瞬时弹性成像技术和血清学评分模型与肝纤维化程度的相关性

Correlation between liver fibrosis degree and FibroS can or serological scoring model

目的比较瞬时弹性成像技术(FibroScan)检查与血清学评分模型(APRI、FIB-4)对肝纤维化程度的临床诊断价值。方法 267例慢性乙型肝炎患者均接受肝组织活检病理检查确诊,术前完善FibroScan检查,同时检测血常规、肝功能等指标,根据公式计算出APRI评分及FIB-4指数,以肝组织病理纤维化分期为金标准,根据ROC曲线评价FibroScan、APRI、FIB-4诊断慢性乙型肝炎肝纤维化程度的能力。结果 FibroScan、APRI、FIB-4与肝纤维化程度有显著的相关性,差异有统计学意义(P<0.01)。FibroScan、APRI、FIB-4诊断显著肝纤维化(S≥2)的ROC曲线下面积(AUC)分别为0.761、0.703、0.629(P均<0.01),诊断早期肝硬化(S≥4)的AUC分别为0.842、0.786、0.746(P均<0.01);FIB-4不能诊断显著肝纤维化,FibroScan、APRI对显著肝纤维化及早期肝硬化的诊断能力较好。结论 FIB-4指数评价慢性乙型肝炎患者显著肝纤维化效能较差,FibroScan、APRI评分对显著肝纤维化的诊断与早期肝硬化的识别效能较好,但仍无法完全代替肝组织活检。

Objective To compare the diagnostic efficacy of Transient elastography （FibroScan） and serological scoring model （ APRI, FIB - 4） on liver fibrosis in patients with chronic hepatitis B （CHB）. Methods A total of 267 patients with CHB and liver biopsy were recruited in this study. FibroScan was performed to obtain the liver stiffness meas- urement （LSM） , and the laboratory indexes, such as blood routine and liver function indexes, were recorded to calculate the APRI and FIB -4. Based on liver fibrosis stage as the gold standard, receiver operating curve （ROC） was used to evaluate the differentiating capacity of these indicators in diagnosis of liver fibrosis. Results There were a significant cor- relations between liver fibrosis stage and FibroScan, APRI or FIB -4 （P 〈0.01 ）. The areas under the ROC curve （AU- ROC） of FibroScan, APRI and FIB -4 for the diagnosis of obvious liver fibrosis （S≥2） were 0. 761, 0. 703 and 0. 629, respectively （ P 〈 0. 01 ） ; for liver cirrhosis （ S≥4 ） were 0. 842, 0. 786 and 0. 746, respectively （ P 〈 0. 01 ）. FIB - 4 could not be applied for diagnosis liver fibrosis, whereas FibroScan and APRI provided good accuracy for the diagnosis of liver fi- brosis. Conclusion FIB -4 is less effective in the diagnosis of liver fibrosis, while FibroScan and APRI are better.