Fibroscan联合血清肝纤维化标志物诊断早期肝硬化的研究  

Diagnosis of the early cirrhosis by Fibroscan and serum liver fibrosis markers

作　　者：赵红[1,2] 吕蓓[3] 黄绍萍[2] 樊贞瑜[2] 陆基华[2] 唐荣[2] 殷科珊[2] 张建良[2] 程计林[1,2] 

机构地区：[1]温州医科大学附属第一医院消化科,浙江温州325000 [2]上海市(复旦大学附属)公共卫生临床中心消化科 [3]复旦大学附属中山医院肝癌研究所

出　　处：《胃肠病学和肝病学杂志》2015年第4期447-451,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探索Fibroscan联合血清学肝纤维化标志物检测诊断早期肝硬化的可行性。方法 34例临床诊断为慢性乙型病毒性肝炎(CHB)患者,同时进行Fibroscan、血清肝纤维化标志物、腹部B超检查和肝穿刺活检,并抽样进行胃镜检查,将非创伤性检查的结果与组织病理诊断比较。应用SPSS V17.0统计学软件,将组织病理学诊断为S2、S3、S4期患者的Fibroscan与血清学肝纤维化标志物的检测值分别进行LSD-t检验;计算肝脏弹性值(FS值)、腹部B超检查结果及Fibroscan联合血清学肝纤维化标志物检测值分别与病理诊断的吻合率。结果病理诊断为S2、S3、S4期的患者,其各期的Fibroscan FS值(9.45±4.36、15.27±4.15、23.50±7.69)、血清学肝纤维化标志物HA值(96.49±49.93、180.76±67.40、396.08±97.30)两两相比,差异有统计学意义(P<0.05);但其余的血清学肝纤维化指标检测值显示,S2、S3期之间差异无统计学意义(P>0.05),S3、S4和S2、S4之间相比,差异有统计学意义(P<0.01);Fibroscan与病理诊断S0-1、S2、S3、S4期的吻合率分别为:33.33%、81.82%、37.50%、67.67%;腹部B超诊断基本正常、慢性肝炎和肝硬化的吻合率分别为:16.67%、67.7%和16.67%;Fibroscan联合肝纤维化标志物诊断与病理诊断的吻合率分别为:57.14%、91.67%、57.14%、87.50%。胃镜检查有食管静脉曲张患者的病理诊断均显示S4期,胃镜检查诊断慢性浅表性胃炎者,其病理诊断均为S2期。结论 Fibroscan与血清学肝纤维化标志物(尤其是HA)联合检测有利于提高肝纤维化的早期诊断率。若结合腹部B超和胃镜检查更有利于临床诊疗和预后判断。Objective To explore the feasibility of early diagnosis of cirrhosis by Fibroscan and serum liver fibrosis markers.Methods Thirty-four cases of chronic hepatitis B （CHB） patients were recruited.Each of them was exami-nated by Fibroscan , serum hepatic fibrosis markers , abdominal ultrasonography , and hepatic biopsy .Then 4 samples taken randomly from them were performed gastroscopy .The non-invasive methods were compared with their pathological diagnosis .SPSS V17 .0 LSD-t test was applied to analyze the values of Fibroscan and serum liver fibrosis markers , in the patients’ pathology diagnosises S2, S3, S4 period, respectively.The match rate was calculated that Fibroscan , abdomi-nal B ultrasound and Fibroscan combined with serum liver fibrosis markers matched the pathological diagnosis .Results The values of Fibroscan and HA in the pathological stage S 2, S3, S4 respectively were 9.45 ±4.36, 15.27 ±4.15, 23.50 ±7.69 and 96.49 ±49.93, 180.76 ±67.40, 396.08 ±97.30 （P〈0.05）.There were no significant differ-ences in the values of the other serum liver fibrosis markers （ CG, LN, PⅢP, CⅣ） between the pathological stage of S 2 and S3 （P〉0.05）, however, there were significant differences between the values of the stages S 2, S4 or S3, S4, re-spectively （P 〈0.01）.The match rates of Fibroscan values and histology of S0-1, S2, S3, S4 were 33.33%, 81 .82%, 37 .50%, 67 .67%, respectively .The match rates of almost normal , chronic hepatitis , cirrhosis tested by ab-dominal ultrasonography and pathological stages S 0-1, S2-3, S4 were 16.67%, 67.7%, 16.67%.The match rates of Fibroscan values combining with serum liver fibrosis markers and 4 pathological stages were 57 .14%, 91 .67%, 57.14%, 87.50%;the patients with esophageal and （or） gastric varices were found by gastroscopy , which their hepat-ic pathological examination showed stage S 4; but the gastroscopy hinted the patients with chronic superficial gastritis whose hepatic pathology exhibited S2.Conclusion Fibroscan combining se

关 键 词：肝纤维化 FIBROSCAN 超声检查 血清肝纤维化指标 肝穿刺活检 

分 类 号：R575.2[医药卫生—消化系统]