瞬时弹性成像与非酒精性脂肪性肝病病理纤维化分期的相关性

Correlation between liver stiffness measurement by Fibroscan and liver fibrosis staging based on a liver biopsy in patients with NAFLD

目的:评价瞬时弹性成像(Fibroscan,FS)在非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)肝纤维化诊断中的作用.方法:选取2008-04/2011-02在北京佑安医院住院,且经病理检查诊断为NAFLD的患者83例,临床检测肝功能、空腹血糖、血脂、尿酸,同时应用FS进行肝脏硬度检测.以病理检查结果为金标准,分析肝脏硬度、生化学指标及病理肝纤维化程度的相关性,采用受试者工作特征(ROC)曲线分析FS诊断NAFLD肝纤维化的准确性.结果:不同程度肝纤维化分期的肝脏硬度值,S0期:4.28kPa±1.32kPa,S1期:7.40kPa±2.13kPa,S2期:11.52kPa±3.86kPa,S3期:19.99kPa±5.42kPa.肝脏硬度与肝纤维化程度呈正相关,Spearman相关系数为0.768,P<0.001.Pearson相关分析显示,FS肝脏硬度检测值与ALT、AST呈正相关,与HDL、ApoA呈负相关(P<0.05).FS诊断S0-S1、S2、S3期的ROC曲线下面积分别为0.889(0.813,0.965)、0.838(0.729,0.948)、0.938(0.000,1.000),诊断界值分别为8.95kPa、10.60kPa、15.66kPa.结论:FS对NAFLD肝纤维化有较高的诊断价值,可作为NAFLD患者诊断和动态随访的依据.

AIM：To evaluate the role of Fibroscan（FS） in the diagnosis of liver fibrosis in patients with nonalcoholic fatty liver disease（NAFLD）.METHODS：A total of 83 patients who were pathologically diagnosed with NAFLD and underwent liver stiffness measurement using FibroScan at Beijing Youan Hospital from April 2008 to February 2011 were included in this study.Staging of liver fibrosis based on a liver biopsy was performed in all patients.Other clinical tests included liver function,FBG,blood lipids and UA.The correlation between liver stiffness and liver f ibrosis degree was analyzed.The receive operating characteristic（ROC） curve was used to analyze the accuracy of Fibroscan in diagnosing liver fibrosis with NAFLD.RESULTS：The liver stiffness differed among patients with different stages of liver fibrosis.The Fibroscan values were 4.28 kPa ± 1.32 kPa,7.40 kPa ± 2.13 kPa,11.52 kPa ± 3.86 kPa,and 19.99 kPa ± 5.42 kPa for patients with S0 to S3 liver f ibrosis,respectively,and liver stiffness was closely related to stage of liver fibrosis（r = 0.768,P 〈 0.001）.Fibroscan score was positively correlated with ALT and AST,but negatively with HDL and ApoA（all P 〈 0.05）.The area under the ROC curve for FibroScan score in assessing liver f ibrosis was 0.889（0.813,0.965） in patients with S1 liver f ibrosis,0.838（0.729,0.948） in those with S2,and 0.938（0.000,1.000） in those with S3.The cut off values were 8.95 kPa,10.60 kPa and 15.66 kPa,respectively.CONCLUSION：Fibroscan is valuable for the diagnosis of liver f ibrosis in patients with NAFLD.