瞬时弹性成像技术诊断肝纤维化总汇.ppt

1130名慢性乙型肝病患者。长达3年的随访，发现重要的结论。1。随着硬度值增加，临床诊断肝硬化的比例明显增加。2，随着硬度值增加，HCC发生率增加。第二图：统计累计肝癌发生率，经过3年的随访，在LSM13Kpa人群中，累计肝癌发生率低于10%。而LSM18Kpa患者，HCC累计发生率接近20%，当23Kpa时，累积肝癌发生率可达到35%以上。 * 更为闪亮的结论：以LSM作为判断肝癌发生率，在LSM13KPA组，无论是慢性乙肝和肝硬化，其肝癌年发生率均低于0.89%，而在13Kpa组，无论是慢性乙肝还是肝硬化，其年肝癌发生率均明显增加，并且肝炎组合肝硬化组有显著性差异。 * Between March 2006 and April 2010, 128 CHB patients with who underwent LSM and liver biopsy (LB) before starting nucleot(s)ide analogues and showed histologically advanced fibrosis (≥F3) with a high viral loads [HBV DNA ≥2,000 IU/mL] were enrolled. All patients were followed regularly to detect LRE development, including hepatic decompensation (variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome) and hepatocellular carcinoma (HCC). The mean age of the patient (72 men, 56 women) was 52.2 years. During the median follow-up period [median 27.8 (12.6-61.6) months], LREs developed in 19 (14.8%) patients (five with hepatic decompensation, 13 with HCC, one with both). Together with age, multivariate analysis identified LSM as an independent predictor of LRE development [P0.044; hazard ratio (HR), 1.038; 95% confidence interval (CI), 1.002-1.081]. The incidence of LREs was similar between patients with F3 fibrosis stage and those with F4 (22.2% vs. 13.6%, P=0.472) whereas it was signficanly different between patients with LSM value ≤19 kPa and those with LSM value 19 kPa (6.9% vs. 44.4%, P0.001). LRE, liver-related event; LSM, liver stiffness measurement; kPa, kilopascal. * TE对肝病严重程度的预测 肝脏硬度值与肝功能评分关系(P = 0.0001) Severity LSM (kPa) (mean?SD) CHB 12.0?8.2 CTP A 22.9?15.5 CTP B 42.2?18.9 CTP C 57.1?16.2 YP Chen. APASL 2010. 失代偿和CTP C的诊断临界值为38.0和 70.0kPa，排除临界值为 14.0和 31.1kPa YP Chen.APASL 2010. TE对HCC的监测和预测价值（1130） Jung et al. Hepatology2011.53(3) Jung. Hepatology2011.53(3) TE对EV的预测价值 Kyu Sik Clin Mol Hepatol. 2012 June; 18(2): 163–173 TE对LRE预测和监测价值(LRE: