Fibroscan在慢性乙型肝炎肝纤维化诊断中的作用及影响因素

The value of Fibroscan in diagnosis of hepatic fibrosis in CHB patients and influencing factors

目的探讨肝脏瞬时弹性超声成像(Fibroscan,FS)在评估慢性乙型肝炎肝纤维化中的作用及影响因素。方法选择上海瑞金医院感染科2009年1月至2011年12月慢性乙型肝炎(CHB)患者410例,运用FS检测肝脏硬度值(Stiffness值)。所有患者同期行经皮肝穿刺活组织检查,同时检测肝功能、血小板、凝血等指标。以肝活检结果为标准绘制FS工作特征曲线,计算受试者工作特征曲线下面积(AUROC),Stiffness值与Ishak评分比对,运用统计学方法进行分析。结果无肝纤维化(S0期)、轻度肝纤维化(S1～S2期)、中度肝纤维化(S3～S4期)和重度肝纤维化及肝硬化(S5期～S6期)患者Stiffness值(kPa)分别为5.45±1.44、7.01±2.42、9.23±3.00、16.87±6.77,对Stiffness值进行组间比较,差异有统计学意义(P<0.01)。Stiffness值与肝纤维化分期呈显著正相关(r=0.67812,P<0.01)。Fibroscan检测显著肝纤维化和肝硬化的AUROC分别为0.840和0.938,其中以Stiffness值8.050kPa作为显著肝纤维化的诊断界值,敏感度为60.3%,特异度为93.7%,阳性预测值为94.71%,阴性预测值为55.83%;以12.150kPa作为重度肝纤维化和肝硬化的诊断界值点,敏感度和特异度分别为75.9%和92.0%,阳性预测值和阴性预测值分别为61.11%和95.86%。逐步回归统计分析,Alb、PLT、AST、年龄、体质量对Stiffness值有影响。结论 Fibroscan评估CHB患者肝纤维化程度尤其是显著肝纤维化和肝硬化准确性高,在诊断与疗效评估中具有较好的应用价值。

Objective To evaluate the value and influencing factors of transient elastography （Fibroscan） in predicting liver fibrosis in patients with chronic hepatitis B （CHB）. Methods Four hundred and ten CHB patients in Shanghai Ruijin hospital from January 2009 to December 2011 were enrolled in this study. FS- methods were applied in measuring the liver stiffness values of all patients. Liver biopsy was performed on the same period as FS, while other biochemical markers were determined as well. Area under receiver operating characteristic curve （AUROC） was constructed to analyze the accuracy rate of liver stiffness for predicting significant fibrosis and cirrhosis. Statistical analysis was appllied to compare Liver stiffness with Ishak fibrosis stage in liver biopsy in each patient. Results Considered SO as no liver fibrosis group, S1-S2 as mild liver fibrosis group, S3-S4 as moderate liver fibrosis group, and S5-S6 as advanced liver fibrosis group, the average stiffness（kPa） of Fibroscan for each group was 5.45 ± 1.44, 7.01 ± 2.42, 9.23 ± 3.00, 16.87 ± 6.77, respectively. To compare the result of statistical analysis, the difference of stiffness among liver fibrosis groups is significant （P〈0.0001）. Stiffness had a significant direct correlation with liver fibrosis（r = 0.67812, P〈0.0001）. The AUROCs of Stiffness for predicting significant fibrosis and cirrhosis were 0. 840 and 0. 938, respectively （P = 0. 000）. The cutoff value for significant fibrosis was Stiffness ≥8. 050; the sensitivity was 60.3%, the specificity was 93.7%, the positive predictive value was94.71% and the negative predictive value was 55. 83%. For cirrhosis, the cutoff value was Stiffness 912. 150; the sensitivity was 75.9% ; the specificity was 92.0%; the positive predictive value was 61.11 %; and the negative predictive value was 95. 86%. According to the result of stepwise regression analysis, Alb, PLT, AST, age and weight are the significant clinical factors which may affect the result of Stiffness values. Conclusion Transient elastography （Fibrosean） is a promising non-invasive method for the detection of fibrosis in CHB patients. It can be used as a useful tool for diagnosing significant liver fibrosis and cirrhosis in CHB patients, and it may play an important role in the follow-up and management of these patients.