FibroTouch联合FIB-4、APRI及GPRI评估肝纤维化

FibroTouch combined with FIB-4,APRI and GPRI in diagnosis of liver fibrosis

目的评估肝脏瞬时弹性成像技术(FibroTouch)联合天冬氨酸氨基转移酶(aspartate transaminase,AST)/血小板(platelet,PLT)比值(APRI)、age-AST-PLT-丙氨酸氨基转移酶(alanine transaminase,ALT)相关的比值(FIB-4)及谷氨酰胺转肽酶(glutamyl transferase,GGT)/PLT比值(GPRI)诊断肝纤维化的临床价值。方法选择2014年1月至2017年4月就诊于河北医科大学第三医院经肝组织病理学证实的慢性肝病患者337例,采用FibroTouch检测肝脏硬度值(liver stiffness measurement,LSM),同步检测ALT、AST、GGT、总胆红素(total bilirubin,TBIL)及PLT,计算FIB-4、APRI及GPRI。应用受试者工作特征(receiver operating characteristic,ROC)曲线对比分析FibroTouch及3种血清学模型的诊断效能,Spearman秩相关检验分析其与影响因素的相关性,验后概率对比分析FibroTouch联合多参数模型的诊断准确度。结果肝组织病理学结果:显著肝纤维化(≥S2)169例,进展期肝纤维化(≥S3)86例,肝硬化(S4)42例。LSM诊断纤维化分期S≥2、S≥3、S=4的ROC曲线下面积依次为0.826、0.882、0.920,明显高于FIB-4(0.734、0.711、0.739)、APRI(0.662、0.669、0.719)和GPRI(0.621、0.674、0.720),P值均<0.01。相关因素分析显示年龄、肝脏炎症程度、ALT、AST及TBIL水平可影响LSM、FIB-4、APRI及GPRI诊断肝纤维化。计算验后概率示,FibroTouch诊断纤维化分期S≥2、S≥3、S=4与肝组织病理学的符合率分别为72.44%、80.52%、84.21%;LSM联合FIB-4诊断肝纤维化的符合率优于LSM联合APRI或GPRI,S≥2、S≥3、S=4分别为85.88%、92.38%、95.83%;进一步联合其余模型的诊断准确率进一步提高,四者联合诊断肝纤维化分期S≥2、S≥3、S=4的符合率分别为95.71%、98.6%、99.08%。结论 FibroTouch联合FIB-4评估慢性肝病肝纤维化程度的准确度高,进一步联合APRI及GPRI可在一定程度上减少肝穿活检的需求,为肝纤维化的无创诊断、动态监测及疗效评估提供可靠依据。

Objective To explore the value of the combination of FibroTouch,fibrosis index based on the 4 factors(FIB-4),AST-to-PLT ratio index(APRI)and GGT-to-PLT vatio index(GPRI)in diagnosis of liver fibrosis in patients with chronic liver disease.Methods A total of 337 patients with chronic liver disease were selected and performed liver biopsy in Department of Traditional and Western Medical Hepatology,the Third Hospital of Hebei Medical University from January 2014 to April 2017.The GPRI,APRI,FIB-4 were calculated and liver stiffness was measured by FibroTouch.The diagnostic values of FibroTouch,GPRI,APRI and FIB-4 for liver fibrosis degree were compared by receiver operating characteristic(ROC)curves,and area under ROC curves(AUROCs)were used to analyze the results of the models.Spearman analysis was used to evaluate the correlation between LSM,APRI,GPRI,FIB-4 and clinical characteristics.Posterior probability was calculated to explore the accuracy of combining four methods in diagnosis of liver fibrosis.Results The patients were divided into significant liver fibrosis group(a liver fibrosis stage of≥S2,n =169),advanced liver fibrosis group(a liver fibrosis stage of≥S3,n =86),liver cirrhosis group(a liver fibrosis stage of =S4,n =42).The AUROCs of the LSM for predicting significant liver fibrosis,advanced liver fibrosis and liver cirrhosis were 0.826,0.882,0.920,which were significantly higher than FIB-4(0.734,0.711,0.739), APRI(0.662,0.669,0.719)and GPRI(0.621,0.674,0.720);LSM was correlated with histopathological fibrosis(r =0.564,P =0.000)and inflammation grade(r =0.651,P =0.000).The probability of LSM in diagnosing liver fibrosis of S≥2,S≥3 and S=4 was 72.44%,80.52%,84.21%.When FIB-4,APRI and GPRI were combined with LSM in diagnosing liver fibrosis of S≥2,S≥3 and S=4,the posterior probability was95.71%,98.6%,99.08%.Conclusion A combination of FibroTouch and FIB-4 can improve the accuracy of diagnosing liver fibrosis,and the demand of liver biopsy will dicrease significantly when combined with APRI and GPRI further,which is beneficial to confirming timely,monitoring dynamically and treating effectively.