实时组织弹性与血清学诊断肝硬化效能的比较  

Comparison of diagnosis efficacies between real-time tissue elastography and serum markers for liver cirrhosis

作　　者：郑梦琳[1] 沈伟[1] 郭佳[1] 谭碧波[1] 李万斌[1] 雷洁雯 

机构地区：[1]第二军医大学东方肝胆外科医院超声科,上海200438

出　　处：《第二军医大学学报》2015年第9期957-960,共4页Academic Journal of Second Military Medical University

基　　金：上海市科委2014年度医学引导类(中;西医)科技项目(14411960402)~~

摘　　要：目的比较实时组织弹性(real-time tissue elastography,RTE)技术、血清学检验诊断肝硬化的诊断价值,探讨临床非侵入性诊断肝硬化的优效方法。方法回顾性分析我院行肝切除手术或肝穿刺活检术住院患者的临床资料(n=124),收集病理学结果、RTE检查和血清学检验资料。RTE用肝纤维化指数(LFI)表示;血清学检验分为直接指标和间接指标,直接指标为肝脏纤维化四项(肝纤四项),包括透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C);间接指标为天冬氨酸转氨酶与血小板计数的比值(AST-to-platelet ratio index,APRI)。以病理诊断为金标准,绘制ROC曲线比较RTE和血清指标对肝硬化的诊断效能。结果 124例患者中非肝硬化组93例(75.0%),肝硬化组31例(25.0%)。以病理结果作为金标准,HA的诊断敏感度为67.7%,特异度为62.4%,准确度为63.7%;APRI指数的诊断敏感度为80.6%,特异度为49.5%,准确度为58.3%;LFI的诊断敏感度为93.5%,特异度为71.0%,准确度为76.6%。结论 LFI、HA、APRI指数对肝硬化均具有诊断价值,其中RTE测定的LFI诊断效能最高,APRI指数具有较高的敏感度但特异度最低。Objective To compare the diagnosis efficacies between real-time tissue elastography （RTE） technique and serum markers for liver cirrhosis, and to explore non invasive diagnosis methods for liver cirrhosis. Methods The clinic data of 124 patients who underwent liver resection or liver biopsy were analyzed retrospectively. Pathological results, RTE data and tests of serum markers were collected. RTE was expressed by liver fibrosis index （LFI）. Tests of serum markers were divided into direct and indirect indicators. Direct indicators were four liver fibrosis detection （liver fibrosis four）, including hyaluronie acid （HA）, laminin （LN）, typeⅢ procollagen amino peptide （PCⅢ）, and type 1V collagen （IV-C）. Indirect indicators were the ratio of aspartate aminotransferase to platelet （AST-to-platelet ratio index, APRI）. Pathology results served as the gold standard, and diagnostic values of RTE and serum markers for cirrhosis were compared by a receiver operating characteristics （ROC） curve analysis. Results Ninety-three （75. 0%） of the 124 patients had no cirrhosis and 31 （25. 0%） had cirrhosis. With pathological results as the gold standard, the sensitivity of HA was 67.7%, the specificity of HA was 62.4%, and the accuracy of HA was 63. 7% the sensitivity of APRI was 80. 6%, the specificity of APRI was 49. 5%, and the accuracy of APRI was 58.3% and the sensitivity of LFI was 93. 5%, the specificity of LFI was 71.0%, and the accuracy of LFI was 76.6%. Conclusion LFI, HA, and APRI index all have diagnostic values for liver cirrhosis, in which LFI detected by RTE has the highest diagnostic efficacy and ARPI is of high specificity but low sensitivity.

关 键 词：弹性成像技术 肝硬化 诊断 血清学试验 

分 类 号：R575.2[医药卫生—消化系统]