| 1 | Liver stiffness in the hepatitis B virus carrier:A non-invasive marker of liver disease influenced by the pattern of transaminases显示文摘AIM: To investigate the usefulness of transient elastography by Fibroscan (FS),a rapid non-invasive technique to evaluate liver fibrosis,in the management of chronic hepatitis B virus (HBV) carriers.METHODS: In 297 consecutive HBV carriers,we studied the correlation between liver stiffness (LS),stage of liver disease and other factors potentially influencing FS measurements.In 87 chronic hepatitis B (CHB) patients,we monitored the FS variations according to the spontaneous or treatment-induced variations of biochemical activity during follow-up.RESULTS: FS values were 12.3 ± 3.3 kPa in acute hepatitis,10.3 ± 8.8 kPa in chronic hepatitis,4.3 ± 1.0 kPa in inactive carriers and 4.6 ± 1.2 kPa in blood donors.We identified the cut-offs of 7.5 and 11.8 kPa for the diagnosis of fibrosis ≥ S3 and cirrhosis respectively,showing 93.9% and 86.5% sensitivity,88.5% and 96.3% specificity,76.7% and 86.7% positive predictive value (PPV),97.3% and 96.3% negative predictive value (NPV) and 90.1% and 94.2% diagnostic accuracy.At multivariate analysis in 171 untreated carriers,fibrosis stage (t = 13.187,P < 0.001),active vs inactive HBV infection (t = 6.437,P < 0.001),alanine aminotransferase (ALT) (t = 4.740,P < 0.001) and HBV-DNA levels (t = -2.046,P = 0.042) were independently associated with FS.Necroinflammation score (t = 2.158,> 10/18 vs ≤ 10/18,P = 0.035) and ALT levels (t = 3.566,P = 0.001) were independently associated with LS in 83 untreated patients without cirrhosis and long-term biochemical remission (t = 4.662,P < 0.001) in 80 treated patients.During FS monitoring (mean follow-up 19.9 ± 7.1 mo) FS values paralleled those of ALT in patients with hepatitis exacerbation (with 1.2 to 4.4-fold increases in CHB patients) and showed a progressive decrease during antiviral therapy.CONCLUSION: FS is a non-invasive tool to monitor liver disease in chronic HBV carriers,provided that the pattern of biochemical activity is taken into account.In the inactive carrier,it identifies non-HBV-related causes of liver damage and transient reactivations.In CHB patients,it may warrant a more appropriate timing of control liver biopsies. | Filippo Oliveri Barbara Coco Pietro Ciccorossi Piero Colombatto Veronica Romagnoli Beatrice Cherubini Ferruccio Bonino Maurizia Rossana Brunetto | 2008 | World Journal of Gastroenterology2008，14，40： | 43 |
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