본문 바로가기
KERD
논문KCI 등재

만성 간질환에서 간탄성률 측정에 영향을 미치는 요인 분석

Factors associated with liver stiffness in chronic liver disease

이민석|정재연|조성원|김영배|김동준|양진모|황성규|이다미|문은준|황주안
대한간학회 (The korean Association for the Study of the Liver)|2009.12|Clinical and Molecular Hepatology|제15권 제4호|pp. 464-473

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

만성 간질환간섬유화Viral hepatitis간탄성률간염 활성도Liver stiffness; Fibrosis stage; Necroinflammatory activity; Biochemical test

초록

목적: 본 논문은 만성 간질환 환자를 대상으로 간탄성률 측정에 영향을 미치는 요인을 알아보기 위해 연구를 시행하였다. 대상과 방법: Transient elastography와 간조직검사를 시행한 만성 간질환 환자 158명을 대상으로 혈액검사 및 간조직 소견을 분석하였으며, 간조직검사 결과는 대한병리학회 기준에 따라 0～4단계로 분류하였다. 결과: 간탄성률은 간조직생검으로 확인한 간섬유화 정도와 유의한 상관관계를 보였다(P=0.636. P<0.001). 간염의 소엽 내 활성도 및 문맥역/문맥주변부 활성도가 높아질수록 간탄성률 측정치도 증가하였으며, spearman 상관계수가 각각 0.359(P<0.001), 0.448 (P<0.001)로 유의하였다. 또한 간탄성률은 혈청 총 빌리루빈치, 직접 빌리루빈치, GGT 수치, INR 등과 양의 상관관계가 있었으며, 혈청 알부민치 및 혈소판치와는 음의 상관관계가 있었다. 다변량 회귀분석에서는 간섬유화(B 3.50, P=0.009) 및 간염의 소엽 내 활성도(B 3.25, P=0.047)만이 간탄성률과 관련이 있는 것으로 나타났다. 결론: 만성 간질환 환자에서 간탄성률은 간섬유화뿐만 아니라 간내 염증 활성도에 의해서도 영향을 받음을 확인하였으며, 간탄성률의 해석에 간섬유화뿐만 아니라 간내 염증 정도도 고려해야 할 것이다.

Abstract

Background/Aims: Transient elastography is a new noninvasive tool for measuring liver stiffness that accurately predicts significant fibrosis and cirrhosis. However, several studies have indicated that liver stiffness can be significantly influenced by major changes in aminotransferase in patients with chronic viral hepatitis. The aim of this study was to determine the factors influencing liver stiffness in patients with chronic liver disease. Methods: We studied 158 patients with chronic liver disease who underwent transient elastography and liver biopsy sampling. Histologic findings on fibrosis and necroinflammatory activity in the biopsy specimens were evaluated according to the Korean Society of Pathologists Scoring System. Routine biochemical tests were performed according to standard methods. Results: Liver stiffness was strongly correlated with liver fibrosis stage (Spearman coefficient=0.636, P<0.001), lobular activity (Spearman coefficient=0.359, P<0.001), and portoperiportal activity grade (Spearman coefficient=0.448, P<0.001). Liver stiffness was significantly associated with serum levels of total bilirubin (P=0.025), direct bilirubin (P=0.049), gamma-glutamyl transpeptidase (P=0.014), platelet count (P=0.004), albumin (P<0.001), and international normalized ratio (P<0.001). Multivariate analysis showed that fibrosis stage (B 3.50, P=0.009) and lobular activity grade (B 3.25, P=0.047) were independently associated with liver stiffness. Conclusions: Liver stiffness as measured by transient elastography is associated with the grade of necroinflammatory activity and the stage of fibrosis, irrespective of serum ALT levels.

참고문헌 (40)

  1. Lok AS, "Chronic hepatitis B", Hepatology, 45, pp.507~539 (2007)
  2. Bravo AA, "Liver biopsy", N Engl J Med, 344, pp.495~500 (2001)
  3. Dienstag JL, "The role of liver biopsy in chronic hepatitis C", Hepatology, 36(1), pp.S152~S160 (2002)
  4. Piccinino F, "Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies", J Hepatol, 2, pp.165~173 (1986)
  5. Regev A, "Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection", Am J Gastroenterol, 97, pp.2614~2618 (2002)
  6. Colloredo G, "Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease", J Hepatol, 39, pp.239~244 (2003)
  7. Bedossa P, "Sampling variability of liver fibrosis in chronic hepatitis C", Hepatology, 38, pp.1449~1457 (2003)
  8. Maharaj B, "Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver", Lancet, 1, pp.523~525 (1986)
  9. Gronbaek K, "Interobserver variation in interpretation of serial liver biopsies from patients with chronic hepatitis C", J Viral Hepat, 9, pp.443~449 (2002)
  10. Parkes J, "Performance of serum marker panels for liver fibrosis in chronic hepatitis C", J Hepatol, 44, pp.462~474 (2006)
  11. Wai CT, "simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C", Hepatology, 27, pp.518~526 (2003)
  12. Le Calvez S, "The predictive value of Fibrotest vs. APRI for the diagnosis of fibrosis in chronic hepatitis C", Hepatology, 39, pp.862~863 (2004)
  13. Imbert-Bismut F, "MULTIVIRC Group. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study", Lancet, 357, pp.1069~1075 (2001)
  14. Fraquelli M, "Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease", Gut, 56, pp.968~973 (2007)
  15. Sandrin L, "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis", Ultrasound Med Biol, 29, pp.1705~1713 (2003)
  16. Kazemi F, "Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices", J Hepatol, 45, pp.230~235 (2006)
  17. Foucher J, "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study", Gut, 55, pp.403~408 (2006)
  18. Ganne-Carrie N, "Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases", Hepatology, 44, pp.1511~1517 (2006)
  19. Castera L, "Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C", Gastroenterology, 128, pp.343~350 (2005)
  20. Colletta C, "Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferases", Hepatology, 42, pp.838~845 (2005)
  21. Friedrich-Rust M, "Performance of transient elastography for the staging of liver fibrosis: a meta- analysis", Gastroenterology, 134, pp.960~974 (2008)
  22. Talwalkar JA, "Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis", Clin Gastroenterol Hepatol, 5, pp.1214~1220 (2007)
  23. Coco B, "Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminase", J Viral Hepat, 14, pp.360~369 (2007)
  24. Oliveri F, "Liver stiffness in the hepatitis B virus carrier: a non-invasive marker of liver disease influenced by the pattern of transaminases", World J Gastroenterol, 14, pp.6154~6162 (2008)
  25. Chan HL, "Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B", J Viral Hepat, 16, pp.36~44 (2009)
  26. Wong GL, "Increased liver stiffness measurement by transient elastography in severe acute exacerbation of chronic hepatitis B", J Gastroenterol Hepatol, 24, pp.1002~1007 (2009)
  27. 서연석, "급성 A형간염에 의한 간내 강성도의 변화", The Korean Journal of Hepatology, 14(4), pp.465~473 (2008), 대한간학회
  28. Sagir A, "Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage", Hepatology, 47, pp.592~595 (2008)
  29. Del Poggio P, "Is transient elastography a useful tool for screening liver disease- World", J Gastroenterol, 15, pp.1409~1414 (2009)
  30. Kim SU, "Liver stiffness measurement using FibroScans is influenced by serum total bilirubin in acute hepatitis", Liver Int, 29, pp.810~815 (2009)
  31. Kleiner DE, "Design and validation of a histological scoring system for nonalcoholic fatty liver disease", Hepatology, 41, pp.1313~1321 (2005)
  32. 강준구, "만성 바이러스간염 환자에서 간탄력도 측정을 이용한 간섬유화 진단", The Korean Journal of Hepatology, 13(4), pp.521~529 (2007), 대한간학회
  33. Ziol M, "Noninvasive assessment of liver fibrosis by measurement of stiffness in patient with chronic hepatitis C", Hepatology, 41, pp.48~54 (2005)
  34. Fung J, "Correlation of liver biochemistry with liver stiffness in chronic hepatitis B and development of predictive model for liver fibrosis", Liver Int, 28, pp.1408~1416 (2008)
  35. Arena U, "Acute viral hepatitis increases liver stiffness values measured by transient elastography", Hepatology, 47, pp.380~384 (2008)
  36. Sanai FM, "Is serum alanine transaminase level a reliable marker of histological disease in chronic hepatitis C infection?", Liver Int, 28, pp.1011~1018 (2008)
  37. Luo JC, "Relationship between serum aminotransferase levels, liver hiotologies and virological status in patients with chronic hepatitis C in Taiwan", J Gastroenterol Hepatol, 13, pp.685~690 (1998)
  38. Pinzani M, "Fibrosis in chronic liver diseases: diagnosis and management", J Hepatol, 42(1), pp.S22~S36 (2005)
  39. Arena U, "Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C", Gut, 57, pp.1288~1293 (2008)
  40. Kim KM, "Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy individuals: a prospective study of living related potential liver donors", J Gastroenterol, 42, pp.382~388 (2007)

관련 논문AI추천

만성 간질환 환자에서 순간탄성측정법(transient elastography, FibroscanⓇ)에 의한 간탄력도에 영향을 줄 수 있는 임상요소허준, 권영오, 박수영, 배락천, 신근영, 오종택, 이응갑, 전성우, 정민규, 조창민, 조한진, 탁원영대한간학회 · Clinical and Molecular Hepatology2010 · 제16권 제2호만성 바이러스간염 환자에서 간탄력도 측정을 이용한 간섬유화 진단강준구, 김동준, 김영배, 박영년, 박진선, 양진모, 정재연, 조성원, 조진희, 황성규대한간학회 · Clinical and Molecular Hepatology2007 · 제13권 제4호알코올간질환 환자에서 간경변 진단을 위한 transient elastography의 유용성김부성, 김상균, 김영석, 김홍수, 김희경, 문종호, 심찬섭, 이문성, 이준성, 장재영, 정승원대한간학회 · Clinical and Molecular Hepatology2009 · 제15권 제1호만성 B형 및 C형 간염 환자의 간섬유화 진단을 위한 비침습적 혈액 표지자 평가어영, 김주원, 윤갑준, 이종한, 조주영대한진단검사의학회 · Laboratory Medicine Online2019 · 제9권 제3호급성 A형간염에 의한 간내 강성도의 변화권용대, 금보라, 김용식, 김창덕, 류호상, 박상훈, 서상준, 서연석, 엄순호, 장진수, 전훈재, 정은석, 진윤태대한간학회 · Clinical and Molecular Hepatology2008 · 제14권 제4호만성 간질환 환자의 간섬유화 평가를 위한 비침습적 검사의 최근 동향유정환대한내과학회 · 대한내과학회지2024 · 제99권 제5호

이 간행물의 다른 논문 (8건)

초치료 만성 B형간염 환자에서 엔테카비어 치료반응 및 관련 인자이명희, 강창준, 조성원, 이다미, 김순선, 조영주, 전수진, 임선교, 정재연pp. 446-453만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교손주현, 김선민, 한동수, 오영하, 김태엽, 노영욱, 전용철, 은창수pp. 454-4634 cm 이하의 단일결절 간세포암종에서 고주파열치료와 경동맥화학색전술의 효과 비교양민재, 이민석, 정재연, 김재근, 왕희정, 조성원, 안소연, 원제환, 문은준, 황주안pp. 474-485PDGF-BB를 처리한 hTERT 간성상세포주의 유전자 발현 양상과 Wnt 신호 활성 양상 분석신혜원, 이경분, 박수영, 이정용, 남석우, 신은, 장자준pp. 486-495유전자 1형 만성 C형간염 환자에서 페그인터페론과 리바비린의 24주와 48주 치료 효과 비교김도영, 박준용, 한광협, 김미나, 전재윤, 윤기태, 안상훈pp. 496-503
원문 보기