瞬时弹性测定在诊断乙型肝炎后肝硬化中的价值及影响因素

Value and impact factors of transient elastography in diagnosis of hepatitis B cirrhosis

目的探讨肝脏瞬时弹性检测仪(fibroscan,FS)在肝硬化患者中的应用及影响因素。方法应用FS对239例慢性肝炎患者进行肝穿前肝脏弹性测量值(liver stiffness measurement,LSM)的测定,同时进行血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、总蛋白(TP)、白蛋白(A)、球蛋白(G)及A/G生化指标的检测。以肝活检病理结果为金标准,对肝纤维化进行分期及炎症分级,比较肝硬化与非肝硬化LSM的关系,采用受试者工作特征(ROC)曲线分析FS诊断肝硬化的准确性。结果肝硬化患者的LSM显著高于非肝硬化患者,26.3(63.4)kPa vs 7.0(33.5)kPa(P<0.01),FS诊断肝硬化的ROC曲线下面积为0.954,敏感度0.98、特异度0.83。多因素回归分析显示肝硬化患者肝脏LSM与患者年龄有线性回归关系,回归系数为0.335,P<0.05。结论 FS诊断肝硬化的准确性较高,且影响其准确性的因素较少,有助于肝硬化患者的鉴别诊断及预后评定。

Objective To investigate the value and the effects of transient elastography instrument fibroscan（FS） for diagnosis of liver cirrhosis in patients with chronic hepatitis B.Methods Two hundred and thirty-nine patients with chronic hepatitis B were enrolled in this study.All of the patients underwent liver stiffness measurement（LSM） by FS before liver biopsy.Simultaneously,the relative detections were performed in serum biochemical parameters such as alanine aminotransferase（ALT）,aspartate transaminase（AST）,total bilirubin（TBIL）,direct bilirubin（DBIL）,total protein（TP）,albumen（A）,globulin（G） and A/G.With the liver biopsy as the gold standard,the liver fibrosis stage and inflammation grade were executed.The receiver operating characteristic（ROC） curve was adopted to analyze the accuracy of FS for diagnosing liver fibrosis,and the relationship of LMS between liver cirrhosis and non-cirrhosis was compared.Results The LSM of cirrhotic patients was significantly higher than that of non-cirrhotic patients,26.3（63.4） kPa vs 7.0（33.5） kPa（P0.01）.ROC area under the curve of LSM for diagnosis of liver cirrhosis was 0.954,the sensitivity and specificity were 0.98,0.83,respectively.Multivariate regression analysis showed that LSM in patients with liver cirrhosis had linear regression with patients＇ age,the regression coefficients 0.335,P0.05.Conclusion FS has very good value for diagnosing liver cirrhosis in patients with chronic hepatitis B,and the influencing factors are less,and FS is helpful to the differential diagnosis and prognostic assessment of patients with cirrhosis.