FibroScan评判中医药抗肝纤维化疗效的价值  

Performance of FlbroScan in evaluating the curative effects of traditional Chinese medicine on liver fibro~

作　　者：林利静[1] 陈高峰[1] 顾宏图[1] 周扬[1] 袁继丽[1] 邢枫[1] 赵长青[1] 徐列明[1] 

机构地区：[1]上海中医药大学肝病研究所上海中医药大学附属曙光医院,201203

出　　处：《中华肝脏病杂志》2014年第2期113-117,共5页Chinese Journal of Hepatology

基　　金：国家重点基础研究发展计划项目（2006CB504800）;上海市教育委员会重点学科（第五期）建设项目（J50307）,上海市高校E-研究院项目（E03008）

摘　　要：目的评价FibroScan评判中医药抗肝纤维化疗效的价值，并探讨多种因素对肝脏弹性值（LSM）变化的影响。方法收集102例接受2次检查的慢性肝病患者的LSM、发病原因、用药情况及2次FibroSan检查时间点前后1个月内的肝功能和凝血各项指标。组内前后比较用配对t检验，两组组间比较用独立样本t检验，多组间比较用方差分析、Q检验、非参数检验用秩和检验或X。检验、Fisher精确检验。结果无明显肝纤维化组、肝纤维化组LSM下降或上升的幅度≥2kPa时，肝硬化组LSM下降或上升的幅度≥4kPa时，前后LSM均数比较，差异有统计学意义。以上述标准统计，治疗后纤维化程度不变及减轻者，联合用药组为78．8％（26／33）、扶正化瘀方组为90．7％（49／54），其他用药组为60．0％（9／15），3组间疗效差异有统计学意义俨=0．018），两两比较结果显示，扶正化瘀方组与其他用药组组间差异有统计学意义（ p=0．010）。在总体患者和LSM升高的患者中，肝功能各项指标和凝血指标差异均无统计学意义p值均〉O．05）。而在LSM下降的患者中，ALT、AST和谷氨酰转肽酶活性下降，且和第1次检查相比，差异有统计学意义。结论Fibro~_an可作为一种无创方法，参与慢性肝病综合疗效评判。其评判肝纤维化疗效的标准：无明显肝纤维化、肝纤维化及肝硬化患者的LSM变化值宜分别设为2kPa、2kPa及4kPa。且FibroScan评判抗肝纤维化疗效未受到ALT、AST、Y一谷氨酰转移酶和凝血酶原时间、国际标准化比值的明显影响。Objective To assess the performance of FibroScan in evaluating the curative effects of traditional Chinese medicine （TCM） on liver fibrosis, and to analyze factors influencing the diagnostic accuracy. Methods Data of FibroScan values, types of disease, use of drug, liver function indexes, prothrombin time （PT） and international normalized ratio （INR） were collected at both pre- （1 month prior） and post-FibroScan for 102 patients who underwent at least two FibroScan procedures. Patients were subgrouped according to presence of fibrosis, presence of cirrhosis, and TCM formulation and statistically analyzed. ResuRs The pre- and post-FibroScan mean liver stiffness measurements （LSMs） were significantly different when the variation of LSM was 〉/2 Ida for the non-fibrotic group （vs. the fibrotic group）, or when the variation was /〉 4 Ida for the cirrhotic group （vs. the non-cirrhotic group）. In addition, the three TCM formulation groups showed significant differences, with the most robust difference exhibited between the FuZheng HuaYu formulation group and the other treatment groups （1~ = 0.010）. No significant differences were observed for the liver function indexes, PT, or INR. However, the oost-FibroScan levels ofalanine aminotmmferase （ALT）, aspartate aminotransfcrase （AST）, and （C^T） was significantly reduced in patients with reduced LSM. Conclusion FibroScan may be a useful non-invasive clinical tool for evaluating the comprehensive curative effect of treatments for chronic liver diseases, and its performance is not obviously impacted by ALT, AST, GGT, PT, and INR. The criteria for efficacy established by FibroScan are 2 kPa for the patients without liver fibrosis and 4 kPa for patients with liver cirrhosis.

关 键 词：肝硬化 弹性成像技术 疗效评判 

分 类 号：R259[医药卫生—中西医结合]