两种常用非创方法在肝纤维化诊断中的作用与局限性

Roles and limitations of two common non-invasive methods in diagnosis of liver fibrosis

目的统计分析腹部二维超声与FibroTouch对肝纤维化的诊断价值以及局限不足,以便更好地指导临床。方法记录相应病例的肝脏硬度值(liver stiffness measurement,LSM)及超声二维图像半定量化评分。以病理为金标准,通过受试者工作特征曲线(receptor operating characteristic curve,ROC)分析超声与FibroTouch在肝纤维化诊断中的价值,并对两种方法在肝硬化阶段的误诊病例进行比较分析。结果超声对明显纤维化期(S≥2)、进展期肝纤维化(S≥3)、早期肝硬化(S=4)诊断的曲线下面积(area under the curve,AUC)分别为0.915、0.873、0.821;FibroTouch检查分别为0.854、0.802、0.727。超声组有87例(34%),FibroTouch组有45例(27%)出现诊断结果偏倚。结论超声与FibroTouch是两种可靠的超声肝纤维化无创诊断方法,可以作为一种行之有效的替代方法,用于疾病诊断、疗效观察。

Objective To investigate the value and limitation of abdominal ultrasonography（AUS）and FibroTouch（FT）in the diagnosis of liver fibrosis for better clinical application.Methods Liver stiffness measurement and semiquantitative AUS score were recorded.Diagnostic value of AUS and FT for liver fibrosis was assessed with receiver operating characteristic curve using liver biopsy as the gold standard.Moreover,cases misdiagnosed of cirrhosis by the two methods were comparatively analyzed.Results The areas under the curve of AUS and FT for apparent fibrosis（S≥2）,progressive fibrosis（S≥3）and early cirrhosis（S=4）were 0.915,0.873,0.821 and 0.854,0.802,0.727,respectively.There were 87 cases（34%）in AUS group and 45 cases（27%）in FT group with biased diagnosis.Conclusion AUS and FT may serve as two reliable ultrasonic non-invasive methods for the diagnosis of liver fibrosis,which can be applied for observation of clinical efficacy.However,liver biopsy and non-invasive methods should be used under comprehensive analysis because of their disadvantages.