RTE、FIB-4、APRI对乙型肝炎患者肝纤维化的诊断价值比较  

Comparison of diagnostic values of RTE,FIB-4 and APRI in liver fibrosis of hepatitis B patients

作　　者：沈伟[1,2] 郑梦琳[2] 郭佳[2] 

机构地区：[1]中国人民解放军第五四六医院特诊科,新疆马兰841700 [2]第二军医大学附属东方肝胆外科医院超声科,上海200438

出　　处：《检验医学与临床》2017年第5期637-639,642,共4页Laboratory Medicine and Clinic

摘　　要：目的比较实时组织超声弹性成像技术(RTE)与血清学诊断指标[天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的肝纤维化指标(FIB-4)]诊断肝纤维化的价值。方法选取行肝切除手术或肝穿刺活检术住院患者104例,比较术前肝纤维化指数(LF index)、FIB-4、APRI与肝组织病理分期的相关性,分别绘制受试者工作特征(ROC)曲线,比较3种无创方法对不同阶段肝纤维化的诊断效能。结果 LF index、FIB-4、APRI值与肝纤维化病理分期均呈显著正相关(P<0.01),LF index诊断显著肝纤维化期(≥S2期)、进展期肝纤维化期(≥S3期)及早期肝硬化期(S4期)的ROC曲线下面积分别为0.833、0.940、0.907,显著高于APRI(0.681,0.651,0.714),差异均有统计学意义(P<0.05)。LF index诊断≥S3期的ROC曲线的下面积显著高于FIB-4(0.822),差异有统计学意义(P<0.05)。结论 RTE诊断乙型肝炎肝纤维化,特别是进展期肝纤维化具有较高的诊断价值,可应用于临床替代部分肝活检。Objective To compare the values of real-time ultrasound elastography（RTE）,aspartate aminotransferase and platelet ratio index（APRI）and liver fibrosis index based on factor 4（FIB-4）for diagnosing liver fibrosis（LF）.Methods One hundred and four inpatients undergoing hepatectomy or liver puncture biopsy were selected.The correlations between preoperative LF index,APRI and FIB-4with the pathological stages of liver tissue were compared.The receiver operating characteristic（ROC）curves were drawn for comparing the diagnostic efficiencies of these noninvasive methods in diagnosing different stages of LF.Results The values of LF index,FIB-4and APRI showed significantly positive correlations with the pathological stages of LF（P〈0.01）.The areas under ROC curve（AUROC）of LF index were 0.833 for significant LF（≥S2）,0.940 for advanced LF（≥S3）and 0.907 for early cirrhosis（S4）,which were significantly higher than 0.681,0.651 and 0.714 of APRI,the differences were statistically significant（P〈0.05）.AUROC of LF index for diagnosing advanced LF was significantly higher than that of FIB-4（0.822）,the difference was statistically significant（P〈0.05）.Conclusion RTE has higher diagnostic value for LF of hepatitis and can be applied in clinic for replacing partial liver biopsy.

关 键 词：实时组织超声弹性成像技术 基于4因子的肝纤维化指标 天门冬氨酸氨基转移酶与血小板比值指数 慢性乙型肝炎 肝纤维化 

分 类 号：R512.6[医药卫生—内科学]