肝脏瞬时弹性超声在药物性肝损伤患者肝纤维化诊断中的作用  

Validation of transient elastography in assessment of hepatic fibrosis in patients with drug-induced liver injury

作　　者：戴维佳[1] 阮隽[1] 汤伟亮[1] 桂红莲[1] 林兰意[1] 周慧娟[1] 谢青[1] 王晖[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：《中华传染病杂志》2013年第9期529-532,共4页Chinese Journal of Infectious Diseases

基　　金：国家自然科学基金资助项目（81070334）;十二五国家科技重大专项资助项目（2012ZX10005004-002002）;中国肝炎防治基金会王宝恩肝纤维化研究基金;上海市公共卫生优秀学科带头人培养计划（GWDTR201202）

摘　　要：目的探讨肝脏瞬时弹性超声（Fibrosean）在评估药物性肝损伤（DILl）患者肝纤维化程度的价值。方法上海交通大学医学院附属瑞金医院感染科2009年7月至2011年4月临床诊断为DILl患者54例，在肝活组织检查前1周内运用Fibroscan检测肝平均瞬时弹性超声硬度值（Stiffness），并与按照Ishak评分进行纤维化分期的患者肝组织病理检查结果比对，使用Spearman等级相关系数方法进行统计学分析，以肝组织检查病理结果为标准绘制Fibroscan受试者工作特征（ROc）曲线，计算ROC曲线下面积（AUC），并计算相应的诊断界值。结果54例DILl患者中，S0期4例、S1期13例、S2期18例、S3期8例、S4期7例、s5期4例和s6期0例。肝脏纤维化程度与ALT、AST和PLT无明显的统计学关联，而与碱性磷酸酶和TBil水平呈正相关。诊断为DILI患者的肝脏纤维化sO～s5的Stiffness值分别为（6．23±1．78）、（7．24±2．86）、（8．80±5．21）、（20．36±8．73）、（23．14±12．85）和（36．60土30．87）kPa。Stiffness值与其肝纤维化分期呈显著正相关（r=0．633，P〈0．01）。以Stiffness值13．25kPa作为中重度肝纤维化的诊断界值，AUC为0．954，灵敏度为84．2％，特异度为94．3％，阳性预测值为88．89％，阴性预测值为91．67％。结论Fibroscan可将DILI患者无或轻度肝脏纤维化与中重度纤维化较好地予以区分。[Abstract] Objective To validate transient elastography （Fibroscan） in assessment of hepatic fibrosis in patients with drug-induced liver injury （DILI）. Methods Liver stiffness was assessed by Fibroscan in totally 54 patients who had been clinically diagnosed with DIM and reconfirmed by liver biopsy within a week in Ruijin Hospital, Shanghai Jiaotong University School of Medicine between Jul 2009 and Apr 2011. Liver stiffness result was compared with Ishak fibrosis score of liver biopsy in each patient. Spearman rank correlation was performed and area under receiver operating characteristic curve （AUC） was used to analyze the accuracy rate and diagnostic cut off of liver stiffness for fibrosis and cirrhosis. Results Among the 54 DILl patients, 4 patients were staged SO, 13 were staged $1, 18 were staged $2, 8 were staged $3, 7 were staged $4, 4 were staged $5, and none was staged $6 by Ishak fibrosis score. Fibrosis stage was not associated with alanine transaminase （ALT）, aspartate aminotransferase （AST） and platelet （PLT） levels, but was positively correlated with alkaline phosphatase （ALP） and total bilirubin （TBil） levels. Average liver stiffness of patients in each stage （SO to $5） was （6.23±1.78）, （7.24±2.86）, （8.80±5.21）, （20.36±8.73）, （23.14＋±12.85） and （36.60± 30.87） kPa, accordingly. Liver stiffness values were positively correlated with stages of liver fibrosis （r=0. 633, P〈0.01）. When taking the stiffness value of 13.25 kPa as a cut-off for moderate and advanced fibrosis （Ishak fibrosis stage of 3 or above）, the AUC was 0. 954, with 84. 2% of sensitivity and 94. 3% of specificity. The positive predictive value was 88. 89% , and the negative predictive value was 91.67% . Conclusions Fibroscan is able to distinguish patients with no or mild liver fibrosis from those with moderate or advanced fibrosis in DILL

关 键 词：肝炎 中毒性 超声检查 肝硬化 

分 类 号：R575.2[医药卫生—消化系统]