Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2022; 28(18): 2021-2033
Published online May 14, 2022. doi: 10.3748/wjg.v28.i18.2021
Clinical utility of two-dimensional shear-wave elastography in monitoring disease course in autoimmune hepatitis-primary biliary cholangitis overlap syndrome
Yu-Ling Yan, Xian Xing, Yi Wang, Xiao-Ze Wang, Zhi Wang, Li Yang
Yu-Ling Yan, Xian Xing, Yi Wang, Xiao-Ze Wang, Zhi Wang, Li Yang, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Ling Yan, Xian Xing, Yi Wang, Xiao-Ze Wang, Zhi Wang, Li Yang, Sichuan University, University of Oxford Huaxi Joint for Gastrointestinal Cancer Centre, Chengdu 610207, Sichuan Province, China
Author contributions: Yan YL and Yang L designed the research study; Wang Z, Wang Y, Xing X and Yan YL performed the research; Wang XZ and Wang Y contributed new reagents and analytic tools; Yan YL and Xing X analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by China Postdoctoral Science Foundation, No. 2020M673263.
Institutional review board statement: The study was reviewed and approved by the West China Hopsital Institutional Review Board (Approval No. 459).
Informed consent statement: The Informed consent was waived by the West China Hopsital Institutional Review Board.
Conflict-of-interest statement: There are no conflicts of interest to be declared.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Yang, MD, Director, Doctor, Full Professor, Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu 610041, Sichuan Province, China. yangli_hx@scu.edu.cn
Received: October 13, 2021
Peer-review started: October 13, 2021
First decision: December 3, 2021
Revised: December 16, 2021
Accepted: April 2, 2022
Article in press: April 2, 2022
Published online: May 14, 2022
Abstract
BACKGROUND

Autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome has a worse prognosis than AIH or PBC alone. Therefore, accurately staging liver fibrosis and dynamically monitoring disease progression are essential.

AIM

To investigate the performance of two-dimensional shear-wave elastography (2D-SWE) for noninvasively staging liver fibrosis and assessing the clinical utility of repeated 2D-SWE for monitoring treatment response in AIH-PBC overlap syndrome.

METHODS

A total of 148 patients diagnosed with AIH-PBC overlap syndrome were retrospectively enrolled. Among them, 82 patients had a 2D-SWE follow-up time of more than 1 year. The Scheuer scoring system was used to evaluate stages of hepatic inflammation and liver fibrosis. The performance of 2D-SWE for staging liver fibrosis was evaluated with the liver biopsy. Changes in liver stiffness (LS) measured by 2D-SWE in patients with or without complete biochemical remission were evaluated.

RESULTS

LS value was strongly correlated with liver fibrosis stage (Spearman r = 0.84, P < 0.0001). The areas under the receiver operating characteristic curves of LS for diagnosing significant fibrosis (≥ S2), severe fibrosis (≥ S3), and cirrhosis (S4) were 0.91, 0.97, and 0.96, respectively. Patients with complete biochemical remission had a considerable decrease in LS values (P < 0.0001). More importantly, the declined LS in patients with S0-S2 was significantly lower than that in patients with S3-S4 (P = 0.0002). In contrast, patients who failed to achieve biochemical remission had a slight but not significant decrease in LS (P = 0.37).

CONCLUSION

LS measured by 2D-SWE is an accurate and reliable method in assessing liver fibrosis, especially for diagnosing severe fibrosis (≥ 3) and monitoring treatment response in patients with AIH-PBC overlap syndrome.

Keywords: Liver fibrosis, Liver biopsy, Diagnostic tests, Autoimmune hepatitis, Primary biliary cholangitis, Inflammation

Core Tip: Two-dimensional shear-wave elastography is an accurate and reliable method in monitoring treatment response in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome.