声辐射力脉冲成像与APRI指数评价慢性丙型肝炎肝纤维化的临床价值

Clinical value of acoustic radiation force impulse imaging and APRI for quantitative evaluating the degree of liver fibrosis in chronic hepatitis C patients

目的探讨声辐射力脉冲成像（acoustic radiation force impulse，ARFI）技术和天门冬氨酸氨基转移酶与血小板比值指数（AST／PLT ratio index，APRI）无创评价慢性丙型肝炎肝纤维化程度的临床应用价值。方法对107例慢性丙型肝炎患者应用ARFI技术检测肝实时弹性，并计算APRI指数，所有患者均于检测后1周内行肝穿刺活检，以病理检查结果为金标准，比较ARFI测值和APRI指数对慢性丙型肝炎肝纤维化的诊断价值。结果慢性丙型肝炎患者肝纤维化分期为S1～S4期的ARFI分别为（1．26±0．27）m／s、（1．45±0．51）m／s、（2．03±0．54）m／s和（2．29±0．82）m／s，APRI分别为0．30±0．46、0．29±0．21、0．59±0．56和0．63±0．35。ARFI和APRI测值均与肝纤维化分期存在相关，相关系数分别为0．61和0．49（P＜0．001）。ARFI和APRI诊断慢性丙型肝炎肝纤维化S≥2的ROC曲线下面积分别为0．779、0．724；S≥3的曲线下面积分别为0．866、0．786；S=4的曲线下面积分别为0．790、0．779。结论ARFI技术较APRI指数能更准确地定量评价慢性丙肝肝纤维化程度，具有良好的临床应用前景。

Objective To investigate the diagnostic value of the acoustic radiation force impulse （ARFI） technology and AST/PLT ratio index （APRI） for the assessment of the liver fibrosis in chronic hepatitis C patients. Methods 107 patients with chronic hepatitis C were included, the subjects were underwent liver biopsy,liver function, blood count, as well as real-time acoustic elastography examination.The APRI was calculated according the following formula, APRI = AST （ULN）/PLT （ 10^9/L）. ARFI and APRI were compared by correlation with liver fibrosis stage in chronic hepatitis C. Referring to the histologic fibrosis stage on liver biopsy,all the ARFI and the APRI value were assessed by using ROC curve analysis. The corresponding cut-off values, sensitivity and specificity were also calculated and compared.Results The mean values of ARFI and APRI were （1.26 ± 0.27）m/s and 0.30±0.46 for the patients with S1,（1.45 ±0.51）m/s and 0.29 ± 0.21 for those with S2,（2.03 ± 0.54） m/s and 0.59 ± 0.56 for those with S1,（1.45 ± 0.51）m/s and 0.29 ± 0.21 for those with S2,（2.03 ± 0.54） m/s and 0.59 ± 0.56 for those with S3,（2.29 ± 0.82） m/s and 0.63 ± 0.35 for those with S4,respectively. ARFI （ r = 0.61, P〈0. 001） had a better correlation with liver fibrosis stage in chronic hepatitis C than APRI （ r = 0.49, P 〈0. 001）. Cut-off points of ARFI and APRI were 1. 529 m/s and 0. 170 for S≥2,1. 780 m/s and 0. 277 for S≥3,1. 780 m/s and 0. 446 for S = 4, respectively. Accordingly, the areas under the ROC curves for ARFI and APRI were 0. 779 and 0. 724 for S≥2,0. 866 and 0. 786 for S≥3,0. 790 and 0. 779 for S= 4,respectively. Coneluslons As a nondnvasive technology, ARFI is more accurate when applied to evaluate liver fibrosis in patients with chronic hepatitis C than APRI. ARFI technology has potential value for quantitatme evaluation of the liver fibrosis for chronic hepatitis C.