만성 간질환 환자에서 순간탄성측정법(transient elastography, FibroscanⓇ)에 의한 간탄력도에 영향을 줄 수 있는 임상요소
Clinical factors influencing liver stiffness as measured by transient elastography (FibroscanⓇ) in patients with chronic liver disease
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목적: 최근 사용되고 있는 순간탄성측정법(FibroscanⓇ)은 비침습적 방법으로 간섬유화를 측정하는 데 유용하다고 알려져 있지만, 급성 간염의 경우나 만성 간염에서의 급성 악화를 보이는 경우에는 간탄력도가 실제의 간섬유화도보다 높게 측정된다는 연구결과를 보여주고 있다. 그로 인하여 만성 간질환 및 간경변을 가진 환자에서 순간탄성측정법으로 측정한 간탄력도(kPa)의 해석에 대한 한계성이 제시되었고, 이에 저자 등은 임상적으로 간경변까지 진행되지는 않았다고 판단되는 만성 간질환 환자에게서 높은 간탄력도와 상관관계를 보이는 임상 요소를 알아보고자 하였다. 대상 및 방법: 만성 간염 혹은 간경변으로 본원에서 추적 중인 환자 중 2007년 11월부터 2008년 3월까지 순간탄성측정법을 시행한 298명을 대상으로 하였다. 만성 간염은 6개월 이상 지속적으로 원인에 노출되는 경우로 하였고, 간세포암 또는 복수를 가진 대상은 연구에서 제외하였다. 바이러스표지자 및 혈청학적 검사를 포함한 혈액검사, 순간탄성측정법을 통해 측정한 간탄력도, 복부초음파검사 또는 컴퓨터단층촬영 등을 조사하였고, 간경변의 진단은 영상학적으로 표면결절이 있고 비장종대에 의한 150×103/μL이하의 혈소판감소증이 있는 경우, 혹은 내시경상 정맥류가 있는 경우 또는 간성혼수 병력이 있는 경우로 하였다. 결과: 다변량 분석을 시행한 결과, 만성 간질환 환자에서 고령(P=0.007), GGT 증가(P= 0.022), 알부민 감소(P=0.015), 총 빌리루빈이 증가(P=0.009)된 경우에 비정상적으로 높은 간탄력도를 나타내었다. 결론: 기존의 연구에 추가하여 연령, GGT, 알부민 역시 간탄력도에 영향을 주는 임상 요소에 관여할 수 있다는 것을 확인하였고, 병력, 혈청학적 검사 및 영상학적 검사 등을 통한 제반의 임상적 요소를 고려하여 간탄력도를 해석하여야 할 것이다.
Abstract
Background/Aims: Transient elastography as performed using the FibroscanⓇ is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (LSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the LSM value obtained by the FibroscanⓇ is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the LSM value obtained using transient elastography as performed using the FibroscanⓇ in patients with chronic liver disease. Methods: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the FibroscanⓇ, laboratory test, ultrasound, and/or abdominal computed tomography. Results: The 298 patients were aged 47.8±12.9 years (mean±SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had LSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that LSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). Conclusions: This study reveals that age, GGT, and albumin are clinical factors influencing LSM values. This reinforces the need to interpret LSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings.
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