四种方法诊断慢性乙型肝炎合并轻度肝脂肪变患者肝纤维化比较  

Diagnostic efficacy of FibroScan and three diagnostic models in diagnosis of liver fibrosis in chronic hepatitis B patients with mild hepatic steatosis

作　　者：张舰琼 徐亮[2] 李萍[2] 刘勇钢[2] 石瑞芳[2] 宓余强[2] 

机构地区：[1]天津医科大学研究生院,天津市300070 [2]天津市第二人民医院天津市肝病研究所

出　　处：《实用肝脏病杂志》2016年第6期663-668,共6页Journal of Practical Hepatology

基　　金：国家重点基础研究发展计划项目973计划(编号:2012CB517501);天津市卫计委中医中西医结合课题(编号:2015061)

摘　　要：目的比较血清学诊断模型APRI、FIB-4和Forns指数及Fibro Scan检查评估合并轻度肝脂肪变的CHB患者肝纤维化的价值。方法在309例经肝活检病理学检查确诊的CHB患者中,194例无肝脂肪变,115例合并轻度肝脂肪变,同期行Fibro Scan检查,得到肝硬度值(LSM),收集实验室检查指标,根据公式计算出相应的APRI、FIB-4、Forns指数。以肝组织病理学表现为金标准,根据受试者工作曲线(ROC)评价4种方法诊断两组患者肝纤维化的效能。结果两组患者LSM、APRI、FIB-4、Forns指数差异均无统计学意义(P均>0.05);在未合并肝脂肪变组,LSM、APRI、FIB-4、Forns指数诊断CHB患者明显肝纤维化(≥F2)的ROC曲线下面积(AUROC)分别为0.77、0.69、0.72、0.69(P均<0.05),其相应的截断点分别为10.2、0.5、0.9、5.3;诊断肝硬化(≥F4)时,其AUROC分别为0.86、0.72、0.77、0.77(P均<0.05),其相应的截断点分别为11.8、0.6、1.3、5.1;在合并肝脂肪变组,它们诊断CHB患者≥F2肝纤维化的AUROC分别为0.79、0.67、0.74、0.77(P均<0.05),其相应的截断点分别为9.7、0.4、1.1、5.7;诊断≥F4的AUROC分别为0.88、0.71、0.75、0.78(P均<0.05),其相应的截断点分别为11.8、1.1、1.5、5.4;APRI和FIB-4不能诊断两组患者轻度肝纤维化(P>0.05);LSM诊断两组≥F2肝纤维化及≥F3或≥F4进展性肝纤维化或肝硬化的效能均优于APRI。结论 APRI评价合并轻度肝脂肪变的CHB患者肝纤维化效能较差,而LSM、FIB-4、Forns指数诊断效能较好,其中轻度肝脂肪变可能影响Forns指数诊断CHB患者肝纤维化效能。Objective To compare the efficacy of serological diagnosis model （APRI,FIB-4,Forns index） and Transient elastography （FibroScan） in evaluation of liver fibrosis in chronic hepatitis B （CHB） patients with mild hepatic steatosis. Methods Three hundred and nine patients with CHB proven by liver biopsy were recruited in this study. Out of them,194 had no,and 115 had hepatic steatosis. All patients with CHB were checked-up by FibroScan to get the liver stiffness measurement （LSM）,and we collected the laboratory indexes to calculate the APRI,FIB-4 and Forns index. We evaluated the efficacies of the four methods in diagnosis of liver fibrosis based on liver biopsy as the gold standard. Results The differences of LSM,APRI,FIB-4,Forns index in patients with and without liver steatosis were not statistically significant （all P〉0.05）;The area under the ROC curve （AUROC） of LSM,APRI,FIB-4 and Forns index for the diagnosis of obvious liver fibrosis （≥F2） in CHB patients without hepatic steatosis were 0.77,0.69,0.72 and 0.69 （all P 〈0.05）,and its corresponding cut-off-values were 10.2,0.5,0.9 and 5.3;the AUROC for the diagnosis of liver cirrhosis（≥F4） were 0.86,0.72,0.77 and 0.77 （all P〈0.05）,and its corresponding cut-off-value were 11.8,0.6,1.3 and 5.1;The AUROC of LSM,APRI,FIB -4 and Forns index for the diagnosis of obvious liver fibrosis （≥F2） in CHB patients with mild hepatic steatosis were 0.79,0.67,0.74 and 0.77 （all P 〈0.05） and its corresponding cut-off-valures were 9.7,0.4,1.1 and5.4;the AUROC for the diagnosis of liver cirrhosis （≥F4） were 0.88,0.71, 0.75 and 0.78 （all P〈0.05）,and its corresponding cut-off-values were 11.8,1.1,1.5 and 5.4;The APRI and FIB-4 didn’t find light hepatic fibrosis in the two groups （P〉0.05;The efficacy of LSM for the diagnosis of hepatic fibrosis was superior to APRI. Conclusions The APRI assessment for the liver fibrosis in patients with CHB with mild liver steatosis is poor,while the LSM,FIB-4 and Forns index

关 键 词：慢性乙型肝炎 肝脂肪变 肝纤维化 诊断 

分 类 号：R512.62[医药卫生—内科学] R575[医药卫生—临床医学]