LSM值与APRI评估慢性肝病肝纤维化程度的临床研究  

Clinical study on LSM value and APRI for assessment of hepatic fibrosis in chronic liver disease

作　　者：高蕾[1] 王银玲[1] 汪茂荣[1] 张馨[1] 王耀峰[1] 王寿明[1] 

机构地区：[1]解放军第81医院全军肝病中心,江苏南京210002

出　　处：《东南大学学报（医学版）》2011年第4期541-544,共4页Journal of Southeast University(Medical Science Edition)

基　　金：南京军区医药卫生科研基金资助项目(07M037)

摘　　要：目的:探讨肝脏硬度测定(LSM)值、天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值指数(APR I)用于评估慢性肝病肝纤维化程度的临床应用价值。方法:对94例慢性肝病患者肝活检当日或前一日作血常规、肝功能检测与瞬时弹性扫描(FS)检查。以肝活检结果为标准,比较LSM值与ARPI评估肝纤维化程度的接受者操作特征(ROC)曲线下面积(AUC),并比较相应的截断点值及其灵敏度和特异度。结果:应用LSM值与APR I区分显著肝纤维化(S≥2)的截断点分别为8.10 kPa、0.45,对应的AUC分别为0.85、0.67;两者区分早期肝硬化(S≥3)和肝硬化(S=4)的截断点分别为9.80 kPa、0.98与13.10 kPa、0.98,对应的AUC分别为0.96、0.66与0.97、0.72。在测定结果与肝纤维化程度相关性上,LSM值(r=0.64,P<0.05)比APR I(r=0.42,P<0.05)更明显。结论:应用LSM值和APR I评估慢性肝病肝纤维化程度时,以LSM值反映更为准确。Objective： To use liver stiffness measurement（LSM） value and aspartate aminotransferase-to-platelet ratio index（APRI） to evaluate the fibrosis in patients with chronic liver diseases and to compare the results with those of liver biopsies as the reference standard.Methods： Ninety four hospitalized patients with chronic liver diseases underwent FibroScan,blood count,liver function tests,as well as liver biopsies on the same day or following next day between April 2009 and March 2010.Referring to the histologic fibrosis stage on liver biopsy,all the LSM value and the calculated APRI were assessed by using receiver operating characteristic（ROC） analysis.The corresponding cut-off values,sensitivity and specificity were also calculated and compared.Results： Cut-off points of LSM and ARPI were 8.10 kPa and 0.45 for S of 2 or greater,9.80 and 0.98 for S of 3 or greater,13.10 kPa and 0.98 for S of 4,respectively.Accordingly,the areas under the ROC curves（AUC） for LSM and ARPI were 0.85 and 0.67 for S of 2 or greater,0.96 and 0.66 for S of 3 or greater,0.97 and 0.72 for S of 4,respectively.LSM（r=0.64,P0.05）had a better correlation than ARPI（r=0.42,P0.05）.Conclusion： Both of LSM and APRI are not invasive,LSM is more accurate when applied to evaluate liver fibrosis in patients with chronic liver diseases.

关 键 词：慢性肝病 肝纤维化 肝脏硬度测定值 天门冬氨酸氨基转移酶与血小板比值指数 

分 类 号：R575.2[医药卫生—消化系统]