血清ALT水平对FibroScan诊断慢性乙肝肝纤维化的影响

Effect of serum ALT level on fibro Scan in diagnosis of liver fibrosis of chronic hepatitis B

目的探讨血清丙氨酸转氨酶(alanine aminotransferase,ALT)水平对肝纤维化扫描仪(Fibro Scan)诊断慢性乙肝肝纤维化的影响。方法选取2012年9月~2014年12月我院收治的乙肝肝纤维化患者195例,依据病理活检后1周的血清ALT水平分为ALT<1×ULN组(108例)、1≤ALT≤2×ULN(49例)、ALT>2×ULN(38例),比较不同临床分级患者的LSM、ALT和不同ALT水平下患者的LSM水平,并通过ROC曲线下面积评估血清ALT对Fibro Scan诊断慢性乙肝肝纤维化的影响。结果肝纤维化1级、2级、3级、4级(肝硬化)患者的LSM和ALT水平差异有统计学意义(P<0.05)。ALT<1×ULN、1≤ALT≤2×ULN、ALT>2×ULN三组中,肝纤维化患者的LSM水平差异有统计学意义(P<0.05)。ALT<1×ULN、1≤ALT≤2×ULN、ALT>2×ULN三组中,肝纤维化的诊断AUC分别为0.931、0.952、0.667,准确度分别为92.34%、85.69%、63.12%,敏感度分别为91.45%、89.61%、44.27%;肝硬化的诊断AUC分别为0.956、0.963、0.952,准确度分别为89.23%、93.17%、94.05%,敏感度分别为95.21%、96.74%、98.15%。结论血清ALT水平超过正常上限2倍可降低Fibro Scan诊断慢性乙肝肝纤维化的准确性,但对肝硬化的诊断无明显影响。

Objective To investigate the effect of alanine aminotransferase(ALT)on liver fibrosis scanner(FibroScan)in diagnosis of patients with liver fibrosis of chronic hepatitis B.Methods195patients with liver fibrosis of chronic hepatitis B who were admitted to our hospital from September2012to December2014were selected.According to ALT level of1week after biopsy,they were divided into ALT<1×ULN group,1≤ALT≤2×ULN group(n=49)and ALT>2×ULN group(n=38).LSM and ALT of patients in different clinical grades were compared and LSM levels of patients with different ALT levels were also compared.Effect of ALT on FibroScan in diagnosis of patients with chronic hepatitis B was evaluated by area under ROC curve.Results LSM and ALT levels of patients with first grade,second grade,third grade and fourth liver fibrosis(liver cirrhosis)were different and the difference was statistically significant(P<0.05).LSM levels of patients with liver fibrosis in ALT<1×ULN group,1≤ALT≤2×ULN group(n=49)and ALT>2×ULN group were different and difference was statistically significant(P<0.05).Areas under the curve(AUC)of diagnosis of liver fibrosis were respectively0.956,0.963and0.9252.Accuracy was92.34%,85.69%and63.12%respectively and sensitivity was91.45%,89.61%and44.27%respectively.AUC of diagnosis of liver cirrhosis was0.956,0.963and0.9252respectively.Accuracy was89.23%,93.17%and94.05%respectively and sensitivity was respectively95.21%,96.74%and98.15%.Conclusion The level of ALT more than2times of the upper limit of normal can reduce the accuracy of FibroScan in diagnosis of liver fibrosis of chronic hepatitis B,but it has no significant effect on the diagnosis of liver cirrhosis.