比较肝剪切波速与血清指标评估肝纤维化

Comparison of liver shear wave velocity and serological indexes in assessment of hepatic fibrosis

目的比较剪切波速(SWV)与血清学指标对肝纤维化的诊断价值。方法对88例慢性肝纤维化患者(肝纤维化组)及50名健康人(对照组)行声脉冲辐射力成像,测量SWV,并检测血清透明质酸(HA)、层黏蛋白(LN)、Ⅳ型胶原(CⅣ)和Ⅲ型前胶原(PCⅢ)水平,比较两组间上述指标的差异;以肝穿活检病理检查结果作为金标准,比较上述指标ROC曲线下面积,评价其诊断肝纤维化效能。结果肝纤维化组和对照组肝脏SWV、血清HA和LN水平差异均有统计学意义(P均<0.05),CⅣ和PCⅢ差异均无统计学意义(P均>0.05),SWV、LN、HA、CⅣ和PCⅢ诊断肝纤维化的曲线下面积分别为0.88、0.72、0.68、0.53和0.50,SWV、LN和HA诊断肝纤维化界值分别为1.35 m/s、46.21ng/ml和66.34ng/ml,其对应的敏感度分别为78.34%、65.56%和57.48%,特异度分别为83.23%、73.35%和67.46%。结论 SWV诊断肝纤维化的敏感度和特异度高于血清学指标。

Objective To compare the value of liver shear wave velocity （SWV） and serological indexes in assessment of hepatic fibrosis. Methods Totally 88 patients with chronic hepatic fibrosis （hepatic fibrosis group） and 50 healthy controis （control group） underwent acoustic radiation force impulse imaging to obtain SWV. Serological indexes including hyaluron- ic acid （HA）, laminin （LN）, collagen type Ⅳ （CⅣ） and procollagen type Ⅲ （PCⅢ） were also detected and compared be- tween the two groups. The area under ROC curve and the diagnostic efficacy of the above indexes were analyzed taking pathological results of liver biopsy as gold standards. Results Significant differences of SWV of the liver as well as HA and LN were found between the two groups （all P%0.05）, whereas no significant difference of CIV nor PCⅢ was found （P：〉0.05）. The area under ROC curve of SWV, LN, HA, CⅣ and PCⅢ for diagnosis of fibrosis was 0.88, 0.72, 0.68, 0.53 and 0.50, respectively, and the sensitivity and specificity of SWV, LN and HA was 78.34%, 65.56%, 57.48% and 83.23%, 73.35%, 67.46% with cut-off value of 1.35 m/s, 46.21 ng/ml and 66.34 ng/ml, respectively. Conclusion The sensitivity and specificity of SWV in diagnosis of liver fibrosis are higher than those of serological indexes.