Fibroscan无创检测慢性乙型肝炎病毒携带者肝纤维化的临床意义

Noninvasive Detection of Liver Fibrosis by Fibroscan in Asymptomatic Carriers with Chronic Hepatitis B Virus

目的探讨Fibroscan无创检测慢性乙型肝炎病毒携带者肝纤维化的临床意义。方法回顾性分析195例慢性乙型肝炎病毒携带者的临床资料(肝功能、HBV DNA定量、肝脏硬度值、肝脾彩超、肝组织病理学等),其中80例行肝脏组织学活检。结果 195例慢性乙型肝炎病毒携带者肝脏硬度值为(6.22±2.50)kPa;HBV DNA定量<500copies/mL组和HBV DNA定量≥500copies/mL组的肝脏硬度值比较无显著差异;病毒携带时间超过15年以上的患者肝脏硬度值明显高于病程≤5年者(P<0.01);肝脏组织炎症坏死分级<G2或纤维化<S2者(49例)肝脏硬度值为(6.72±2.33)kPa,炎症坏死分级≥G2或纤维化≥S2者(31例)肝脏硬度值为(9.95±4.00)kPa,两组比较有显著差异(P<0.01)。结论动态检测慢性乙型肝炎病毒携带者肝脏硬度值有助于监测肝纤维化的发生,并对肝活检时机的选择有指导意义。

Objective To investigate the clinical application of Fibroscan to noninvasive detection of liver fibrosis in asymptomatic carriers（ASCs）with chronic hepatitis B virus（HBV）.Methods Clinical data of 195 chronic HBV ASCs were retrospectively analyzed,including liver function,HBV DNA quantitation,liver stiffness（LS）,color Doppler ultrasound results of the liver and spleen and histopathological findings of the liver.LS was evaluated by transient elastography（Fibroscan）.Liver biopsy was performed in 80 carriers for histological examination.Results The LS value was（6.22±2.50）kPa in 195 cases.There was no significant difference in the LS value between HBV DNA 500copies/mL and HBV DNA≥500copies/mL groups.The LS value in patients with HBV carrying duration15years was significantly higher than that in patients with HBV carrying duration≤5years（P〈0.01）.It was（6.72±2.33）kPa in patients（n=49）with liver tissue inflammation and necrosisG2or fibrosisS2and was（9.95±4.00）kPa in patients（n=31）with liver tissue inflammation and necrosis ≥G2or fibrosis ≥S2,with significant difference found between the two groups（P〈0.01）.Conclusion Dynamic surveillance of liver fibrosis by Fibroscan in chronic HBV ASCs facilitates monitoring the occurrence of liver fibrosis,and it is helpful to establish the optimal timing for a liver biopsy for HBV ASCs.