瞬时弹性成像对慢性乙肝肝纤维化诊断的研究  

Study of FibroScan on Diagnosis of Liver Fibrosis in Patients with Chronic Hepatitis B

作　　者：徐燕[1] 李桂明[1] 薛芳[1] 冯艳玲[1] 施裕新[1] 

机构地区：[1]上海市公共卫生临床中心医学影像科,上海201508

出　　处：《现代生物医学进展》2014年第7期1279-1282,1290,共5页Progress in Modern Biomedicine

基　　金：中国肝炎防治基金会王宝恩肝纤维化研究基金(20100039)

摘　　要：目的:探讨瞬时弹性成像(FibroScan)诊断慢性乙型肝炎肝纤维化的准确性。方法:选取慢性乙型肝炎患者289例,其中未做病理组198例,病理组91例,正常对照50例,病理组患者行病理肝纤维化检测,未做病理组患者检查B超,全部患者及正常对照应用FibroScan进行肝脏硬度检测(liver stiffness measurement,LSM)值测量。分析未做病理组慢乙肝组与正常对照组间及未做病理组慢乙肝组B超肝纤维化各级间LSM值的差异;病理慢乙肝组采用受试者工作特征(Receiver Operating haracteristic,ROC)曲线分析FibroScan诊断肝纤维化的准确性,并得出各期诊断界值;根据该诊断界值对未做病理慢乙肝组进行FibroScan肝纤维化分期,分析其与B超肝纤维化分级的一致性。结果:LSM值在未做病理慢乙肝组和正常对照组间及B超肝纤维化各级间差别显著(P<0.05);其中病理组统计结果显示F1、F2、F3、F4期肝纤维化的ROC曲线下面积(Area under Receiver Operating Characteristic,AUROC)分别为0.726、0.847、0.806、0.864,诊断界值分别为6.5、7.4、10.1、17.0 kPa,敏感性分别为69.62%、68.33%、66.67%、72.22%,特异性分别为66.67%、87.10%、85.71%、91.78%;肝纤维化的FibroScan分期和B超分级具有一致性(Kappa值=0.366,P<0.05)。结论:FibroScan对慢性乙型肝炎肝纤维化尤其是严重肝纤维化及肝硬化诊断准确性高,具有良好的临床应用价值。Objective： To explore the accuracy of transient elastography （FibroScan） for the detection of liver fibrosis. Methods： A total of 289 patients diagnosed with chronic hepatitis B were involved in the study, non-pathology group （198 subjects）, pathology group （91 subjects） and the control group（50 subjects）. Pathology group were subjected to liver biopsy, Non-pathology group were examined by B-ultraosound,meanwhile, FibroScan was used for liver stiffness measurement （LSM） of everyone. The differences of LSM between control group and non-pathology group and LSM differences between B-ultrasound liver fibrosis levels of non-pathology were analyzed. In pathology group, the Receive Operating Characteristic （ROC） curve was adopted to analyze the accuracy of FibroScan for diagnosing liver fibrosis and the diagnostic cutoffs were counted. Liver fibrosis levels of non-pathology group were staged by cutoffs above and also classified by B-ultrosound, the consistency of them was analyzed. Results： LSM differences between control group and non-pathology group and that between B-ultraosound liver fibrosis levels of non-pathology were significantly different （P〈0.05）. The statistical results pathology group show that the areas under the ROC curve were 0.726, 0.847, 0.806, 0.864 for patients with fibrosis F1, F2, F3, F4, the cutoff values were 6.5, 7.4,10.1,17.0 kPa, the sensitivities were 69.62%, 68.33 %, 66.67 %, 72.22 %, the specificities were 66.67 %, 87.10 %, 85.71%, 91.78 %. Liver fibrosis staged by FibroScan was consistent with that classified B-ultrosound （Kappa=0.366, P〈0.05）. Conclusions： The diagnosis of liver fibrosis of chronic hepatitis B especially severe fibrosis and cirrhosis by FibroScan has high accuracy. FibroScan is valuable for clinic application.

关 键 词：慢性乙型肝炎 肝纤维化 瞬时弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]