实时组织弹性成像技术对慢性乙型肝炎肝纤维化的诊断价值

Diagnostic value of real-time tissue elastography for liver fibrosis in patients with chronic hepatitis B

目的探讨实时组织弹性成像技术(RTE)对慢性乙型肝炎患者肝纤维化程度的诊断价值。方法选取2013年3-8月于首都医科大学附属北京天坛医院和佑安医院就诊的86例慢性乙型肝炎患者,按照肝纤维化病理分期分组,依次进行RTE检查、血清生化学指标检测、肝穿刺活组织检查,计算肝纤维化指数(LFI)和APRI指数。各纤维化分期之间的比较采用单因素方差分析,进一步两两比较采用LSD-t检验,LFI与肝纤维化病理分期的相关性检验采用Spearman相关分析。计算LFI诊断肝纤维化的灵敏度、特异度,分别以肝纤维化S≥2(显著肝纤维化)、S≥4(早期肝硬化)为判断阳性的标准绘制受试者工作特征曲线(ROC),并与APRI指数进行比较。结果除S0与S1之间LFI差异无统计学意义(P=0.298),其余各期差异均有统计学意义(P=0.000)。LFI与病理分期有明显相关性,相关系数r=0.831,P<0.001。LFI诊断显著肝纤维化和早期肝硬化的曲线下面积分别为0.873(P<0.001)、0.923(P=0.002),诊断阈值分别为2.74、3.61,敏感度、特异度分别为0.766、0.872和0.833、0.878,明显优于APRI指数。结论 RTE技术对显著肝纤维化和早期肝硬化有较高的诊断价值,是慢性乙型肝炎肝纤维化无创诊断的一种重要方法。

Objective To investigate the diagnostic value of real - time tissue elastography （RTE） in evaluating liver fibrosis in patients with chronic hepatitis B （CHB）. Methods Eighty -six patients with CHB, who visited Beijing Tiantan Hospital and Beijing You＇an Hospital from March to August, 2013, were grouped according to the pathological stages of liver fibrosis. They were examined by RTE, biochemical tests, and liver biopsy. Then, liver fibrosis index （LFI） and aspartate aminotransferase - to - platelet ratio index （APRI） were calculated. Comparison between groups was made by one - way analysis of variance, followed by LSD t - test for multiple comparisons. The correlation between LFI and pathological stage of liver fibrosis was analyzed by Spearman correlation test. The sensitivity and specificity of LFI for the diagnosis of liver fibrosis were calculated. Regarding S≥2 （significant liver fibrosis） and S≥4 （early liver cirrhosis） as the positive standards, the receiver operating characteristic （ROC） curve was drawn and compared with APRI. Results LFI differed significantly across the groups （P = 0. 000）, except the comparison between SO and S1 （P = O. 298 ）. LFI was significantly correlated with pathological stage （r =0. 831, P 〈0. 001 ）. The areas under the ROC curve of LFI in diagnosing significant liver fibrosis and early liver cirrhosis were 0. 873 （ P 〈 0.001 ） and 0.923 （P = 0. 002）, respectively ; the diagnostic thresholds were 2.74 and 3.61, respectively; the sensitivity and specificity were 0.766/0. 872 and 0.833/0. 878, respectively. LFI was significantly superior to APRI. Conclusion RTE has high diagnos- tic values for significant liver fibrosis and early liver cirrhosis and is an important noninvasive diagnostic method for liver fibrosis in patients with CHB.