM升高,9例持续缓解患者SSM总体呈下降趋势。结论诱导化疗后SSM与MRD密切相关,用FS检测SSM或可联合FCM检测MRD对AML患者进行动态随访、评估预后。

摘要： 目的探讨脾脏硬度(SSM)在骨髓增生异常综合征(MDS)患者预后中的意义。方法选取2016年2月-2020年3月在河北中石油中心医院就诊的40例初治MDS患者设为MDS组,同时选取18名健康志愿者设为对照组,分别进行SSM检测。比较两组SSM差异,进一步分析SSM与临床特征及预后的关系。结果MDS组SSM为[34.53(19.11~55.20)]kPa,高于对照组的[13.51(8.32~26.53)]kPa,差异有统计学意义(P0.05);不同SSM、危险度分级、原始细胞比例、染色体核型间EFS、OS比较,差异有统计学意义(P<0.05)。结论SSM与危险度分级、染色体核型、原始细胞比例等有关,或可用来评估MDS患者预后。

摘要： BACKGROUND Childhood obesity and fatty liver are associated with adverse outcomes such as diabetes,metabolic syndrome,and cardiovascular diseases in adulthood.It is very important to identify relevant risk factors and intervene as early as possible.At present,the relationship between maternal and offspring metabolic factors is conflicting.AIM To estimate the association of maternal obesity and gestational diabetes mellitus(GDM)with overweight/obesity and fatty liver risk in offspring at 8 years of age.METHODS The prospective study included mothers who all had a 75-g oral glucose tolerance test at 24-28 wk of gestation and whose offspring completed follow-up at 8 years of age.Offspring birth weight,sex,height,weight,and body mass index(BMI)were measured and calculated.FibroScan-502 examination with an M probe(Echosens,Paris,France)was prospectively conducted in offspring aged 8 years from the Shanghai Prenatal Cohort Study.RESULTS A total of 430 mother-child pairs were included in the analysis.A total of 62(14.2%)mothers were classified as obese,and 48(11.1%)were classified as having GDM.The mean age of the offspring at follow-up was 8 years old.Thirty-seven(8.6%)offspring were overweight,14(3.3%)had obesity,and 60(14.0%)had fatty liver.The prevalence of overweight,obesity and fatty liver in offspring increased significantly across maternal BMI quartiles(all P<0.05).Among offspring of mothers with GDM,12(25.0%)were overweight,4(8.3%)were obese,and 12(25.0%)had fatty liver vs.25(6.5%),10(2.6%)and 48(12.6%),respectively,for offspring of mothers without GDM(all P<0.05).In multiple logistic regression,after adjustment for variables,the OR for fatty liver in offspring was 8.26(95%CI:2.38-28.75)for maternal obesity and GDM.CONCLUSION This study showed that maternal obesity can increase the odds of overweight/obesity and fatty liver in offspring,and GDM status also increases the odds of overweight/obesity in offspring.Weight management and glycemic control before and during pregnancy need to be highlighted in primary prevention of pediatric obesity and fatty liver.

摘要： 目的:探讨FibroScan对乙型肝炎病毒DNA>20000 IU/mL但丙氨酸氨基转移酶(ALT)小于或等于正常上限2倍的慢性乙型肝炎患者肝纤维化程度的诊断价值。方法:选取2018年1月—2019年8月在苏州市第五人民医院肝病科确诊的乙型肝炎病毒DNA>20000 IU/mL但ALT小于或等于正常上限2倍的慢性乙型肝炎患者57例,同时行FibroScan、声脉冲辐射力成像(ARFI)检测,测定血液生化指标计算天冬氨酸氨基转移酶与血小板比值指数(APRI),以肝组织病理结果为金标准,ROC曲线分析FibroScan、ARFI和APRI无创评估乙肝肝纤维化的价值。结果:肝纤维化分期≥S2、≥S3和S4时,FibroScan、ARFI、APRI的ROC曲线下面积(AUC)分别为0.88、0.89、0.98,0.86、0.82、0.89和0.69、0.70、0.73;两两比较结果显示,FibroScan评估各期的AUC与同期的ARFI无统计学差异;FibroScan评估各期的AUC均明显大于同期的APRI(Z=2.26,P=0.01;Z=2.33,P=0.01;Z=2.84,P20000 IU/mL但ALT小于或等于正常上限2倍的慢性乙型肝炎患者,FibroScan评估肝纤维化严重程度的综合价值优于ARFI和APRI,尤其是评估S4时,可作为判断接受抗病毒治疗的依据。

摘要： 目的探讨肝脏脂肪衰减参数(CAP)对慢性乙型肝炎(CHB)患者抗病毒疗效及肝纤维化的影响。方法回顾性分析2019年1月至2021年1月柳州市人民医院肝病科收治e抗原阳性的180例CHB患者临床资料,根据瞬时弹性成像技术检测结果,按照CAP分为A组(CAP292 db/m)60例。分析抗病毒治疗12、24、48和96周时的生化学、病毒学、血清学应答情况,各组随机入组20例进行肝病理检查评估肝纤维化情况。结果3组在年龄、性别、基线ALT、AST、HBV DNA水平无差异,与A组相比,C组患者体质指数、三酰甘油(TG)、总胆固醇(TC)和GGT水平较高(P<0.05),B组的TC、TG水平高于A组,差异有统计学意义(P<0.05)。对三组各随机入组20例患者进行肝活检,根据病理结果分为肝硬化组和非肝硬化组,logistics回归分析发现两组CAP值、BMI、TG差异有统计学意义(P<0.05)。行ROC分析,CAP、TG评分曲线下面积(AUC)最大,分别为0.780、0.746。恩替卡韦抗病毒治疗后第12周、24周、48周,患者ALT水平复常A组为35例(58.33%)、60例(100%)、60例(100%);B组为22例(36.67%)、55例(91.67%)、59例(98.33%);C组为14例(23.33%)、21例(35%)、48例(80%),A组和C组差异有统计学意义(P<0.01)。HBV DNA转阴率随着恩替卡韦治疗时间的延长逐渐增加。24周时三组HBV DNA转阴率分别为96.67%(58例),75%(45例),63.33%(38例),其中A组和B组,A组和C组均差异有统计学意义(P<0.01)。在抗病毒治疗第48周和第96周,HBeAg血清转换率逐渐升高,A组为8.33%(5例),11.67%(7例);B组为1.67%(1例),5%(3例);C组为0,1.67%(1例),其中A组和C组HBeAg转阴率差异有统计意义(P<0.05)。结论CAP值、TG、BMI是CHB患者发生肝硬化的影响因素。

摘要： 目的:探讨不同水平的转氨酶(ALT)对FibroScan检测肝脏硬度值及对肝纤维化分期准确性的影响。方法:回顾性分析195例最终纳入本研究的慢性乙型肝炎(CHB)患者,根据血清ALT水平分为ALT0.05),2×ULN≤ALT<3×ULN,3×ULN≤ALT<4×ULN,4×ULN≤ALT<5×ULN,及ALT≥5×ULN四组治疗前后LSM存在统计学差异(P<0.05),且随着ALT水平不断升高,LSM也越高。结论:FibroScan对诊断CHB所致肝纤维化的准确性可能受ALT升高的影响;对于ALT<2×ULN的CHB患者无明显影响,但是对ALT≥2×ULN的患者,其诊断的准确性降低。

摘要： 慢性乙型病毒性肝炎(CHB)可导致肝细胞的慢性炎症坏死,形成肝纤维化,最终导致肝硬化及多种并发症.CHB的发展及转归与肝脏纤维化的程度密切相关,准确判断肝纤维化分期对指导慢性肝脏疾病的治疗、评估预后、监测疾病进展有重要作用.肝组织病理活检虽是诊断肝纤维化的"金标准",但因其是一种创伤性检查,患者接受度不高,不适于动态监测.而肝纤维化扫描仪(FibroScan)是一种无创评估肝纤维化的工具,重复性好,近年来被广泛认可.

摘要： BACKGROUND Transient elastography(FibroScan)is a new and non-invasive test,which has been widely recommended by the guidelines of chronic hepatitis B virus(HBV)management for assessing hepatic fibrosis staging.However,some confounders may affect the diagnostic accuracy of the FibroScan device in fibrosis staging.AIM To evaluate the diagnostic value of the FibroScan device and the effect of hepatic inflammation on the accuracy of FibroScan in assessing the stage of liver fibrosis in patients with HBV infection.METHODS The data of 416 patients with chronic HBV infection who accepted FibroScan,liver biopsy,clinical,and biological examination were collected from two hospitals retrospectively.Receiver operating characteristic(ROC)curves were used to analyze the diagnostic performance of FibroScan for assessing the stage of liver fibrosis.Any discordance in fibrosis staging by FibroScan and pathological scores was statistically analyzed.Logistic regression and ROC analyses were used to analyze the accuracy of FibroScan in assessing the stage of fibrosis in patients with different degrees of liver inflammation.A non-invasive model was constructed to predict the risk of misdiagnosis of fibrosis stage using FibroScan.RESULTS In the overall cohort,the optimal diagnostic values of liver stiffness measurement(LSM)using FibroScan for significant fibrosis(≥F2),severe fibrosis(≥F3),and cirrhosis(F4)were 7.3 kPa[area under the curve(AUC)=0.863],9.7 kPa(AUC=0.911),and 11.3 kPa(AUC=0.918),respectively.The rate of misdiagnosis of fibrosis stage using FibroScan was 34.1%(142/416 patients).The group of patients who showed discordance between fibrosis staging using FibroScan and pathological scores had significantly higher alanine aminotransferase and aspartate aminotransferase levels,and a higher proportion of moderate to severe hepatic inflammation,compared with the group of patients who showed concordance in fibrosis staging between the two methods.Liver inflammation activity over 2(OR=3.53)was an independent risk factor for misdiagnosis of fibrosis stage using FibroScan.Patients with liver inflammation activity≥2 showed higher LSM values using FibroScan and higher rates of misdiagnosis of fibrosis stage,whereas the diagnostic performance of FibroScan for different fibrosis stages was significantly lower than that in patients with inflammation activity<2(all P<0.05).A non-invasive prediction model was established to assess the risk of misdiagnosis of fibrosis stage using FibroScan,and the AUC was 0.701.CONCLUSION Liver inflammation was an independent risk factor affecting the diagnostic accuracy of FibroScan for fibrosis stage.A combination of other related noninvasive factors can predict the risk of misdiagnosis of fibrosis staging using FibroScan.

摘要： 目的 研究不同血清谷丙转氨酶(ALT)水平的慢性HBV感染者肝纤维化指标的变化.方法 2018年4月～2020年4月我院诊治的68例慢性HBV感染者(HBV携带者21例,CHB患者47例),根据血清ALT水平不同将患者分为A组(ALT0.05);肝组织病理学检查诊断肝纤维化S0期24例,S1期13例,S2期13例,S3期10例,和S4期8例,不同肝纤维化分组在A组、B组和C组分布无显著性差异(P>0.05);24例S0期肝纤维化患者LSM为(10.9±2.8)kPa,13例S1期LSM为(11.3±3.0)kPa,31例>=S2期LSM为(12.8±3.3)kPa(P0.05);经ROC分析发现,以血清ALT=63.8 U/L为截断点判断S2期及以上肝纤维化的AUC为0.400(SE=0.070,95％CI=0.262～0.538,P=0.185),其诊断的灵敏度和特异度分别为0.364和0.370,而以LSM=12.3 kPa为截断点判断S2期及以上肝纤维化的AUC为0.868(SE=0.042,95％CI=0.785～0.950,P=0.000),其诊断的敏感度和特异度分别为0.955和0.717.结论 对于慢性HBV感染者,无论血清ALT水平高低都可能存在显著性肝纤维化,血清ALT或血清肝纤维化指标无诊断肝纤维化的能力,而使用FibroScan检测LSM可能有助于早期发现严重的肝纤维化而给予及时的处理.

摘要： @@肝纤维化是肝组织的慢性损伤的一种病理改变，以肝组织内细胞外基质(extra cellular matrix,ECM)成分的过度增生与异常沉积为特征，是慢性肝病的共同病变特点，进一步发展导致肝硬化及其并发症，严重影响患者健康。因此抗肝纤维化治疗是慢性肝病的重要治疗措施。诊断是治疗与疗效评价的前提，对慢性肝病肝纤维化程度的评估是判断病情、决定治疗及随访疗效的关键环节。肝纤维化是一个动态病理过程，理想的诊断方法应既能反映已形成的纤维组织的量，又能反映纤维化进程的活跃程度，甚至能反映其消散程度，这一直是人们不断探索的目标。

摘要： @@肝纤维化是肝组织的慢性损伤的一种病理改变，以肝组织内细胞外基质(extra cellular matrix,ECM)成分的过度增生与异常沉积为特征，是慢性肝病的共同病变特点，进一步发展导致肝硬化及其并发症，严重影响患者健康。因此抗肝纤维化治疗是慢性肝病的重要治疗措施。诊断是治疗与疗效评价的前提，对慢性肝病肝纤维化程度的评估是判断病情、决定治疗及随访疗效的关键环节。肝纤维化是一个动态病理过程，理想的诊断方法应既能反映已形成的纤维组织的量，又能反映纤维化进程的活跃程度，甚至能反映其消散程度，这一直是人们不断探索的目标。

摘要： @@肝纤维化是肝组织的慢性损伤的一种病理改变，以肝组织内细胞外基质(extra cellular matrix,ECM)成分的过度增生与异常沉积为特征，是慢性肝病的共同病变特点，进一步发展导致肝硬化及其并发症，严重影响患者健康。因此抗肝纤维化治疗是慢性肝病的重要治疗措施。诊断是治疗与疗效评价的前提，对慢性肝病肝纤维化程度的评估是判断病情、决定治疗及随访疗效的关键环节。肝纤维化是一个动态病理过程，理想的诊断方法应既能反映已形成的纤维组织的量，又能反映纤维化进程的活跃程度，甚至能反映其消散程度，这一直是人们不断探索的目标。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。

摘要： 目的：探讨瞬时弹性记录仪(FibroScan(R))测量肝纤维化的成功率影响因素及其可重复性。rn 方法：用FibroScan(R)对637例健康人群、慢性乙肝病毒携带者、慢性肝炎和肝硬化患者共进行1201次肝脏硬度测量。对同一检测对象,两位操作者分别检测或同一操作者分别进行2次系列检测,每系列检测取10个检测值,取平均值为最终检测值。分析评价体重指数、性别、年龄、疾病状态等对检测成功率的影响,组内相关系数(ICC)评价FibroScan(R)检测结果的可重复性。rn 结果：14例无法获得弹性值,失败率为1.7%。失败率与疾病状况无关,与体重指数(t=3.104,P=0.002)呈负相关。女性成功率较男性低(t=-2.189,P=0.030)。对同一检测对象,同一操作者多次操作或不同操作者进行FibroScan(R)检测,ICC分别为0.970、0.847;对于健康和慢性乙肝病毒携带受检者,FibroScan检测稳定性下降(ICC分别为0.736、0.639)。肝硬化患者FibroScan(R)弹性值与相关并发症及肝功能Child-Pugh评分呈正相关。rn 结论：FibroScan(R)检测慢性肝病患者肝纤维化程度稳定性良好;高体重指数降低操作成功率;高弹性值可能预测肝硬化并发症及肝功能状态。