实时组织弹性成像联合APRI、FIB-4对慢性乙型肝炎所致显著肝纤维化的诊断价值

Diagnostic value of real-time tissue elastography combined with APRI and FIB-4 for significant liver fibrosis caused by chronic hepatitis B

目的探讨实时组织弹性成像(RTE)联合天冬氨酸转氨酶与血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)对慢性乙型肝炎所致显著肝纤维化的诊断价值。方法128例慢性乙型肝炎患者均进行RTE检查、血清生化检测、肝穿刺活检。使用Spearman相关分析进行肝纤维化指数(LFI)、APRI、FIB-4与肝纤维化病理分期的相关性检验,对三种无创诊断数据进行多因素Logistic回归分析,构建联合诊断模型。以肝纤维化≥S2(显著肝纤维化)为阳性标准绘制受试者工作特征曲线(ROC曲线),分析联合诊断模型与LFI、APRI、FIB-4单独诊断的诊断效能。结果肝穿刺活检病理分期结果显示,128例慢性乙型肝炎患者中,S0期21例,S1期28例,S2期35例,S3期26例,S4期18例。Spearman相关分析发现,LFI、APRI、FIB-4与肝纤维化病理分期呈正相关性(r=0.834、0.426、0.374,P<0.05)。以肝纤维化≥S2(显著肝纤维化)为阳性标准绘制ROC曲线,结果显示,联合诊断模型诊断显著肝纤维化的曲线下面积(AUC)为0.927,诊断阈值为2.338时约登指数最大,敏感度、特异度分别为91.6%、82.3%,明显优于LFI、APRI、FIB-4单独诊断。结论RTE技术联合APRI、FIB-4对慢性乙型肝炎所致显著肝纤维化有较高的诊断价值。

Objective To discuss the diagnostic value of real-time tissue elastography(RTE)combined with aspartate aminotransferase-to-platelet ratio index(APRI)and Fibrosis index based on the 4 factor(FIB-4)for significant liver fibrosis caused by chronic hepatitis B.Methods All 128 patients with chronic hepatitis B underwent RTE examination,serum biochemical tests,and liver aspiration biopsy.Spearman correlation analysis was used to examine the correlation between liver fibrosis index(LFI),APRI,FIB-4 and pathological stages of liver fibrosis.Multivariate Logistic regression analysis was conducted on the three noninvasive diagnostic data to build a combined diagnostic model.The diagnostic efficacy of the combined diagnostic model with LFI,APRI,and FIB-4 alone was analyzed by plotting the subject operating characteristic(ROC)curve using liver fibrosis≥S2(significant liver fibrosis)as a positive criterion.Results The results of pathological staging of liver aspiration biopsy showed that among 128 patients with chronic hepatitis B,21 cases were in stage S0,28 cases in stage S1,35 cases in stage S2,26 cases in stage S3,and 18 cases in stage S4.Spearman correlation analysis showed that LFI,APRI,FIB-4 were positively correlated with the pathological stages of liver fibrosis(r=0.834,0.426,0.374;P<0.05).The ROC curve was plotted using liver fibrosis≥S2(significant liver fibrosis)as a positive criterion,and the results showed that the area under the curve(AUC)of the combined diagnostic model for the diagnosis of significant liver fibrosis was 0.927.The Jorden index was the largest when the diagnostic threshold was 2.338,and the sensitivity and specificity were 91.6%and 82.3%,respectively,which were significantly better than those of LFI,APRI and FIB-4 alone.Conclusion RTE combined with APRI and FIB-4 are of great value in the diagnosis of significant liver fibrosis caused by chronic hepatitis B.