瞬时弹性成像在慢性乙型肝炎肝纤维化诊断中的应用

Application of Fibro Scan in diagnosis of liver fibrosis in patients with chronic hepatitis B

目的探讨瞬时弹性成像(FS)在慢性乙型肝炎(乙肝)肝纤维化诊断中的应用价值。方法选取慢性乙肝患者165例,其中轻度肝纤维化者77例,中度肝纤维化者47例,重度肝纤维化及肝硬化者41例;另选同期健康体检者50例。采用FS扫描仪检测所有受试者肝脏硬度值;采用常规及临床生化检查检测血小板、AST、谷氨酰转肽酶及胆固醇,计算APRI指数、Forns指数。采用受试者工作特征(ROC)曲线分析FS、APRI、Forns单独及联合诊断慢性乙肝肝纤维化的准确性。结果在诊断中度肝纤维化时,FS、Forns、APRI的ROC曲线下面积(AUC)值分别为0.807、0.786、0.767,诊断界值分别为8.5 k Pa及8.1、11.7,敏感度分别为83.3%、60.0%、73.3%,特异度分别为81.6%、92.1%、76.3%;在诊断重度肝纤维化及肝硬化时,FS、Forns、APRI的AUC值分别为0.896、0.886、0.829,诊断界值分别为16.3 k Pa及8.4、9.3,敏感度分别为73.3%、80.0%、73.3%,特异度分别为90.6%、83.0%、88.7%。在诊断中度肝纤维化时,FS+APRI+Frons、FS+Frons、FS+APRI、FS的AUC值分别为0.851、0.832、0.826、0.807,敏感度分别为66.7%、76.7%、70.0%、83.3%,特异度分别为97.4%、81.6%、89.5%、81.6%;在诊断重度肝纤维化及肝硬化时,FS+APRI+Frons、FS+Frons、FS+APRI、FS的AUC值分别为0.922、0.904、0.907、0.896,敏感度分别为86.7%、86.7%、80.0%、73.3%,特异度分别为88.7%、83.0%、88.7%、90.6%。结论 FS对慢性乙肝肝纤维化诊断准确性高,联合血清学检测诊断效能增高,具有良好的临床应用价值。

Objective To explore the application value of transient elastography （FibroScan） in the diagnosis of liver fibrosis of chronic hepatitis B （ CHB） .Methods A total of 165 patients diagnosed with chronic hepatitis B were involved in the study, including 77 mild fibrosis patients, 47 moderate fibrosis patients, 41 severe fibrosis and cirrhosis patients .In addition, 50 subjects were selected as control group .FibroScan was used for measurement of liver stiffness measurement （LSM）.Patient group were subjected to blood platelet , aspartate aminotransferase（AST）, glutamyl transpeptidase （GGT） and cholesterol detection by normal and clinical biochemical test , and then APRI and Forns were caculated .The receive operating characteristic （ ROC） curve was adopted to analyze the accuracy of transient elastography alone and combination of APRI、Forns for the detection of liver fibrosis .Results In the diagnosis of moderate fibrosis , the AUC were 0.807, 0.786, 0.767 respectively, the cutoff value were 8.5, 8.1, 11.7 respectively, the sensitivity were 83.3%, 60.0%, 73.3%respectively, the specificity were 81.6%, 92.1%, 76.3%respectively.In the diagnosis of severe fibrosis and cir-rhosis, the AUC of FS, Forns, APRI were 0.896, 0.886, 0.829 respectively, the cutoff value were 16.3, 8.4, 9.3 re-spectively;the sensitivity were 73.3%, 80.0%, 73.3%respectively, the specificity were 90.6%, 83.0%, 88.7% re-spectively.In the diagnosis of moderate fibrosis , the AUC of FS ＋APRI ＋Frons, S＋Frons, FS ＋APRI and FS were 0.851, 0.832, 0.826, 0.807 respectively, the sensitivity were 66.7%, 76.7%, 70.0%, 83.3%respectively, the spe-cificity were 97.4%, 81.6%, 89.5%, 81.6%respectively.In the diagnosis of severe fibrosis and cirrhosis , the AUC of FS＋APRI＋Frons, FS＋Frons, FS＋APRI and FS were 0.922, 0.904, 0.907, 0.896 respectively;the sensitivity were 86.7%, 86.7%, 80.0%, 73.3%respectively;the specificity were 88.7%, 83%, 88.7%, 90.6%respectively.Con-clusions The diagnosis of liver fibrosis of chronic hepatitis B by FibroScan has high accuracy .When the hematic-biochem-ical index is combined the diagnosibility of combined detection is stronger .FibroScan and combined diagnosis are valuable for clinic application .