Fibroscan诊断早期乙型肝炎相关肝细胞癌的价值分析

Value of transient elastography(Fibroscan)in diagnosis of hepatitis B related hepatocellular carcinoma

目的早期诊断对提高原发性肝癌患者生存率尤为关键,本研究旨在探讨肝脏瞬时弹性硬度检查(Fibroscan)诊断早期乙型肝炎(简称乙肝)相关肝癌的临床价值。方法选取156例慢性乙肝患者,分为肝癌组(51例)和非肝癌组(105例),收集所有研究对象的临床资料及相关实验室检查结果,并采用Fibroscan测定肝硬度值(LS),分析肝癌的高危因素、LS评价肝纤维化的临床价值。结果肝癌家族史、HBV-DNA水平(log10>5 IU/ml)、AFP水平(>400 mg/L)、高LS值(>13 k Pa)是肝癌发生的危险因素(均P<0.05)。当LS诊断界值为13 k Pa时,Fibroscan诊断肝癌的灵敏度和特异度分别为82.35%、78.09%;当LS诊断界值为18 k Pa,Fibroscan诊断肝癌的灵敏度下降(62.75%),特异度升高(88.57%)。结论 LS和慢性乙肝患者发生肝癌的风险密切相关,Fibroscan作为一种无创预测肝癌的方式,在肝癌早期诊断中有积极意义。

Objective To explore the significance of Fibroscan on early diagnosis of hepatitis B related hepatocellular carcinoma because early diagnosis is especially important to improve survival rate of patients with primary liver cancer. Method A total of 156 chronic hepatitis B patients were included.All patients were divided into hepatocellular carcinoma group(51 cases) and non cancer group(105 cases). The clinical data of all subjects and lab examination results were collected. Liver stiffness value(LS) was measured by Fibroscan. The risk factors of hepatocellular carcinoma(HCC) and the clinical value of LS in the assessment of liver fibrosis were analyzed. Results Familial history of HCC,HBV-DNA level(log10>5 IU/ml), serum AFP level(>400 mg/L), high LS value(>13 k Pa)were risk factors for HCC(all P<0.05). When LS=13 k Pa was adopted as the cutoff value for HCC, the sensitivity and specificity was 82.35%, 78.09%, respectively. When LS=18 k Pa was adopted as the cutoff value, the sensitivity was declined(62.75%), but the specificity was increased(88.57%). Conclusion LS is closely related with risk of hepatocellular carcinoma in patients with chronic HBV, so Fibroscan has positive significance in the early diagnosis of liver cance as a noninvasive prediction.