嶋 﨑宏明

Background Liver stiffness (LS) has been reported to correlate with fibrosis stage (F). The correlation between LS and fibrosis stage and the reduction of LS by antiviral therapy were examined in patients with hepatitis B infection. Methods LS was measured by FibroScan in 212 patients infected with hepatitis B virus. Liver biopsies were done in 51 patients. Changes of LS were assessed in 29 patients treated with nucleotide or nucleoside analogs and 52 patients without antiviral therapy. Results LS was significantly correlated with fibrosis stage (rho = 0.686, P < 0.0001). The optimal cut-off values of LS were 7.1 kPa for F >= 2, 10.7 kPa for F >= 3, and 16.0 kPa for F4. LS was significantly reduced by antiviral therapy, from 12.9 (range 6.2-17.9) kPa to 6.6 (4.4-10.3) kPa measured at an interval of 512 (range 366-728) days (P < 0.0001). Eleven of 19 (58%) patients with baseline fibrosis stages of F3-4 deduced from LS had 2-point or greater reductions of deduced stage at the last LS measurement. The change ratio of hyaluronic acid (P = 0.0390) was associated with a 2-point or greater reduction of deduced fibrosis stage. Without antiviral therapy, LS tended to increase, increasing from 6.1 (range 3.9-8.5) kPa to 6.3 (range 4.4-9.7) kPa at an interval of 422 (range 358-709) days (P = 0.0682). Conclusions LS was significantly correlated with fibrosis stage in patients with chronic hepatitis B. The reduction of LS by antiviral therapy was significantly correlated with the reduction of hyaluronic acid. Thus, we conclude that LS can be useful to assess the progression and regression of liver fibrosis stage noninvasively.

Aim: Transient elastography is a non-invasive tool to measure liver stiffness (LS), which has been reported to correlate with stage of liver fibrosis. Extrahepatic cholestasis was reported to cause elevated LS, which is considered to be attributed to the increased hydrostatic pressure in the liver. In the present study, the correlation of LS with laboratory data was investigated in extrahepatic cholestasis. The change of LS after biliary drainage was also assessed. Methods: LS was measured in 29 patients with extrahepatic cholestasis due to carcinomas in 12 and non-neoplastic diseases of biliary tract or pancreas in 17. Results: In 15 patients, LS was 11.4 kPa or higher which suggested liver cirrhosis in chronic infection of hepatitis C virus. LS significantly correlated positively with serum bilirubin levels (r = 0.726, P < 0.0001) and negatively with serum aspartate aminotransferase (AST) levels (r = -0.481, P = 0.0082) and alanine aminotransferase (ALT) levels (r = -0.631, P = 0.0002). Biliary drainage led to a reduction of bilirubin by 13.5 to 0.9 mg/dL which was significantly correlated with a reduction of LS by 14.3 to 0.5 kPa (r = 0.524, P = 0.0257). Conclusion: In extrahepatic cholestasis, the elevation of LS which is probably attributed to the increased hydrostatic pressure in the liver, correlates positively with the accumulation of bilirubin but negatively with damage of hepatocytes indicated by ALT levels. Further studies on the mechanism underlying the elevation of LS should be helpful to elucidate the pathogenesis of extrahepatic cholestasis.

AIM: To construct and evaluate a new non-invasive fibrosis index for assessment of the stage of liver fibrosis. METHODS: A new fibrosis index (Fibro-Stiffness index) was developed in 165 of 285 patients with chronic hepatitis C, and was validated in the other 120 patients where liver biopsy was performed. Its usefulness was compared with liver stiffness (LS) measured by FibroScan, the aminotransferase-to-platelet ratio index, the Forns index and the FibroIndex. RESULTS: The Fibro-Stiffness index consists of LS, platelet count and prothrombin time. The values of the Fibro-Stiffness index differed significantly between neighboring fibrosis stages except F0-F1. The area under the receiver operating characteristics curves of the Fibro-Stiffness index for prediction of F >= 2 (0.90), F >= 3 (0.90) and F = 4 (0.92) in the estimation group and those for F >= 3 (0.93) and F = 4 (0.97) in the validation group were the highest among the 5 methods examined. The accuracy of the Fibro-Stiffness index had highest values for F >= 2, F >= 3 and F = 4 in both the estimation and validation groups. The diagnostic performance for F = 4 was improved by a combination of the Fibro-Stiffness index with serum hyaluronic acid level. CONCLUSION: The Fibro-Stiffness index was constructed and validated. It showed superior diagnostic performance to other indices for F >= 2, 3 and 4. (C) 2010 Baishideng. All rights reserved.

症例は76歳男性で、健診にて胆嚢結石を指摘された既往があり、近医にてC型肝炎と多発肝細胞癌(HCC)を指摘され紹介受診した。肝両葉の多発HCCにCDDP肝動注併用カテーテル的動脈下顎塞栓術計3回で腫瘍マーカーは正常化した。その後発熱と倦怠感で入院し、CTで脾周囲の低吸収域と脾実質の圧排所見、胆嚢・総胆管末端に小結石を認めた。超音波ガイド下の経皮的ドレナージで胆汁様液が穿刺され、脾周囲biloma(胆汁性嚢胞)疑いで内視鏡的逆行性胆管膵管造影(ERCP)を行った。総胆管結石と肝内胆管末梢より脾臓周囲への造影剤漏出・貯留を認め、bilomaの診断で内視鏡的胆道ドレナージチューブを挿入留置した。Biloma穿刺液からKlebsiella pneumoniaeが検出され、抗生剤投与で陰性化した。Bilomaは縮小し、内視鏡的乳頭切開術と総胆管の採石を行い、ERCPにて胆汁漏出の消失を認めた。