만성 바이러스간염 환자에서 간탄력도 측정을 이용한 간섬유화 진단
Liver Stiffness Measurement for the Diagnosis of Hepatic Fibrosis in Patients with Chronic Viral Hepatitis
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초록
목적: FibroScan 은 간의 탄력도를 측정하여 비침습적으로 간의 섬유화 정도를 진단하는 검사로, 만성 바이러스간염 환자를 대상으로 검사의 유용성 여부를 확인하기 위해 연구를 시행하였다. 대상 및 방법: 2005년 10월부터 2006년 8월까지 FibroScan 과 간조직검사를 시행한 만성 B형, C형간염 환자 103명을 분석하였으며, 간조직검사 결과는 대한병리학회 기준에 따라 0-4단계로 분류하였다. 결과: 간의 탄력도는 3.5-57.1kPa (평균: 11.8, 표준편차: 8.9)였고, 간섬유화 정도에 따른 간탄력도의 평균은 F1, F2, F3, F4에서 각각 5.8±1.8 kPa, 11.3±6.8 kPa, 11.8±6.0 kPa, 23.4±16.5 kPa였다. 간탄력도는 간조직생검으로 확인한 간섬유화 정도와 유의한 상관관계를 보였다(r=0.56, P<0.001). AUROC 곡선은 F2 이상의 집단에서 0.93 (95%신뢰구간: 0.86-0.99)이었고, F3 이상과 F4에서는 각각 0.72 (95%신뢰구간: 0.62-0.82), 0.80 (95%신뢰구간: 0.67- 0.92)이었다. F2 이상의 간섬유화를 진단하는 값으로 7.5 kPa를 선정했을 때 민감도는 84%, 특이도는 90%였다. 결론: FibroScan 은 만성 바이러스간염 환자의 유의한 섬유화(≥F2)와 간경변증을 잘 반영하였으며, 특히 F2 이상인 집단에서 측정된 간의 탄력도가 유의한 차이를 보여, 항바이러스치료의 결정에 유용할 것이다.
Abstract
Background/Aims: FibroScanⓇ is a new medical device that noninvasively measures liver stiffness. The aim of this study was to assess the accuracy of the liver stiffness measurement by FibroScanⓇ for making the diagnosis of liver fibrosis in patients with chronic viral hepatitis. Methods: We studied 103 patients with chronic viral hepatitis B or C and they underwent FibroScanⓇ and liver biopsy between October 2005 and August 2006. Liver fibrosis was staged on a 0-4 scale according to the Korean Society of Pathologists Scoring System. The diagnostic accuracy was assessed by analysis of the receiver operator characteristics (ROC). Results: The liver stiffness was 3.5-57.1 kPa (mean: 11.8, SD: 8.9). The mean value of liver stiffness in each fibrosis stage group (F1, F2, F3 and F4) was 5.8±1.8 kPa, 11.3±6.8 kPa, 11.8±6.0 kPa and 23.4±16.5 kPa, respectively. Liver stiffness measured by FibroScanⓇ showed reliable correlation with the liver fibrosis stage as confirmed by liver biopsy (r=0.56, p<0.001). The AUROC (95% CI) of ≥ F2, ≥ F3 and F4 was 0.93 (0.86-0.99), 0.72 (0.62-0.82) and 0.80 (0.67-0.92), respectively. The sensitivity and specificity of 7.5 kPa, which was the cutoff value for ≥ F2, was 84% and 90%, respectively. Conclusions: FibroScanⓇ is a reliable method for the diagnosis of significant fibrosis (≥F2) and cirrhosis in patients with chronic liver disease. The liver stiffness measurement by FibroScanⓇ showed good diagnostic performance for significant fibrosis.
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