Radiology:在预测慢性乙型肝炎HCC的进展中,你知道这一评分系统吗?

2021-11-22 shaosai MedSci原创

乙型肝炎病毒(HBV)感染是导致肝硬化、肝衰竭和肝细胞癌(HCC)等终末期肝病的最常见原因之一。

乙型肝炎病毒(HBV)感染是导致肝硬化、肝衰竭和肝细胞癌(HCC)等终末期肝病的最常见原因之一。调查显示,全球有超过4亿人长期感染HBV,中国有超过9000万的慢性乙型肝炎(CHB)感染者,HCC的风险是CHB患者的终身忧患。迄今为止,肝硬化一直是HCC发展的最重要的风险因素。然而,没有临床肝硬化的患者仍有发生HCC的风险。最有效其准确的HCC监测手段仍有争议。

目前使用血清学指标的临床评分--如指导年龄、性别、HBV DNA水平、核心启动子突变和肝硬化评分(以下简称GAG-HCC);由肝硬化、年龄、男性性别和糖尿病构建的HCC预测评分(以下简称CAMD)。以及由年龄、白蛋白水平、胆红素水平、HBV DNA水平和肝硬化构建的中国大学HCC预测得分(以下简称CU-HCC)模型预测HCC在3年和5年随访中的发展,显示受试者工作特征曲线下面积(AUC)约为0.7到0.8,。在前面提到的评分模型中,只考虑了使用传统US扫描所描述的临床特征或腹水来评估的失代偿肝硬化。此外,传统的US在评估肝纤维化和肝硬化时依赖于经验和主观建议。因此,早期的肝硬化可能会在传统的US中被遗漏。

在线免费使用:乙肝患者肝癌风险预测(GAG-HCC)

使用瞬时弹性成像(TE)获得的肝脏硬度测量(LSM)是在没有肝硬化的情况下对HCC发展的一种良好的评估手段,并已被纳入改善HCC评分系统的预测性能。年龄、血清白蛋白水平和HBV DNA水平构建的HCC预测评分,即LSM-HCC,以及由LSM、性别、年龄、丙氨酸氨基转移酶(ALT)水平和乙肝e抗原阳性构建的CHB评分(以下简称mREACH-B)的改良风险估计。然而,TE是用独立的专用设备和特定的探针进行的,而且该系统不提供B型解剖图像。二维(2D)剪切波弹性成像(SWE)是基于使用传统US系统实现的剪切波。以前的研究表明,该技术对CHB患者的肝脏纤维化分期有很好的诊断性能,二维SWE在描述肝脏纤维化方面明显优于TE,特别是在F3和F4期纤维化的患者中尤为显著。一些研究表明,二维SWE可能有助于预测HCC的发展。然而二维SWE是否可以作为预测HCC风险评分的有效组成部分,特别是在没有临床肝硬化的患者中,还有待进一步的探讨及研究

近日,发表在Radiology杂志的一项研究评估了应用二维SWE完善的风险评分在预测无临床肝硬化的CHB患者的HCC发展方面的表现,为临床对CHB患者的早期诊断及评估提供了强有力的手段支持

在2011年4月至2015年12月期间接受US和二维SWE检查的经活检证实的CHB患者被纳入本研究。在进行二维SWE和活检后,患者接受定期随访以检测HCC。该评分系统是通过将Cox比例危害模型的参数除以最小的参数并将分配的点数简化为整数而建立的。新评分的预测性能与其他评分的预测性能进行了比较。

在654名患者中(平均年龄,37岁;范围,30-43岁;510名男性),26人发展为HCC。对年龄、血小板计数和二维SWE的肝脏硬度测量等变量进行加权,形成所谓的APS评分,其中60分的临界值对HCC风险有最好的区分。APS评分(受试者工作特征曲线下的面积[AUC],0.89)优于由年龄、白蛋白水平、胆红素水平、乙肝病毒(HBV)DNA水平和肝硬化构建的中国大学HCC预测评分(AUC,0.70;P = .005),略高于由年龄、性别、HBV DNA水平、核心启动子突变和肝硬化或GAG-HCC评分指导的评分(AUC,0.82;P = .052)。在接受瞬时弹性成像的患者中,APS评分的AUC为0.79,而CHB中HCC的修正风险估计,或mREACH-B评分的AUC为0.82(P = .05)。无论是否使用抗病毒治疗,炎症等级是低还是高,或者丙氨酸转氨酶水平是正常还是高,APS评分在患者中的表现都更好(所有P>0.05)。

 

 图表显示了低风险(根据年龄、血小板计数和二维剪切波弹性成像[APS评分]构建的HCC预测,小于60分)和高风险(APS评分大于等于60分)患者之间累积肝细胞癌(HCC)发展的比较。

总之,基于二维剪切波弹性成像的基线肝脏硬度测量、年龄和血小板计数的APS评分可准确预测慢性乙型肝炎(CHB)患者的肝细胞癌(HCC)发展。对无临床肝硬化高危患者的早期发现十分有效研究结果可在原先被认为是相对低风险的患者中识别出高风险的HCC患者。同时APS评分可以协助临床医生有效地修改对CHB患者的管理和监测方案

原文出处

Ting Zhang,Genglin Zhang,Xinlei Deng,et al.APS (Age, Platelets, 2D Shear-Wave Elastography) Score Predicts Hepatocellular Carcinoma in Chronic Hepatitis B.DOI:10.1148/radiol.2021204700

 

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    2021-11-28 ms5000000740006324

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    2021-11-24 jiyangfei
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