만성 간질환 환자에서 순간 탄성도와 간조직 검사에 의한 간섬유화 비교 = Comparison of Transient Elastography and Hepatic Fibrosis Assessed by Histology in Chronic Liver Disease

국문 초록 (Abstract)

목적: 최근 새롭게 개발된 순간 탄성도는 간경도를 측정하여 빠르고 간단하면서도 비침습적으로 간섬유화 정도를 측정하는 방법이다. 몇몇 연구 결과들에 의하면 Fibroscan을 이용한 간경도 측정으로 C형 간염 환자의 간섬유화 정도를 비교적 정확히 예측할 수 있었다. 이 연구의 목적은 HCV 외 다양한 병인을 가진 국내 만성 간질환 환자의 간섬유화 정도를 측정하는 데 순간 탄성도의 정확성 및 임상적인 유용성을 간조직 검사 결과와 비교하여 알아보고자 하였다. 대상 및 방법: 최근 6개월 이내에 간조직 검사를 시행한 54명의 만성 간 질환 환자를 대상으로 하였다. 만성 간질환의 원인은 HBV, HCV, 자가면역, 비알코올 지방간염이었다. 간섬유화 등급은 대한병리학회 소화기병리연구회가 제안한 간조직 기술지침에 따라 섬유화 4등급으로 나누어 판독하였다. 결과: Fibroscan의 간경도 측정치는 F0는 5.10 kPa, F1 이 9.72 kPa, F2가 8.48 kPa, F3는 16.96 kPa, F4에서는 19.86 kPa를 보여주었다. 간섬유화 등급이 높아질수록 간경도 측정치도 증가하였으며, 이들의 상관관계는 spearman 상관상수가 0.614로 유의하였다. 결론: Fibroscan을 사용한 간경도 측정법은 통증을 동반하지 않고 검사 시간이 짧으며 합병증이 없다는 점에서 만성 간질환 환자의 간섬유화 정도를 측정하는데 있어 간조직 검사에 비해 간편한 검사법이나 그 진단적 가치를 확인하기 위해서는 다양한 원인질환을 대상으로 다른 섬유화의 혈청표지자들과 함께 많은 수의 환자들을 대상으로 전향적인 연구가 필요할 것으로 생각한다.

다국어 초록 (Multilingual Abstract)

Background/Aims: Transient elastography (Fibroscan, Echosens, France) is a new, simple, and non-invasive method to assess the degree of hepatic fibrosis by measuring liver stiffness. Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C. The aim of this study was to evaluate accuracy of Fibroscan for the detection of hepatic fibrosis in Korea with various etiologies of chronic liver disease by comparison with fibrosis assessed by histologic examination. Methods: Fifty-four patients with chronic liver diseases, which were histologically confirmed within recent 6 months were enrolled. Etiologies were HBV, HCV infection, autoimmune hepatitis, and non alcoholic steatohepatitis. Hepatic fibrosis was graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. Results: Fibroscan values were significantly higher in F3 (16.96 kPa) and F4 (19.86 kPa) than others (p=0.003). Liver stiffness measurement was significantly correlated to the fibrosis stage (r=0.614, p＜0.0001). Conclusions: Liver stiffness measurement by Fibroscan is a promising method for the assessment of hepatic fibrosis in chronic liver disease because it accompanies no complication. (Korean J Gastroenterol 2008;51:241-247)

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