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Applicability and variability of liver stiffness measurements according to probe position

World Journal of Gastroenterology 2009年第27期15卷 3398-3404页

作者： Patrick Ingiliz Kim Pav Chhay Mona Munteanu pascal lebray Yen Ngo Dominique Roulot Yves Benhamou Dominique Thabut Vlad Ratziu Thierry Poynard Dominique Thabut Vlad Ratziu Thierry Poynard AP-HP Hospital Group Pitié-Salpêtrière Hepatology Department47-83 Hospital Boulevard Paris 75651 France BioPredictive 40 Bac street Paris 75007 France AP-HP Hepatology Department Avicenne hospitalBobigny 93000France AP-HP Hospital Group Pitié-Salpêtrière Hepatology Department47-83 Hospital Boulevard Paris 75651 France

AIM: To investigate the liver stiffness measurement (LSM) applicability and variability with reference to three probe positions according to the region of liver biopsy. METHODS: The applicability for LSM was defined as at least 10 valid measurements with a success rate greater than 60% and an interquartile range/median LSM < 30%. The LSM variability compared the inter-position concordance and the concordance with FibroTest. RESULTS: Four hundred and forty two consecutive patients were included. The applicability of the anterior position (81%) was significantly higher than that of the reference (69%) and lower positions (68%), (both P = 0.0001). There was a signif icant difference (0.5 kPa, 95% CI 0.13-0.89; P < 0.0001) between mean LSM estimated at the reference position (9.3 kPa) vs the anterior position (8.8 kPa). Discordance between positions was associated with thoracic fold (P = 0.008). The discordance rate between the reference position result and FibroTest was higher when the 7.1 kPa cutoff was used to define advanced fibrosis instead of 8.8 kPa (33.6% vs 23.5%, P = 0.03).CONCLUSION: The anterior position of the probe should be the fi rst choice for LSM using Fibroscan, as it has a higher applicability without higher variability compared to the usual liver biopsy position.

关键词：硬度测量适用性肝脏可变性探头位置测量范围一致性肌病

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Pathological evolution of hepatitis C virus-“Healthy carriers”

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World Journal of Gastroenterology 2008年第24期14卷 3861-3865页

作者： Rodolphe Sobesky pascal lebray Bertrand Nalpas Anas Vallet-Pichard Hélène Fontaine Jean-Luc Lagneau Stanislas Pol INSERM U785 Centre Hépato-BiliaireHpital Paul Brousse United Hepatologie Hopital CochinUniversite Paris V-Rene Descartes

AIM: To determine factors associated with fibrosis progression in hepatitis C virus (HCV)-infected patients without signifi cant initial pathological lesions. METHODS: Seventy six untreated HCV-infected pa-tients with initially normal liver as defi ned by a Knodell score≤3,with 2 liver biopsies and detectable HCV-RNA were included. Markers of fibrosis progression were assessed. RESULTS: Median duration of infection and time between paired biopsies was 13 (95% CI: 1-28) and 4 (95% CI: 2-16) years respectively. Alanine-transaminase (ALT) activity was normal in 43.4% of cases. 50% demonstrated progression of the necro-in? ammation and 34% of fi brosis after a median time evolution of 4 years (95% CI: 2-16). The median dif-ference in the necro-inflammation and fibrosis score between biopsies was low,1.5 and 0.0 respectively. Univariate analysis showed there was no difference between fibrosis activity or evolution according to genotype or viral load. A higher fibrosis progression (P = 0.03) was observed in patients with body mass index (BMI) > 25. Fibrosis progression correlated with the time interval between biopsies (P = 0.01). A sig-nifi cant progression of activity (1.7 vs 0.4,P 25 and the time interval between 2 biopsies. CONCLUSION: There is no fibrosis progression in 66% of patients without signifi cant initial histopatho-logical lesion. Fibrosis progression is associated with elevated ALT and BMI > 25.

关键词：丙肝病毒肝纤维化肝切片检查丙氨酸-转氨酶

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