瞬时弹性成像联合APRI和FIB-4指数模型无创诊断慢性HBV感染者肝纤维化的临床价值  

Diagnostic value of transient elastography( Fibro Touch) combined with APRI and FIB-4 on liver fibrosis in patients with chronic hepatitis B

作　　者：代倩[1] 李晶晶[1] 马双双[1] 郜玉峰[1] 叶珺[1] 邹桂舟[1] 

机构地区：[1]安徽医科大学第二附属医院肝病科,合肥230601

出　　处：《安徽医科大学学报》2017年第3期430-434,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1608085MH164)

摘　　要：目的探讨瞬时弹性成像联合谷草转氨酶/血小板比值(APRI)和FIB-4指数无创诊断慢性乙型肝炎病毒(HBV)感染者肝纤维化程度的临床价值。方法对265例慢性HBV感染者进行肝脏穿刺病理学检查,并于穿刺当日检测患者相关临床指标,应用瞬时弹性成像技术(FibroT ouch)检测肝脏硬度(LSM),根据临床指标分别得出APRI和FIB-4指数结果。以肝脏病理结果为金标准,分别绘制LSM、APRI及FIB-4指数的受试者工作曲线(ROC),评价其对显著纤维化(≥S2)、严重肝纤维化(≥S3)和肝硬化(S=4)的预测价值,并将APRI、FIB-4指数分别与LSM值联合诊断慢性HBV感染者肝脏纤维化程度,并利用联合法计算诊断肝纤维化程度的灵敏度、特异度等。结果随着肝纤维化程度的加重,LSM值(rs=0.622,P<0.001)与肝纤维化分期相关性明显高于APRI及FIB-4指数。在265例患者中,FibroT ouch在诊断慢性HBV感染者显著肝纤维化(≥S2)、严重肝纤维化(≥S3)、肝硬化(S=4)的AUC分别为0.810、0.881、0.961,明显高于APRI和FIB-4相应的ROC曲线下面积。据ROC曲线得出诊断显著肝纤维化(≥S2)、严重肝纤维化(≥S3)、肝硬化(S=4)的FibroT ouch、APRI和FIB-4各自截断值,得出在肝纤维化各分期的诊断中,FibroT ouch特异度及敏感度均高于APRI、FIB-4。同时将FibroT ouch分别与APRI、FIB-4联合诊断,并联诊断可提高诊断的敏感度。其与APRI并联时其敏感度可达到91.11%以上,与FIB-4并联时敏感度亦可明显上升。而串联诊断则可明显提高诊断的特异度,其中FibroT ouch与APRI串联时其特异度可达94.42%以上。结论 FibroT ouch无创诊断肝纤维化的灵敏度及特异度均优于APRI及FIB-4。APRI、FIB-4与FibroT ouch联合诊断肝纤维化的灵敏度及特异度明显优于FibroT ouch、APRI、FIB-4单项指标。Objectives To explore the clinical value of transient elastography （FibroTouch） combined with aspar- tame aminotransferase to platelet ratio index （APRI） and fibrosis index based on the 4 factor （FIB-4） on liver fi- brosis in patients with chronic hepatitis B. Methods The severity of liver fibrosis in 265 chronic hepatitis B pa- tients was assessed by liver biopsy and liver stiffness measurement（LSM） was checked by FibroTouch; routine la- boratory indicators were examined to calculate APRI and FIB4 index. The diagnostic value of FibroTouch, APRI and FIB-4 index in significant fibrosis, advanced fibrosis and cirrhosis were assessed according to the area under the receiver operating characteristic curves （ROC）. APRI and FIB-4 index were combined with LSM to evaluate the liver fibrosis degree of patients with chronic hepatitis B respectively and calculated the sensitivity（ SN）, speci- ficity （SP） et al. Results With the increase of liver fibrosis, the value of LSM （ r=- 0. 622, P 〈 0. 001 ） had high- er correlation than APRI and FIB-4 indexes in liver fibrosis stage. Diagnosis of 265 chronic HBV patients, the area under ROC curve of FibroTouch for significant fibrosis （ ≥S2）, advanced fibrosis （≥S3 ） and cirrhosis （ S = 4 ） were 0. 810, 0. 881 and 0. 961 respectively, which were significantly higher than APRI and FIB-4 index. The cutoff val- ue of FibroTouch, APRI and FIB-4 index in significant fibrosis （ ≥S2）, advanced fibrosis（ ≥S3 ） and cirrhosis （S = 4） were obtained according to the area under the ROC cure. The sensitivity and specificity of FibroTouch on any hepatic fibrosis stage were all better than APRI and FIB-4. FibroTouch was combined with APRI or FIB-4 indexs re- spectively; parallel test improved the sensitivity of diagnosis. The value of sensitivity was more than 91.11% when FibroTouch combined with APRI by the parallel test respectively and the sensitivity also increased obviously when combined with FIB-4. However, the specificity of

关 键 词：瞬时弹性成像 FIB-4 APRI 肝纤维化 无创诊断 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]