增强肝纤维化试验在慢性丙肝患者肝纤维化诊断中准确性的研究

Diagnostic accuracy of enhanced liver fibrosis test to assess liver fibrosis in patients with chronic hepatitis C

目的探讨增强肝纤维化（ELF）试验在慢性丙肝患者肝纤维化诊断中的准确性。方法选取2011年1月-2013年4月在本院进行肝活组织检查的慢性丙型肝炎患者156例,对其临床资料进行前瞻性研究。ELF试验包括3项血清标志物的检测：透明质酸（HA）、基质金属蛋白酶组织抑制物-1（TIMP-1）和Ⅲ型前胶原氨基端肽（PⅢNP）。采用Metavir评分系统将肝纤维化进行分期。结果在肝纤维化的诊断中,ELF=7.72时,诊断显著肝纤维化（F≥2）的ROC曲线下面积（AUROC）为0.94（95%CI：0.89-0.97）,敏感性为93.0%,特异性为83.0%;ELF试验诊断显著肝纤维化的敏感性和特异性分别为93.3%和81.0%。在肝硬化的诊断中,ELF=9.30时,诊断肝硬化（F=4）的AUROC为0.94（95%CI：0.88-0.96）,敏感性为93.0%,特异性为86.0%。结论 ELF试验是有效诊断慢性丙肝患者肝纤维化的无创性检查方法,能够准确的诊断肝纤维化分期和肝硬化。

Objective To assess the diagnostic value of enhanced liver fibrosis（ELF）test to predict liver fibrosis in patients with chronic hepatitis C. Methods This is a prospective study and it included 156 patients with chronic hepatitis C from January 2011 to April 2013.Hyaluronic acid,tissue inhibitor of matrix metalloproteinase typeⅠ,and amino-terminal propeptide typeⅢ procollagen were measured by enzyme-linked immunosorbent assay with the ELF test.Fibrosis stage was determined using the Metavir scoring system. Results In our study,for the diagnosis of significant fibrosis（Metavir F≥2）a cut-off value〉7.72 provides a sensitivity of 93.0%and a specificity of 83.0%.The areas under the receiver operator characteristic curve were 0.94（P〈0.01）.For the diagnosis of cirrhosis（Metavir F=4）a cut-off value〉9.3 provides a sensitivity of 93.0%and a specificity of 86.0%. Conclusion The ELF test is a promising non-invasive method for assessing liver fibrosis in patients with chronic hepatitis C.It is effective in the diagnosis of both fibrosis and cirrhosis.