多项肝纤维化无创诊断模型在乙肝后肝硬化中的诊断效能

Diagnostic efficiency of multiterm hepatic fibrotic non-invasive diagnosis model in hepatitis B-caused cirrhosis

目的探讨肝纤维化指数模型(FIB-4指数)、谷草转氨酶(AST)/血小板计数(Plt)比值指数(APRI)评分、瞬时弹性成像在乙型肝炎(乙肝)后肝硬化中的诊断效能。方法选取2016年1月至2017年1月在该院住院的慢性乙肝(慢性乙肝组82例)及肝硬化(肝硬化组40例)患者采用瞬时弹性成像检测其肝脏硬度(LSM)值,同时检测谷丙转氨酶(ALT)、AST、Plt,计算出Fi B-4指数及APRI评分,分别分析LSM值、FIB-4指数及APRI在慢性乙肝后肝硬化中的诊断效能。结果两组患者性别及ALT水平比较,差异均无统计学意义(P>0.05);肝硬化组AST、Plt与慢性乙肝组比较,差异均有统计学意义(P<0.001)。慢性乙肝组患者的中位数E值、FIB-4指数、APRI评分[分别为(5.97±2.53)、(1.82±1.43)、(0.45±0.29)分]明显低于肝硬化组[分别为(13.97±10.08)、(4.29±2.82)、(0.93±0.63)分],差异均有统计学意义(P<0.05)。在慢性乙肝组患者中,肝脏E值与FIB-4指数及APRI评分均无明显相关性[相关系数(r)=0.158、0.104,P>0.05];而FIB-4与APRI评分则具有显著相关性(r=0.834,P<0.001)。在肝硬化组中,肝脏E值与FIB-4指数无明显相关性(r=0.308,P=0.053),而与APRI评分显著相关(r=0.412,P=0.008),且FIB-4指数与APRI评分也存在显著相关性(r=0.786,P<0.001)。结论在肝纤维化无创诊断模型中,瞬时弹性成像在诊断乙肝后肝硬化中的诊断效能最高,FIB-4指数次之,APRI评分最低。

Objective To investigate the diagnostic efficiency of fibrosis index model(FIB-4 index),AST/Plt ratio index(APRI)score and transient elastography in hepatitis B-caused cirrhosis.Methods Eighty-two inpatients with chronic hepatitis B(CHB group)and 40 inpatients with liver cirrhosis(liver cirrhosis group)in this hospital from January 2016 to January 2017 were selected.The liver stiffness measurement(LSM)value was measured by adopting the transient elastography,meanwhile the levels of ALT,AST and Plt were detected,and the Fib-4 index and APRI score were calculated.Then the diagnostic efficiency of LSM value,Fib-4 index and APRI in hepatitis B caused cirrhosis were analyzed respectively.Results The sex and ALT level had no statistical differences between the two groups(P>0.05);AST and Plt had statistical difference between the liver cirrhosis group and the hepatitis B group(P<0.001).The median E value,FIB-4 index and APRI score were 5.97±2.53,1.82±1.43 and(0.45±0.29)scores in the CHB group,which were significantly lower than 13.97±10.08,4.29±2.82 and(0.93±0.63)scores in the liver cirrhosis group,the differences were statistically significant(P<0.05).In the CHB group,the liver E value had no obvious correlation with Fib-4 index and APRI score(r=0.158,0.104,P>0.05);while FIB-4 index had significant correlation with APRI score(r=0.834,P<0.001).In the liver cirrhosis group,the liver E value had no obvious correlation with FIB-4 index(r=0.308,P=0.053),while had significant correlation with APRI score(r=0.412,P=0.008),moreover the significant correlation was also existed between FIB-4 index and APRI score(r=0.786,P<0.001).Conclusion In the hepatic fibrotic non-invasive diagnosis model,the transient elastography has the highest diagnostic efficiency in diagnosing hepatitis B-caused cirrhosis,followed by Fib-4 index,and the APRI score is lowest.