声触诊组织量化联合谷草转氨酶/血小板比值对慢性乙型病毒性肝炎患者肝纤维化分期的价值

Virtual touch tissue quantification and aspartate aminotransferase to platelet ratio for staging hepatic fibrosis in patients with chronic hepatitis B

目的探讨采用声触诊组织量化（VTQ）技术联合谷草转氨酶/血小板比值（APRI）对慢性乙型病毒性肝炎患者肝纤维化分期的价值。方法将117例慢性乙型病毒性肝炎患者按照穿刺活检病理结果,分为F1-F4组,均接受VTQ检查,测量并计算肝脏右叶s5-s8段的剪切波速度作为VTQ值,同时计算每例患者的APRI。随机选择34名健康志愿者作为对照组（F0组）,同法测量、记录所有指标。分析VTQ、APRI与病理学分期的相关性,采用ROC曲线评价VTQ、APRI及二者线性结合（VTQ＋APRI）分期F2以上级别肝纤维化的效能。结果各组VTQ值比较,除F1与F2组间差异无统计学意义（P〉0.05）外,其余各组两两比较差异有统计学意义（P〈0.05）;APRI除F0与F1组间差异无统计学意义（P〉0.05）,其余各组间比较均差异有统计学意义（P〈0.05）。患者VTQ和APRI与肝纤维化病理学分期均呈正相关（r=0.814,0.677,P〈0.001）。评价≥F2级肝纤维化时,VTQ比APRI显示出更好的特异度（89.83%vs71.19%）,阳性预测值（92.11%vs 82.47%）,阳性似然比（7.48vs 3.02）,ROC曲线下面积（AUC）亦较大（0.898vs0.845）;而VTQ＋APRI的AUC、敏感度、阴性预测值分别为0.913、82.61%、76.47%,均高于单独应用VTQ（0.898、76.09%、70.67%）。结论 VTQ与APRI均与慢性乙型病毒性肝炎患者肝纤维化程度相关。对于F2以上级别肝纤维化,VTQ的诊断准确性高于APRI,而二者结合的诊断效能更高。

Objective To explore the value of virtual touch tissue quantification（VTQ）and aspartate aminotransferase to platelet ratio index（APRI）for staging hepatic fibrosis in patients with chronic hepatitis B（CHB）.Methods Totally 117 patients with CHB were divided into F1—F4groups according to the histological result,and underwent VTQ system exams,the value of shear wave velocity of VTQ of hepatic segments s5—s8were measured and the APRI were also acquired for each examinee.A total of 34 healthy volunteers were selected as control group（F0group）,and underwent the same examinations as CHB patients.The correlation between VTQ,APRI and histological result was analyzed,and then the diagnostic performance of VTQ,APRI and（VTQ＋APRI）for significant fibrosis（≥F2）was evaluated by ROC curve.Results There were statistically significant differences among these 5groups for VTQ（all P〈0.05）except for F1 and F2group（P〉0.05）;as to APRI,except F0 and F1group,the rest of measurement showed significant difference（all P〈0.05）;VTQ and APRI of patients demonstrated positive correlation with the histological stage（r=0.814,0.677,both P〈0.001）.Compare to APRI,VTQ showed better specificity（89.83% vs 71.79%）,positive predictive values（92.11% vs82.47%）,positive likelihood ratio（7.48 vs 3.02）and more the area under the ROC curve（AUC,0.898 vs 0.845）for significant fibrosis（≥F2）.The AUC,sensitivity,negative predictive values of VTQ＋APRI was respectively 0.913,82.61% and 76.47%for significant fibrosis（≥F2）,higher than those of VTQ（0.898,76.09%,70.67%）.ConclusionVTQ and APRI correlated with the stage of hepatic fibrosis in CHB patients.For significant fibrosis（≥F2）,VTQ showed better diagnostic accuracy than APRI,but a combination of both is the best method in diagnosis of hepatic fibrotic stage.