瞬时弹性成像技术与多参数模型评估慢性肝病肝纤维化程度的临床研究

Liver transient elastography Fibro Touch and multi-parameters model in the diagnosis of liver fibrosis

目的评估肝脏瞬时弹性成像技术Fibro Touch对肝纤维化诊断的准确性和应用价值。方法选择经肝活体组织检查确诊的慢性肝病患者200例,通过瞬时弹性成像技术方法检测肝脏硬度(LSM);并测定丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、总红胆素(TBil)及血小板(PLT)计数,计算AST/PLT比值(APRI)和基于4因子的纤维化指数(FIB-4)指数。分析LSM、APRI及FIB-4指数与肝纤维化程度的相关性;分析LSM、APRI及FIB-4对慢性肝病肝纤维化诊断的准确性。结果慢性肝病患者LSM与肝纤维化分期呈显著正相关(r=0.732,P<0.001),APRI及FIB-4指数与肝纤维化分期呈中等程度正相关(r=0.312;r=0.396,均P<0.05)。当以S≥2为分割点对患者进行分组,LSM值、APRI值与FIB-4 ROC曲线下面积分别为0.826、0.726和0.775,S≥3时为0.914、0.757和0.782,S=4时为0.938、0.715和0.765。以S≥2为分割点时,三者组合的准确性均高于LSM单独使用,以LSM+FIB-4准确性最高。以S≥3或S=4为分割点时,各指标的联合诊断能力均低于LSM单独的诊断能力。结论肝纤维化早期Fibro Touch联合FIB-4可提高诊断的准确性。

Objective To evaluate the accurate and application value of liver transient elastography FibroTouch in the diagno- sis of liver fibrosis. Methods A total of 200 patients who were definitely diagnosed as chronic liver disease were examined for liver stiffness measurement （LSM） by using the technology of liver transient elastography FibroTouch. Alanine aminotransferase （ALT） , As- partate aminotransferase （AST） ,total red choline （TBIL） and platelet （PLT） count were measured at the same time. AST/PLT ratio index （APRI） and FIB-4 index were calculated. The relationship between LSM and indexes of APRI/FIB-4 as well as diagnostic accu- racy of those parameters for chronic liver fibrosis were analyzed. Results LSM and hepatic fibrosis stages was positively correlated （ r = 0. 732 ,P 〈 0. 001 ）. The indexes of APRI and FIB-4 was moderately positive correlated with hepatic fibrosis stages （ r = 0. 312 and 0. 396, all P 〈 0. 05）. When S ≥ 2 was used as the cut point,the area under ROC curve of LSM,APRI and FIB-4 were 0. 826,0. 726 and 0. 775,respectively. When S ≥ 3,the area under ROC curve of the three parameters was 0. 914 、0. 757 and 0. 782, respectively. When S = 4,the area under ROC curve of the three parameters was 0. 938,0. 715 and 0. 765 ,respectively. When S ≥2 was used as the cut point, the accuracy of any combination of the three parameters was higher than that of a parameter alone with the highest accura- cy when used LSM ＋ FIB4. However,any combination of the three parameters showed lower accuracy than that of LSM alone. Conclu- sion LSM combined with FIB-4 can improve the diagnosis accuracy.