Fibro Touch瞬时弹性成像诊断慢性乙型肝炎合并肝癌患者肝纤维化程度应用研究  

Value of transient elastography measured with Fibro Touch in the diagnosis of liver fibrosis in chronic hepatitis patients with hepatocellular carcinoma

作　　者：雷洁雯 谭碧波[1] 李万斌[1] 陈燕[1] 郭佳[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院超声科,上海200438

出　　处：《临床军医杂志》2017年第9期930-933,共4页Clinical Journal of Medical Officers

基　　金：上海市科委引导类科技项目(14411960402)

摘　　要：目的探讨Fibro Touch瞬时弹性成像技术在诊断慢性乙型肝炎合并肝癌患者肝纤维化程度中的应用价值。方法选取2015年5—8月第二军医大学附属东方肝胆外科医院收治的慢性乙型肝炎合并肝癌患者446例,其中,测试组288例,验证组158例。所有患者均根据病理标准诊断肝纤维化程度(S0~S4期);同时,术前接受Fibro Touch瞬时弹性成像检查,采用受试者工作特征曲线(ROC)评价Fibro Touch瞬时弹性成像技术诊断慢性乙型肝炎合并肝癌患者肝纤维化程度的敏感度与特异度。结果根据病理标准诊断,测试组患者中,肝纤维化程度S0期35例,S1期47例,S2期83例,S3期37例,S4期86例;验证组患者中,S0期27例,S1期18例,S2期45例,S3期16例,S4期53例。根据Fibro Touch瞬时弹性成像诊断,测试组中,无或轻度肝纤维化(S0/S1期)、明显肝纤维化(S2/S3/S4期)、严重肝纤维化(S3/S4期)及肝硬化(S4期)的ROC曲线下面积分别为0.89(95%可信区间0.85~0.93),0.86(95%可信区间0.82~0.90),0.84(95%可信区间0.80~0.88)及0.85(95%可信区间0.81~0.89);验证组中,则分别为0.94(95%可信区间0.90~0.97),0.91(95%可信区间0.86~0.95),0.87(95%可信区间0.81~0.92)及0.86(95%可信区间0.79~0.91)。测试组诊断≥S1期的敏感度与特异度分别为88.14(95%可信区间83.5~91.9)与77.14(95%可信区间59.9~89.6),验证组分别为84.96(95%可信区间77.7~90.6)与81.48(95%可信区间61.9~93.7);测试组诊断≥S2期的敏感度与特异度分别为82.04(95%可信区间76.1~87.0)与69.51(95%可信区间58.4~79.2),验证组分别为78.07(95%可信区间69.4~85.3)与86.96(95%可信区间73.7~95.1);测试组诊断≥S3期的敏感度与特异度分别为82.11(95%可信区间74.2~88.4)与66.06(95%可信区间58.3~73.2),验证组分别为79.71(95%可信区间68.3~88.4)与79.12(95%可信区间69.3~86.9);测试组诊断=S4期的敏感度与特异度分别为76.74(95%可信区间66.4~85.2)与72.28(95%可信区间65.6~78.3),验证组分别为71.70(95%可信区间57Objective To investigate the application value of Fibro Touch transient elastography（TE） in the diagnosis of liver fibrosis in chronic hepatitis（CH） patients with hepatocellular carcinoma.Methods A retrospective study was performed on 446 cases of CH patients combined with hepatocellular carcinoma.All the patients were divided into the index cohort（n=288） and the validated cohort（n=158）.All patients were diagnosed with hepatic fibrosis by pathological criteria（S0 to S4）.At the same time,preoperative Fibro Touch TE imaging was performed,ROC evaluation was used to detect Fibro Touch TE imaging diagnosis of liver fibrosis degree of sensitivity and specific degrees of chronic hepatitis B with liver cancer patients.Results According to the liver fibrosis grading criterion,index cohort included S0（n=35）,S1（n=47）,S2（n=83）,S3（n=37） and S4（n=86）; the validated cohort includes S0（n=27）,S1（n=18）,S2（n=45）,S3（n=16） and S4（n=53）.According to the diagnosis of Fibro Touch TE imaging,in the index cohort,the area under ROC curve of non or mild liver fibrosis（S0/S1）,significant liver fibrosis（S2/S3/S4）,severe liver fibrosis（S3/S4） and liver cirrhosis（S4） were 0.89（95% CI 0.85 to 0.93）,0.86（95% CI 0.82 to 0.90）,0.84（95% CI 0.80 to 0.88） and 0.85（95% CI0.81 to 0.89）,respectively; in the validated cohort were 0.94（95% CI 0.90 to 0.97）,0.91（95% CI 0.86 to 0.95）,0.87（95% CI0.81 to 0.92） and 0.86（95% CI 0.79 to 0.91）,respectively.The sensitivity and specificity more than S1 in index cohort was 88.14（95% CI 83.5 to 91.9） and 77.14（95% CI 59.9 to 89.6）,in validated cohort was 84.96（95% CI 77.7 to 90.6） and 81.48（95% CI 61.9 to 93.7）.The sensitivity and specificity more than S2 in index cohort was 82.04（95% CI 76.1 to 87.0） and 69.51（95% CI 58.4 to 79.2）,in validated cohort was 78.07（95% CI 69.4 to 85.3） and 86.96（95% CI 73.7 to 95.1）.The sensitivity and specificity more than S3 in index cohort was 82.1

关 键 词：瞬时弹性成像 肝纤维化 慢性乙型肝炎 肝癌 

分 类 号：R575.2[医药卫生—消化系统]