肝硬度检测联合APRI指数对慢性乙型肝炎患者肝纤维化程度的诊断价值

Diagnostic value of LSM combined with APRI for liver fibrosis due to chronic hepatitis B

目的评价肝硬度(LS)联合APRI指数对慢性乙型肝炎肝纤维化的诊断价值。方法收集2009年8月-2013年1月本院收治的慢性乙型肝炎患者147例,按肝纤维化病理分期分组,利用声脉冲辐射力技术(ARFI)检测LS,并化验肝功能及血常规计算APRI指数。组间比较采用方差分析,采用Spearman相关性进行相关性检验。利用受试者工作特征曲线(ROC)分析LS对肝纤维化程度的诊断价值,并比较LS、APRI及两者联合诊断S≥1(存在肝纤维化)及S≥2(显著肝纤维化)的ROC曲线下面积。结果不同分组之间年龄、LS、AST、血小板(PLT)、APRI各组差异均有统计学意义(P<0.05),LS及APRI与病理分期具有良好的相关性,相关系数(r s)分别为0.793,0.699(P<0.05);病理分期与AST,PLT的r s分别为0.292,-0.230(P<0.05)。单独LS、APRI、联合LS与APRI评价S≥1及S≥2的ROC曲线下面积分别为0.843、0.818、0.909和0.916、0.846、0.943;联合诊断ROC曲线下面积均大于单独LS或APRI诊断(P<0.05)。结论 LS联合APRI有助于提高早期肝纤维化程度的诊断。

Objective To evaluate the diagnostic value of liver stiffness （LS） combined with aspartate aminotransferase - to-platelet ratio index （APRI） for liver fibrosis due to chronic hepatitis B. Methods One hundred and forty - seven patients with chronic hepatitis B admit-ted to our hospital from August 2009 to January 2013 were staged and grouped according to liver fibrosis pathology. LS was determined with acoustic radiation force impulse, and APRI was calculated from the results of liver function test and routine blood examination. Comparisons between groups were conducted using the analysis of variance. Correlation analysis was performed with the Spearman test. The diagnostic val-ue of LS for liver fibrosis was assessed with the receiver operating characteristic （ROC） curve. The areas under the ROC curve （AUC） of LS and APRI, either alone or in combination, for diagnoses of S ≥ 1 （ presence of liver fibrosis） and S ≥2 （ significant liver fibrosis） were compared. Results Age, LS, aspartate aminotransferase （AST）, platelet count （PLT）, and APRI differed significantly across the groups （ P 〈 0.05 ）. LS and APRI were strongly correlated with pathological stages, with correlation coefficients of 0. 793 and 0. 699 （ P 〈 0.05 ）. The correlation coefficients of AST and PLT with pathological stages were 0. 292 and - 0. 230 （ P 〈 0.05 ）. The AUCs of LS, APRI, and LS plus A PRI were 0. 843,0. 818, and 0. 909, respectively, for diagnosis of S ≥ 1 and 0.916, 0. 846, and 0. 943, respectively, for diagnosis of S ≥2, suggesting that the joint use of LS and APRI outperforms LS or APRI alone in the diagnosis of liver fibrosis （ P 〈 0.05 ）. Conclu-sion LS combined with APRI improve the diagnosis of early - stage liver fibrosis.