肝脏瞬时弹性成像和血清肝纤维化指标对肝移植术后肝纤维化的诊断价值研究

Value of transient elastography and serologic markers of liver fibrosis in diagnosing liver fibrosis in liver transplant patients

目的评价肝脏瞬时弹性成像(FibroScan)及血清肝纤维化4项[透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(Ⅳ-C)和血清Ⅲ型前胶原(PCⅢ)]对肝移植患者发生明显肝纤维化(F>2)的诊断价值。方法选择2013年2月28日一2014年7月8日在本院治疗的行经皮肝脏穿刺活体组织检查的肝移植和非肝移植慢性肝病患者各40例,进行FibroScan检查以及血清肝纤维化4项检测。将肝脏硬度测定(liver stiffness measurement,LSM)值和血清肝纤维化4项结果与病理检查的肝纤维化程度进行相关性分析,用受试者工作特征曲线(receiver-operating characteristic curve,ROC曲线)分析和评估LSM值和血清肝纤维化4项对肝移植患者明显肝纤维化的诊断价值。结果肝移植患者HA和LSM值与肝纤维化评分呈正相关,r_s分别为0.689和0.782。HA和LSM值诊断肝移植患者明显纤维化的ROC曲线下面积分别为0.789和0.943。明显肝纤维化患者中,肝移植者的LSM值高于非肝移植患者(P<0.05);无明显肝纤维化(F≤2)的患者中,肝移植者Ⅳ-C和PCⅢ低于非肝移植患者(P均<0.05)。结论 LSM值和血清HA与肝移植患者的肝纤维化评分呈正相关,它们对肝移植患者的明显肝纤维化具有一定的诊断价值。

Objective To evaluate the value of transient elastography （FibroScan） and four serologic markers of liver fibrosis [hyaluronic acid （HA）, laminin （LN）, collagen type IV （Ⅳ-C） and procollagen type Ⅲ（PCⅢ）] in diagnosis of significant liver fibrosis （F〉2） in liver transplant patients. Methods A total of 80 patients with chronic liver disease, who had liver biopsy in our hospital from February 28, 2013 to July 8, 2014, were enrolled in the study, of whom 40 underwent liver transplantation and the others didn＇t. Liver stiffness was measured by FibroScan and the four serologic markers of liver fibrosis were detected. Correlations between the value of liv-er stiffness measurement （LSM） and the four serologic markers of liver fibrosis and liver fibrosis stages obtained by liver biopsy were ana-lyzed. Receiver-operating characteristic （ROC） curves were used to analyze and evaluate the diagnostic value of LSM by FibroScan and the four serologic markers for significa nt liver fibrosis in liver transplant patients. Results HA and LSM value in liver transplant pa-tients were positively correlated with Metavir fibrosis scores, with rs of 0.689 and 0.782, respectively. The areas under ROC curve of di-agnosing significant liver fibrosis with HA and LSM value in liver transplant patients were 0.789 and 0.943, respectively. In patients with significant liver fibrosis, LSM value of patients undergoing liver transplantation was significantly higher than that of patients without undergoing liver transplantation （P〈0.05）, while in patients with F≤2,Ⅳ-C and PCⅢof patients undergoing liver transplantation were significantly lower than those of patients without undergoing liver transplantation （P〈0.05）. Conclusions LSM value and HA have positive correlations with Metavir fibrosis scores in liver transplant patients, and can be used to diagnose significant liver fibrosis in liver transplant patients.