Fibroscan诊断慢性乙型肝炎肝纤维化的价值

Value of Fibroscan in diagnosis of chronic hepatitis B liver fibrosis

目的探讨瞬时弹性成像（Fibroscan）诊断慢性乙型肝炎（CHB）肝纤维化的价值。方法肝活检CHB患者115例,应用Fibroscan检测肝硬度值（LSM）,同时检测相关生化指标。利用受试者工作特征曲线下面积（AUROC）评价LSM对纤维化分期的诊断价值。结果 S0、S1、S2、S3、S4的LSM（k Pa）分别为（5.78±1.42）、（7.68±2.43）、（9.61±4.08）、（13.61±4.73）、（18.02±6.61）,与肝纤维化分期（S）正相关（r=0.715,P〈0.001）。LSM诊断S2～4、S3～4和S4的AUROC分别为0.838、0.907、0.914。当LSM界值分别为8.50 k Pa（S2～4）、10.35 k Pa（S3～4）、11.75 k Pa（S4）时,灵敏度和特异度分别为73.7%和83.3%、90.3%和85.7%、94.0%和81.6%,阳性预测值和阴性预测值分别为83.3%和73.8%、68.3%和96.0%、47.1%和98.8%。结论 Fibroscan对S2以上的肝纤维化具有诊断价值,尤其诊断S3～4和早期肝硬化（S4）的价值较高。

Objective To investigate the value of Fibroscan in diagnosis of chronic hepatitis B（CHB） liver fibrosis. Methods There were 115 patients with CHD by liver biopsy. Fibroscan was applied in liver stiffness measurement（LSM） and related biochemical criterion. Diagnostic value of LSM for fibrosis stage was evaluated by area under receiver operating characteristic curve（AUROC）. Results LSM（k Pa） of S0, S1, S2, S3, and S4 were respectively（5.78±1.42）,（7.68±2.43）,（9.61±4.08）,（13.61±4.73）, and（18.02±6.61）. That was positively correlated with fibrosis stage（S）（r=0.715, P0.001）. AUROC of LSM in diagnosis of S2～4, S3～4, and S4 were respectively 0.838, 0.907, and 0.914. When the LSM were at the critical values as 8.50 k Pa（S2～4）, 10.35 k Pa（S3～4）, and 11.75 k Pa（S4）, the sensitivity and specificity were 73.7% and 83.3%, 90.3% and 85.7%, 94.0% and 81.6%, the positive prediction rate and negative prediction rate were 83.3% and 73.8%, 68.3% and 96.0%, 47.1% and 98.8%. Conclusion Fibroscan has diagnostic value for liver fibrosis above S2, and its value is high in diagnosis of S3～4 and early liver cirrhosis（S4）.