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liver stiffness measurement can Predict liver Inflammation in Chronic Hepatitis B Patients with Normal Alanine Transaminase

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Journal of Clinical and Translational Hepatology 2023年第4期11卷 817-826页

作者： Ling-Ling Huang Xue-Ping Yu Qing-Fa Ruan Yan-Xue Lin Huan Li Wen Jin Rui-Feng Liu Yan-Lan Liang Yu-Rui Liu Yue-Yong Zhu Jia-Ji Jiang Ri-Cheng Mao Da-Wu Zeng Department of Hepatology Hepatology Research InstituteThe First Affiliated hospitalFujian Medical UniversityFuzhouFujianChina Department of Infectious Diseases The First Hospital of Quanzhou Affiliated to Fujian Medical UniversityQuanzhouFujianChina Hepatology Center Xiamen Hospital of Traditional Chinese MedicineXiamenFujianChina Department of Infectious Diseases Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency ResponseNational Medical Center for Infectious DiseasesHuashan HospitalFudan UniversityShanghaiChina Hepatology Mengchao Hepatobiliary Hospital of Fujian Medical UniversityFuzhouFujianChina Hepatology Fujian Medical University Xiamen Humanity HospitalXiamenFujianChina

Background and Aims:To determine whether liver stiffness measurement(LSM)indicates liver inflammation in chronic hepatitis B(CHB)with different upper limits of normal(ULNs)for alanine aminotransferase(ALT).Methods:We grouped 439 CHB patients using different ULNs for ALT:cohort I,≤40 U/L(439 subjects);cohort II,≤35/25 U/L(males/females;330 subjects);and cohort III,≤30/19 U/L(males/females;231 subjects).Furthermore,84 and 96 CHB patients with normal ALT(≤40 U/L)formed the external and prospective validation groups,respectively We evaluated the correlation between LSM and biopsy-confirmed liver inflammation,and determined diagnostic accuracy using area under the curve(AUC).A noninvasive LSM-based model was developed using multivariate logistic ***:Fibrosis-adjusted LSM values significantly increased with increasing *** AUCs of LSM in cohorts I,II,and III were 0.799,0.796,and 0.814,respectively,for significant inflammation(A≥2)and 0.779,0.767,and 0.770,respectively,for severe inflammation(A=3).Cutoff LSM values in all cohorts for A≥2and A=3 were 6.3 and 7.5 kPa,***,external,and prospective validations showed high diagnostic accuracy of LSM for A≥2 and A=3,and no significant differences in AUCs among the four *** and globulin independently predicted A≥*** AUC of an LSM-globulin model for A≥2 exceeded those of globulin,ALT,and AST,but was similar to that of ***:LSM predicted liver inflammation and guided the indication of antiviral therapy for CHB in patients with normal ALT.

关键词： Hepatitis B virus liver inflammation Fibrosis liver stiffness measurement Alanine aminotransferase

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liver stiffness measurement Can Reflect the Active liver Necroinflammation in Population with Chronic liver Disease:A Real-world Evidence Study

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Journal of Clinical and Translational Hepatology 2019年第4期7卷 313-321页

作者： Leijie Wang Mingyu Zhu Lihua Cao Mingjie Yao Yiwei Lu Xiajie Wen Ying Zhang Jing Ning Huiling Long Yueyong Zhu Guoxin Hu Shuangsuo Dang Qingchun Fu Liang Chen Xinxin Zhang Jingmin Zhao Zhiliang Gao Yuemin Nan Fengmin Lu Department of Microbiology&Infectious Disease Center School of Basic Medical SciencesPeking University Health Science CenterBeijingChina Department of Infectious Diseases Rui Jin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina liver Disease Center Qinhuangdao Third HospitalQinhuangdaoHebeiChina Department of Anatomy and Embryology School of Basic Medical SciencesPeking University Health Science CenterBeijingChina Eshelman School of Pharmacy University of North CarolinaChapel HillNCUSA Department of Traditional and Western Medical Hepatology The Third Hospital of Hebei Medical UniversityShijiazhuangHebeiChina Department of Infectious Diseases The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdongChina liver Research Center First Affiliated Hospital of Fujian Medical UniversityFuzhouFujianChina Department of Infectious Diseases Peking University Shenzhen HospitalShenzhenGuangdongChina Department of Infectious Diseases Second Affiliated Hospital of Medical College of Xi'an Jiaotong UniversityXi'anShaanxiChina Shanghai liver Diseases Research Center 85th HospitalNanjing Military CommandShanghaiChina Department of liver Disease Shanghai Public Health Clinical CenterFudan UniversityShanghaiChina Department of Pathology and Hepatology The Fifth Medical Center of PLA General HospitalBeijingChina Intervention and Cell Therapy Center Peking University Shenzhen HospitalShenzhenGuangdongChina

Background and Aims: Non-invasive evaluation of liver nec-roinflammation in patients with chronic liver disease is an un-met need in clinical *** diagnostic accuracy of transient elastography-based liver stiffness measurement(LSM)for liver fibrosis could be affected by liver necroinflam-mation,the latter of which could intensify stiffness of the *** results have prompted us to explore the diagnosis potential of LSM for liver ***: Three cross-sectional cohorts of liver biopsy-proven chronic liver dis-ease patients were enrolled,including 1417 chronic hepatitis B(CHB)patients from 10 different medical centers,106 non-al-coholic steatohepatitis patients,and 143 patients with auto-immune-related liver *** longitudinal cohort of 14 entecavir treatment patients was also *** re-ceiver operating characteristic(ROC)curve was employed to explore the diagnostic value of ***: In CHB patients,LSM value ascended with the increased severity of liver nec-roinflammation in patients with the same fibrosis *** positive correlation between LSM and liver necroinflammation was also found in non-alcoholic steatohepatitis and autoim-mune-related liver diseases ***,the ROC curve exhibited that LSM could identify moderate and se-vere inflammation in CHB patients(area under the ROC curve as 0.779 and 0.838)and in non-alcoholic steatohepatitis pa-tients(area under the ROC curve as 0.826 and 0.871),*** moderate diagnostic value was also found in autoimmune-related liver diseases *** addition,in the longitudinal entecavir treated CHB cohort,a decline of LSM values was observed in parallel with the control of inflam-matory activity in ***: Our study implicates a diagnostic potential of LSM to evaluate the severity of liver necroinflammation in chronic liver disease patients.

关键词： liver stiffness measurement liver necroinflammatory grade Alanine aminotransferase Chronic liver disease

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Early diagnostic value of liver stiffness measurement in hepatic sinusoidal obstruction syndrome induced by hematopoietic stem cell transplantation

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World Journal of Clinical Cases 2022年第26期10卷 9241-9253页

作者： You-Wen Tan Yi-Chun Shi Department of Hepatology The Third Hospital of Zhenjiang Affiliated Jiangsu UniversityZhenjiang 212003Jiangsu ProvinceChina

Hematopoietic stem cell transplantation(HSCT)-sinusoidal obstruction syndrome(SOS),also known as veno-occlusive disease,is a clinical syndrome characterized by symptoms,such as right upper quadrant pain,jaundice,fluid retention,and hepatomegaly,and is caused by pre-treatment-related hepatotoxicity during the early stages after *** diagnosis of HSCT-SOS is based on the revised Seattle or Baltimore *** revised standard by the European Society for Bone Marrow Transplantation in 2016 has good practicability and can be used in combination with these two *** studies have shown the value of liver stiffness measurement(LSM)in the early diagnosis of *** studies investigated LSM specificity and sensitivity for the early diagnosis of *** can distinguish SOS from other post-HSCT complications,enabling a clear differential *** has been shown that median LSM of patients with SOS is significantly higher than that of patients with other treatment-related liver complications(e.g.,acute cholecystitis,cholangitis,antifungal drug-related liver injury,liver graft-versus-host disease,isolated liver biochemical changes,and fulminant Epstein Barr virus related hepatitis reactivation).Therefore,the above data confirmed the utility of LSM and strongly suggested that LSM improves the positive predictive value of the SOS diagnostic clinical score after allogeneic *** diagnosis of SOS is beneficial in preventing severe HSCT complications.

关键词： Hematopoietic stem cell transplantation Sinusoidal obstruction syndrome liver stiffness measurement Stem cell

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Clinical value of predictive models based on liver stiffness measurement in predicting liver reserve function of compensated chronic liver disease

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World Journal of Gastroenterology 2022年第42期28卷 6045-6055页

作者： Rui-Min Lai Miao-Miao Wang Xiao-Yu Lin Qi Zheng Jing Chen Department of Hepatology Hepatology Research InstituteThe First Affiliated HospitalFujian Medical UniversityFuzhou 350005Fujian ProvinceChina Department of Endocrinology The 910th Hospital of The Joint Service Support ForceQuanzhou 362000Fujian ProvinceChina

BACKGROUND Assessment of liver reserve function(LRF)is essential for predicting the prognosis of patients with chronic liver disease(CLD)and determines the extent of liver resection in patients with hepatocellular *** To establish noninvasive models for LRF assessment based on liver stiffness measurement(LSM)and to evaluate their clinical *** A total of 360 patients with compensated CLD were retrospectively analyzed as the training *** new predictive models were established through logistic regression analysis and were validated internally in a prospective cohort(132 patients).RESULTS Our study defined indocyanine green retention rate at 15 min(ICGR15)≥10%as mildly impaired LRF and ICGR15≥20%as severely impaired *** constructed predictive models of LRF,named the mLPaM and sLPaM,which involved only LSM,prothrombin time international normalized ratio to albumin ratio(PTAR),age and model for end-stage liver disease(MELD).The area under the curve of the mLPaM model(0.855,0.872,respectively)and sLPaM model(0.869,0.876,respectively)were higher than that of the methods for MELD,albumin bilirubin grade and PTAR in the two cohorts,and their sensitivity and negative predictive value were the highest among these methods in the training *** addition,the new models showed good sensitivity and accuracy for the diagnosis of LRF impairment in the validation *** The new models had a good predictive performance for LRF and could replace the indocyanine green(ICG)clearance test,especially in patients who are unable to undergo ICG testing.

关键词： liver stiffness measurement Chronic liver disease liver reserve function Indocyanine green clearance test Predictive model

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Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients:A systematic review and meta-analysis

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World Journal of Gastroenterology 2020年第18期26卷 2247-2267页

作者： Yue Li Lei Li Hong-Lei Weng Roman Liebe Hui-Guo Ding Department of Gastroenterology and Hepatology Beijing You’an Hospital Affiliated with Capital Medical UniversityBeijing 100069China Department of Medicine Ⅱ Section Molecular HepatologyMedical Faculty MannheimHeidelberg UniversityMannheim 68167Germany Department of Medicine Ⅱ Saarland University Medical CenterHomburg 66424Germany

BACKGROUND Computed tomography(CT),liver stiffness measurement(LSM),and magnetic resonance imaging(MRI)are non-invasive diagnostic methods for esophageal varices(EV)and for the prediction of high-bleeding-risk EV(HREV)in cirrhotic ***,the clinical use of these methods is *** To evaluate the accuracy of LSM,CT,and MRI in diagnosing EV and predicting HREV in cirrhotic *** We performed literature searches in multiple databases,including Pub Med,Embase,Cochrane,CNKI,and Wanfang databases,for articles that evaluated the accuracy of LSM,CT,and MRI as candidates for the diagnosis of EV and prediction of HREV in cirrhotic *** sensitivity and specificity,positive likelihood ratio and negative likelihood ratio,diagnostic odds ratio,and the areas under the summary receiver operating characteristic curves were *** quality of the articles was assessed using the quality assessment of diagnostic accuracy studies-2 *** was examined by Q-statistic test and I2 index,and sources of heterogeneity were explored using metaregression and subgroup *** bias was evaluated using Deek’s funnel *** statistical analyses were conducted using Stata12.0,Meta Disc1.4,and Rev *** Overall,18,17,and 7 relevant articles on the accuracy of LSM,CT,and MRI in evaluating EV and HREV were retrieved.A significant heterogeneity was observed in all analyses(P<0.05).The areas under the summary receiver operating characteristic curves of LSM,CT,and MRI in diagnosing EV and predicting HREV were 0.86(95%confidence interval[CI]:0.83-0.89),0.91(95%CI:0.88-0.93),and 0.86(95%CI:0.83-0.89),and 0.85(95%CI:0.81-0.88),0.94(95%CI:0.91-0.96),and 0.83(95%CI:0.79-0.86),respectively,with sensitivities of 0.84(95%CI:0.78-0.89),0.91(95%CI:0.87-0.94),and 0.81(95%CI:0.76-0.86),and 0.81(95%CI:0.75-0.86),0.88(95%CI:0.82-0.92),and 0.80(95%CI:0.72-0.86),and specificities of 0.71(95%CI:0.60-0.80),0.75(95%CI:0.68-0.82),and 0.82(9

关键词： Multidetector computed tomography imaging Magnetic resonance imaging liver stiffness measurement liver cirrhosis Esophageal varices Meta-analysis

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Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

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World Journal of Gastroenterology 2017年第31期23卷 5746-5754页

作者： You-Wen Tan Xing-Bei Zhou Yun Ye Cong He Guo-Hong Ge Department of Hepatology the Third Hospital of Zhenjiang Affiliated Jiangsu University

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were *** The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P liver inflammation and necrosis.

关键词： liver stiffness measurement Hepatitis B virus FIB-4 Aspartate aminotransferase-to-platelet ratio index Normal Alanine aminotransferase

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Nationwide retrospective study of hepatitis B virological response and liver stiffness improvement in 465 patients on nucleos(t)ide analogue

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World Journal of Gastroenterology 2022年第31期28卷 4390-4398页

作者： Alnoor Ramji Karen Doucette Curtis Cooper Gerald Yosel Minuk Mang Ma Alexander Wong David Wong Edward Tam Brian Conway David Truong Philip Wong Lisa Barrett Hin Hin Ko Sarah Haylock-Jacobs Nishi Patel Gilaad G Kaplan Scott Fung Carla S Coffin Department of Medicine University of British ColumbiaVancouver v6t 1z3Canada Department of Medicine University of AlbertaEdmonton t6g 2r7Canada Department of Medicine The Ottawa Hospital Research InstituteUniversity of OttawaOttawa ON K1H 8L6Canada Department of Medicine University of ManitobaWinnipeg r3e 3j7Canada Department of Medicine University of SaskatchewanSaskatoon s7n 5e5Canada Department of Medicine University Health NetworkToronto m5g 2c4Canada Pacific Gastroenterology Associates Vancouver v6z 2k5Canada Vancouver Infectious Disease Centre Vancouver v6z 2c7Canada Department of Medicine McGill UniversityMontreal h3a 0g4Canada Department of Microbiology and Immunology Dalhousie UniversityHalifax b3h 4r2Canada Cumming School of Medicine University of CalgaryCalgary t2n 1n4Canada

BACKGROUND Hepatitis B virus(HBV)nucleos(t)ide analog(NA)therapy reduces liver disease but requires prolonged therapy to achieve hepatitis B surface antigen(HBsAg)*** is limited North American real-world data using non-invasive tools for fibrosis assessment and few have compared 1st generation NA or lamivudine(LAM)to tenofovir disoproxil fumarate(TDF).AIM To assess impact of NA on virological response and fibrosis regression using liver stiffness measurement(LSM)(i.e.,FibroScan®).METHODS Retrospective,observational cohort study from the Canadian HBV *** collected included demographics,NA,HBV DNA,alanine aminotransferase(ALT),and *** were HBV monoinfected patients,treatment naïve,and received 1 NA with minimum 1 year *** In 465(median 49 years,37%female,35%hepatitis B e antigen+at baseline,84%Asian,6%White,and 9%Black).Percentage of 64(n=299)received TDF and 166 were LAM-treated with similar median duration of 3.9 and 3.7 years,*** mean baseline LSM was 11.2 kPa(TDF)vs 8.3 kPa(LAM)(P=0.003).At 5-year follow-up,the mean LSM was 7.0 kPa in TDF vs 6.7 kPa in LAM(P=0.83).There was a significant difference in fibrosis regression between groups(i.e.,mean-4.2 kPa change in TDF and-1.6 kPa in LAM,Pliver fibrosis regression rarely leads to HBsAg loss.

关键词： Nucleos(t)ide analog therapy Functional cure Hepatitis B virus surface antigen loss Fibrosis regression liver stiffness measurement Transient elastography

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Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

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World Journal of Gastroenterology 2023年第25期29卷 4072-4084页

作者： Long-Bao Yang Xin Gao Hong Li Xin-Xing Tantai Fen-Rong Chen Lei Dong Xu-Sheng Dang Zhong-Cao Wei Chen-Yu Liu Yan Wang Department of Gastroenterology The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710004Shaanxi ProvinceChina Department of Emergency The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710004Shaanxi ProvinceChina

BACKGROUND Acute bleeding due to esophageal varices(EVs)is a life-threatening complication in patients with *** diagnosis of EVs is mainly through upper gastrointestinal endoscopy,but the discomfort,contraindications and complications of gastrointestinal endoscopic screening reduce patient *** to the bleeding risk of EVs,the Baveno VI consensus divides varices into high bleeding risk EVs(HEVs)and low bleeding risk EVs(LEVs).We sought to identify a non-invasive prediction model based on spleen stiffness measurement(SSM)and liver stiffness measurement(LSM)as an alternative to EVs *** To develop a safe,simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal *** Data from 200 patients with viral cirrhosis were included in this study,with 140 patients as the modelling group and 60 patients as the external validation group,and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno Ⅵ *** patients were divided into the HEVs group(66 patients)and the LEVs group(74 patients).The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses,and a noninvasive prediction model was ***,the discrimination ability,calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation *** Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral *** this basis,logistic regression analysis was used to construct a prediction model:Ln[P/(1-P)]=-8.184-0.228×SSM+0.642×*** area under the curve of the new model was *** the cut-off value was 0.27,the sensitivity,specificity,positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%,82.43%,83.52%,and 100%,respectively.C

关键词： Cirrhosis High-risk esophageal varices Non-invasive prediction model Spleen stiffness measurement liver stiffness measurement Upper gastrointestinal endoscopy

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Study of detection times for liver stiffness evaluation by shear wave elastography

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World Journal of Gastroenterology 2014年第28期20卷 9578-9584页

作者： Ze-Ping Huang Xin-Ling Zhang Jie Zeng Jian Zheng Ping Wang Rong-Qin Zheng Department of Medical Ultrasonics the Third Affiliated Hospital of Sun Yat-sen University

AIM: To investigate enough valid measurements (VMs) to assess liver fibrosis in chronic hepatitis B patients (CHB).

关键词： liver stiffness measurement Elastography Shear wave elastography Non-invasive diagnosis liver fibrosis

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Changing liver stiffness predict regression in advanced fibrosis patients with chronic hepatitis B,but not in moderate fibrosis patients

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Gastroenterology & Hepatology Research 2023年第1期5卷 13-18页

作者： Zhengxin Li Tingting Zhu Zhimin Zhao Li Shen Gaofeng Chen Hongtu Gu Chenghai Liu Shuguang Hospital Shanghai University of Traditional Chinese MedicineShanghai 201203China Shanghai Key Laboratory of Traditional Chinese Clinical Medicine Shanghai 201203China Gongli Hospital of Shanghai Pudong New Area Shanghai 200135China

Background and objective:liver stiffness measurement(LSM)may effectively correlate to the presence of liver fibrosis,but it is controversial to use for the prediction of clinical ***,we aimed to evaluate the predictive value of liver stiffness for the regression of liver ***:In this study,we collected data from a clinical cohort of patients who are received anti-virus therapies for 48 weeks.180 naive chronic hepatitis B(CHB)patients,who received paired LSM and liver biopsy with pre-and post-treatments were *** methods(FibroScan and iLivTouch)test ***:The area under the receiver operating characteristics curve(AUROC)of changing LSM for fibrosis regression is higher in advanced fibrosis patients(F5/6)than in moderate fibrosis patients(F3/4)in both FibroScan(0.719,95%CI,0.590–0.848;P=0.003;vs 0.617,95%CI,0.379–0.856,P=0.282)and iLivTouch(0.707,95%CI,0.567–0.847;P=0.011;vs 0.583,95%CI,0.422–0.744;P=0.377).A higher kappa value was received in advanced stage than in moderate stage both in FibroScan(0.392,P=0.001 vs 0.265,P=0.053)and iLivTouch(0.326,P=0.019 vs 0.030,P=0.833).Cut-off set as 4.10 kPa(sen,69.4%;spe,73.9%)in FibroScan,as 4.25 kPa(sen,56.8%;spe,72.2%)in ***:The changing LSM can be used for predicting the liver fibrosis regression in advanced stage of CHB patients.

关键词： chronic hepatitis B liver stiffness measurement liver fibrosis non-invasive test

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