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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2018; 24(6): 737-743
Published online Feb 14, 2018. doi: 10.3748/wjg.v24.i6.737
Performance of transient elastography in assessing liver fibrosis in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome
Hui-Min Wu, Li Sheng, Qi Wang, Han Bao, Qi Miao, Xiao Xiao, Can-Jie Guo, Hai Li, Xiong Ma, De-Kai Qiu, Jing Hua
Hui-Min Wu, Li Sheng, Qi Wang, Han Bao, Qi Miao, Xiao Xiao, Can-Jie Guo, Hai Li, Xiong Ma, De-Kai Qiu, Jing Hua, Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai 200127, China
Hui-Min Wu, Li Sheng, Qi Wang, Han Bao, Qi Miao, Xiao Xiao, Can-Jie Guo, Hai Li, Xiong Ma, De-Kai Qiu, Jing Hua, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Hui-Min Wu, Li Sheng, Qi Wang, Han Bao, Qi Miao, Xiao Xiao, Can-Jie Guo, Hai Li, Xiong Ma, De-Kai Qiu, Jing Hua, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai 200127, China
Author contributions: Wu HM and Li S contributed equally to this work and collected and analyzed the data; Wang Q coordinated the research; Bao H and Xiao X performed the transient elastography and coordinated liver biopsy; Miao Q contributed to histological examination; Qiu DK, Ma X, Hua J, Li H, and Guo CJ analyzed the data; Hua J designed the study; Wu HM, Li S and Hua J wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81470842 and No. 81770572 to Hua J.
Institutional review board statement: The study received a waiver of the approval requirement from the ethics committee.
Informed consent statement: All patients signed an informed consent form for liver biopsy.
Conflict-of-interest statement: We declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing Hua, MD, PhD, Professor, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, No. 160, Pujian Road, Shanghai 200127, China. hua-jing88@hotmail.com
Telephone: +86-21-68383113 Fax: +86-21-63200874
Received: November 7, 2017
Peer-review started: November 8, 2017
First decision: November 21, 2017
Revised: December 5, 2017
Accepted: January 1, 2018
Article in press: January 1, 2018
Published online: February 14, 2018
AIM
To investigate the performance of transient elastography (TE) for diagnosis of fibrosis in patients with autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome.
METHODS
A total of 70 patients with biopsy-proven AIH-PBC overlap syndrome were included. Spearman correlation test was used to analyze the correlation of liver stiffness measurement (LSM) and fibrosis stage. Independent samples Student’s t-test or one-way analysis of variance was used to compare quantitative variables. Receiver operating characteristics (ROC) curve was used to calculate the optimal cut-off values of LSM for predicting individual fibrosis stages. A comparison on the diagnostic accuracy for severe fibrosis was made between LSM and other serological scores.
RESULTS
Patients with AIH-PBC overlap syndrome had higher median LSM than healthy controls (11.3 ± 6.4 kPa vs 4.3 ± 1.4 kPa, P < 0.01). LSM was significantly correlated with fibrosis stage (r = 0.756, P < 0.01). LSM values increased gradually with an increased fibrosis stage. The areas under the ROC curves of LSM for stages F ≥ 2, F ≥ 3, and F4 were 0.837 (95%CI: 0.729-0.914), 0.910 (0.817-0.965), and 0.966 (0.893-0.995), respectively. The optimal cut-off values of LSM for fibrosis stages F ≥ 2, F ≥ 3, and F4 were 6.55, 10.50, and 14.45 kPa, respectively. LSM was significantly superior to fibrosis-4, glutaglumyl-transferase/platelet ratio, and aspartate aminotransferase-to-platelet ratio index scores in detecting severe fibrosis (F ≥ 3) (0.910 vs 0.715, P < 0.01; 0.910 vs 0.649, P < 0.01; 0.910 vs 0.616, P < 0.01, respectively).
CONCLUSION
TE can accurately detect hepatic fibrosis as a non-invasive method in patients with AIH-PBC overlap syndrome.
Core tip: Our research determined that transient elastography can accurately detect hepatic fibrosis as a non-invasive method in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome. Liver stiffness measurements were significantly superior to fibrosis-4, glutaglumyl-transferase/platelet ratio, and aspartate aminotransferase-to-platelet ratio index scores for detecting severe fibrosis.
