FibroTest-ActiTest对慢性乙型肝炎肝纤维化和炎症的诊断价值  

FibroTest-ActiTest for predicting liver fibrosis and inflammatory activity in Chinese patients with chronic hepatitis B

作　　者：桂红莲[1] 谢青[1] 王晖[1] 周惠娟[1] 蔡伟[1] 安宝燕[1] 姜山[1] 许蓓[1] 林之莓[1] 徐玉敏[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《中华肝脏病杂志》2008年第12期897-901,共5页Chinese Journal of Hepatology

基　　金：上海市科委“登山计划”项目（064119521）

摘　　要：目的验证FibroTest—ActiTest（FT—AT）对慢性HBV感染者肝脏纤维化和炎症程度的诊断价值，并分析导致FT和肝活组织检查两者不一致性的原因。方法选择经皮肝穿刺活组织检查的慢性HBV感染患者100例，并当天留取血清做相关生物化学指标检测。以受试者工作特征（ROC）曲线判定诊断价值。结果100份肝组织标本长度为8～30mm（中位数15mm）；可供评价汇管区5～26个（中位数为9个）。所有患者中存在显著纤维化（F3～F6）者39例，显著炎症（A2～A4）者65例。诊断显著炎症（A2～A4）、显著纤维化（F3～F6）和肝硬化（F5～F6）的ROC曲线下面积分别是0．833、0．840和0．862，95％可信区间分别为0．753～0．913、0．750～0．929和0．721～1．003。FT≤0．31以86％阴性预测值排除显著肝纤维化，而FT≥0．72则以92％阳性预测值确诊显著肝纤维化。FT和肝活组织检查结果比较，纤维化存在2级以上差异者有26例；其不一致性：3例归咎于肝活组织检查，7例归咎于FT，16例原因未定。结论FTAT可较准确评估慢性乙型肝炎患者的肝纤维化和炎症状态。当选择合适分界值判定有无显著肝纤维化时，FT可使68％的患者避免肝穿刺，并保证87％的诊断准确率。Objectives To confirm the diagnostic value ofFibroTest-ActiTest （FT-AT） in predicting liver fibrosis and inflammatory activity in patients with chronic hepatitis B （CHB）, and to study the discor- dances between FT and their liver biopsies. Methods A study was performed on 100 patients with CHB who underwent liver biopsies in our hospital. Serum samples for biochemical markers were taken on the day of their biopsies. Diagnostic accuracies were assessed by ROC curve analysis. Results The median biopsy specimen size was 15mm （range： 8-30）, with 9 （median） portal tracts （range 5-26）. Thirty-nine patients were classified as Ishak F3-F6 in fibrosis and 65 patients as A2-A4 in inflammation. Areas under ROC curve for diagnosis of significant inflammation （A2-A4）, significant fibrosis （F3-F6）, and cirrhosis （F5-F6） were 0.833 （95% CI： 0.753-0.913）, 0.840 （0.750-0.929）, and 0.862 （0.721-1.003）, respectively. FT ≤ 0.31 had aNPV of 86% for excluding significant fibrosis, whereas FT≥ 0.72 had a PPV of 92% for predicting significant fibrosis. Among the 26 patients with 2 fibrosis stages of discordances between FT and biopsy, the discordance was attributable to biopsy in 3 cases, to FT in 7, and undetermined in 16. Conclusion This study confirms the diagnostic value of FT-AT and suggests that 68% of our patients with CHB can be reliably identified by FT without a liver biopsy and with a dignosis accuracy of 87%.

关 键 词：肝炎 乙型 慢性 肝纤维化 诊断 无创伤 受试者工作特征曲线 FibroTest-ActiTest 

分 类 号：R512.62[医药卫生—内科学] R373.21[医药卫生—临床医学]