非创伤性诊断指标优势组合对肝纤维化诊断价值的初步研究

A preliminary study of the combination of noninvasive parameters in the diagnosis of liver fibrosis

目的 探讨非创伤性诊断指标的优势组合及其对肝纤维化的诊断价值。 方法 以肝活检组织学分级分期为标准，检测200例慢性肝病患者同期血清学指标、免疫学指标、肝纤维化血清标志物及B超、CT、MRI，运用逐步回归方法判别分析获得肝纤维化非创伤性诊断指标的优势组合,并计算其敏感性、特异性及准确率。 结果 以S_0为无纤维化组，S_1＋S_2＋S_3＋S_4为纤维化组，获得指标组合：B超门静脉每分钟血流流量参数、年龄、B超肝右叶最大斜径、CT/MRI肝表面波浪状表现、γ-谷氨酰转肽酶(GGT)，其诊断敏感性为80.36％，特异性为86.67％，准确率为81.10％；以S1+S2为轻度肝纤维化组，S3＋S4为重度肝纤维化组，获得指标组合：透明质酸(HA)、A/G比值、B超脾长径，其诊断敏感性为59.57%，特异性为91.26%，准确率为81.33%；以S_1＋S_2＋S_3为纤维化组，S_4为肝硬化组，获得指标组合：HA、CT/MRI肝内胆管附近小囊状改变情况、B超肝包膜厚度、年龄、症状积分，其诊断敏感性为77.78%，特异性为91.45%，准确率为89.63%。 结论 非创伤性诊断指标的优势组合对诊断肝纤维化具有较高的敏感性和特异性，其诊断价值高于单一指标。

Objective To explore the combination of noninvasive parameters and its significance in the diagnosis of liver fibrosis. Methods Liver biopsy was performed on 200 patients with chronic liver diseases, and the biochemical parameters, serum fibrotic markers, and B ultrasound, CT, and MRI were detected in the corresponding period. Then, by the regression, we obtained the combination of the noninvasive parameters and evaluated the significance in the diagnosis of liver fibrosis. Results Three combinations have been obtained. The parameters in the first combination which was used to differentiate fibrosis and no fibrosis(S0 vs S1+S2+S3+S4) were the parameter of blood flow of portal vein per minute by B ultrasonographg, age, the maximum oblique line of right liver by B ultrasound, the wave expression of the surface of liver by CT/MRI and GGT. The parameters in the second combination which was used to evaluated the degree of fibrosis(S1+S2 vs S3+S4) were HA, A/G and the longest length of spleen by B ultrasound . The third combination which was used to distinguish fibrosis with cirrhosis (S1+S2+S3 vs S4) was composed by HA, the little cyst-like change near the intrahepatic duct , thickness of liver capsule by B ultrasound, age and the index of symptoms. All the three combinations were sensitive, specific, and accurate. Conclusion The combinations of noninvasive parameters is more valuable than single parameter in the diagnosis of liver fibrosis. [