西村 貴士^{1, 2}, 吉田 昌弘¹, 西村 純子¹, 中野 智景^{1, 2}, 青木 智子³, 會澤 信弘², 廣田 誠一⁴, 藤元 治朗⁵, 西口 修平², 飯島 尋子^{1, 2}

Takashi NISHIMURA^{1, 2}, Masahiro YOSHIDA¹, Junko NISHIMURA¹, Chikage NAKANO^{1, 2}, Tomoko AOKI³, Nobuhiro AIZAWA², Seiichi HIROTA⁴, Jiro FUJIMOTO⁵, Syuhei NISHIGUCHI², Hiroko IIJIMA^{1, 2}

¹兵庫医科大学超音波センター, ²兵庫医科大学肝胆膵内科, ³公立八鹿病院内科, ⁴兵庫医科大学病院病理部, ⁵兵庫医科大学肝胆膵外科

¹Ultrasound Imaging Center, Hyogo College of Medicine, ²Depertment of Internal Medicine, Division of Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, ³Department of Internal Medicine, Yoka Hospital, ⁴Depertment of Surgical Pathology, Hyogo College of Medicine, ⁵Depertment of Surgery, Division of Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine

キーワード :

【Background and Aim】
Shear wave ultrasound elastography is one of the non-invasive method for assessing liver fibrosis and widely used. In patients with chronic hepatitis C achieved sustained virological response（SVR）with interferon（IFN）therapy, liver fibrosis gradually improved, however, the evaluation of liver fibrosis using shear wave elastography after SVR is controversial. We examined the evaluation of liver fibrosis after SVR for chronic hepatitis C patients using shear wave elastography.
【Methods】
From October 2008 to August 2015，621 patients with chronic hepatitis C before IFN therapy（non-IFN group）and 49 with chronic hepatitis C after SVR（SVR group）underwent liver biopsy within 4 months after Virtual Touch Quantification（VTQ）by Siemens ACUSON S2000/S3000. Shear wave velocities（Vs value m/s）were measured 3 to 5 times and the mean value was recorded. We evaluated to find relationship between VTQ and other parameters in the patients with non-IFN group and SVR group. This study was approved by the institutional ethics committee.
【Result】
The mean age of non-IFN group was 60.1±12.4 years and male for 46.7％．The stages of liver fibrosis were 2.1％，31.9％，17.7％，27.9％，20.5％ for F0，F1，F2，F3 and liver cirrhosis, respectively. Vs values of each fibrosis stage were F0 for 1.40，F1 for 1.22，F2 for 1.33，F3 for 1.58，F4 for 2.22，and the progression of F parameter was significantly associated with the elevation of VTQ（P＜0.001）. Univariate analysis for the association with VTQ demonstrated that F parameter, A parameter, albumin, AST, Blood sugar, platelet, hyaluronic acid, hemoglobin were associated with VTQ and by multivariate analysis F parameter was significantly associated with VTQ（p＜0.001）. The stages of liver fibrosis in 49 patients with SVR by IFN therapy for chronic hepatitis C were 2.0％，65.3％，10.2％，16.3％，6.1％for F0，F1，F2，F3 and liver cirrhosis, respectively. Vs values of each fibrosis stage were F0 for 1.21，F1 for 1.07，F2 for 1.04，F3 for 1.23，F4 for 2.00. In the subject of SVR group, only liver cirrhosis（F4）was significantly associated with elevation of VTQ. Univariate analysis for the association with VTQ demonstrated that F parameter, A parameter, albumin, AST, platelet, Hyaluronic acid, hemoglobin were associated with VTQ and by multivariate analysis F parameter and hemoglobin were significantly associated with VTQ（p＜0.001）. Vs values of fibrosis stage F1 and F2 for SVR group were significantly lower than for Non-IFN group（F1;P＜0.01，F2;P＜0.05）and Vs values of fibrosis stage F3 and F4 for SVR group were lower than for non-IFN group.
【Conclusion】
VTQ was significantly associated with F parameter in non-IFN group and SVR group, however, VTQ of each fibrosis stage in SVR-group were low compared to in Non-SVR group. The diagnosis of liver fibrosis using shear wave elastography for chronic hepatitis C patient with SVR should be careful.