FibroScan行肝脏硬度检测和APRI评估慢性丙型肝炎患者肝纤维化程度价值比较

Prediction of liver fibrosis by liver stiffness measurement andaspartate aminotransferase/platelet ratio in patients with chronic hepatitis C

目的探讨使用FibroScan行肝脏硬度检测(LSM)和应用门冬氨酸氨基转移酶/血小板比值(APRI)评估慢性丙型肝炎(CHC)患者肝纤维化程度的价值。方法2016年5月~2020年5月我院收治的CHC患者133例和同期健康体检者133名,接受FibroScan检查及血生化和血液检查,计算APRI。CHC患者接受肝穿刺活检。结果CHC患者LSM和APRI分别为(10.3±4.2)和(0.8±0.3),显著高于健康人[分别为(4.3±2.0)和(0.3±0.1),P<0.05];52例S_(1)期患者LSM和APRI分别为(6.5±2.4)和(0.6±0.2),37例S_(2)期患者LSM和APRI分别为(10.3±2.9)和(0.9±0.3),28例S_(3)期患者LSM和APRI分别为(14.5±4.1)和(1.2±0.5),16例S_(4)期患者LSM和APRI分别为(18.4±5.7)和(1.8±0.6),相差显著(P<0.05);经ROC分析LSM预测CHC患者显著肝纤维化(大于等于S2)的曲线下面积(AUC)为0.891,标准误为0.033,P=0.000,95%可信区间为0.826~0.956,最佳截断点为11.200,其诊断的敏感度为0.625,特异度为0.925,而APRI预测CHC患者显著肝纤维化的AUC为0.776,标准误为0.050,P=0.000,95%可信区间为0.678~0.875,最佳截断点为0.795,其敏感度为0.643,特异度为0.887;经相关性分析发现,LSM和APRI与CHC患者肝纤维化程度呈正相关(P<0.05)。结论应用LSM和APRI评估CHC患者肝纤维化程度有一定的临床价值,特别是对于存在显著肝纤维化的患者,可早期作出病情判断,对指导临床处理有很大的帮助,值得进一步研究。

Objective The aim of this study was to predict liver fibrosis by liver stiffness measurement(LSM)and aspartate aminotransferase/platelet ratio(APRI)in patients with chronic hepatitis C(CHC).Methods A total of 133 patients with CHC and 133 volunteers were enrolled in this study in our hospital between May 2016 and May 2020,and all of them underwent LSM by FibroScan check-up and got APRI in clinic assessment.All CHC patients received liver biopsies for liver fibrosis evaluation.Results The LSM and APRI in patients with CHC were(10.3±4.2)and(0.8±0.3),both significantly higher than[(4.3±2.0)and(0.3±0.1),respectively,P<0.05]in healthy persons;the LSM and APRI in 52 patients with liver fibrosis stage 1(S_(1))were(6.5±2.4)and(0.6±0.2),in 37 with S_(2) were(10.3±2.9)and(0.9±0.3),in 28 with S_(3) were(14.5±4.1)and(1.2±0.5),in 16 with S_(4) were(18.4±5.7)and(1.8±0.6),significantly different among them(P<0.05);the ROC analysis showed that the AUC of LSM was 0.891 in predicting significant liver fibrosis defined as equal to or greater than S2,with the standard error(SE)of 0.033(P=0.000,95%confidence interval(CI)of 0.826-0.956),the primal cut-off-value of 11.200,the sensitivity(Se)of 0.625 and the specificity(Sp)of 0.925,while the AUC of APRI was 0.776,with the SE of 0.050(P=0.000,95%CI of 0.678-0.875,the cut-off-value of 0.795,the Se of 0.643 and Sp of 0.887);both the LSM and APRI were positively correlated to liver fibrosis in patients with CHC(P<0.05).Conclusion Both LSM and APRI could be applied to the diagnosis and staging assessment of liver fibrosis in patients with CHC,which warrants further multi-central clinical investigation.