급성 A형간염에 의한 간내 강성도의 변화
Changes in liver stiffness during the course of acute hepatitis A
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목적: 만성 간염 환자에서 liver stiffness (LS) 측정이 간섬유화를 평가하는 데 매우 유용한 검사로 알려져 있으나, 일부 환자에서는 LS와 실제 간 섬유화 단계 사이에 상당한 차이가 관찰된다. 본 연구는 간의 괴사염증 정도가 이런 두 검사 결과 사이의 차이에 관여하는가를 평가하기 위해 시행하였다. 대상과 방법: 급성 A형간염으로 본원에 입원한 환자를 대상으로 하였다. 입원 후 환자의 혈청 ALT 수치와 bilirubin 수치의 변화에 따라 환자의 입원 당시 급성 A형간염의 단계를 염증단계, 황달단계 및 회복단계로 분류하였으며, 회복단계에서 입원한 환자(입원 후 ALT 및 bilirubin 수치가 계속 감소하는 경우)는 본 연구에서 제외하였다. 입원 시 LS를 측정하였으며 상태가 호전되어 퇴원한 후 추적하였다. LS값과 급성 A형간염의 진행단계, LS 측정 당시의 혈청 AST, ALT 및 bilirubin 수치와의 상관관계를 분석하였다. 결과: 76명의 급성 A형간염 환자가 본 연구에 포함되었으며 연령의 중앙값은 29세였다(남자 46명 여자 30명). 이들 중 33명(43.4%)은 염증단계에, 43명(56.6%)은 황달단계에 입원하였다. 염증단계에 입원한 33명에서 급성 A형간염의 증상이 발생한 후 혈청 ALT가 최고치에 도달할 때까지의 기간은 7±3일이었으며, 전체 대상 환자에서 증상이 발생한 후 bilirubin이 최고치에 도달할 때까지의 기간은 11±4일이었다. 입원 중 측정한 LS값은 8.9±3.3 kPa였다. LS값은 bilirubin 수치와만 상관관계를 보였으며, LS 상승(>7.08 kPa)과 관련이 있는 인자도 bilirubin 수치뿐이었다. 급성 간염의 증상이 발생한 후 LS값은 점차 상승하다가 증상 발생 후 8～9일 정도에 최고치에 도달한 후 점차 감소하였다. 결론: 심한 간의 괴사염증은 LS를 높여 간섬유화 단계를 실제보다 과대평가할 수 있으므로 급성 악화를 동반한 만성 간염 환자에서 LS를 측정한 경우 결과의 판정에 유의하여야 할 것으로 생각된다.
Abstract
Backgrounds/Aims: In some patients with chronic hepatitis, liver stiffness (LS) findings do not reflect fibrosis stage. This study was performed to evaluate whether acute liver inflammation could influence LS findings. Methods: Patients with acute hepatitis A admitted to our hospital were included. Hepatitis was classified on admission using serum ALT and bilirubin levels as inflammation phase, jaundice phase, or recovery phase. Patients who admitted during the recovery phase (whose ALT and bilirubin levels fell continuously during hospitalization) and therefore, their peak-ALT and peak bilirubin levels could not be determined were exduded. Enrolled patients underwent FibroScan during hospitalization and after discharge. Results: Seventy-six patients with acute hepatitis A were enrolled (median age, 29 years; 46 men and 30 women). Among them, 33 (43.4%) and 43 (56.6%) patients were admitted during the inflammation phase and jaundice phase, respectively. For patients admitted during the inflammation phase, mean (±SD) time from symptom-onset day to maximum ALT level was 7 (±3) days. For all patients, mean time from symptom- onset to maximum bilirubin level was 11 (±4) days. Mean LS during admission was 8.9 (±3.3) kPa (median, 8.4 kPa). LS was significantly correlated with serum bilirubin level, which was the only factor found to be significantly associated with the increased LS (>7.08 kPa). In all patients, LS increased gradually from the symptom-onset and peaked at 8-9 days later. Conclusions: Severe hepatic inflammation can affect the LS findings and thus, care is required when assessing fibrosis stage using LS measurement in patients with severe inflammation. (Korean J Hepatol 2008;14:465-473)
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