采用FibroScan和天冬氨酸转氨酶与血小板比值指数评估慢性乙型肝炎患者肝纤维化程度  

Clinical study on the liver stiffness value measured by FibroScan and aspartate transaminase-to-platelet ratio index for evaluation of hepatic fibrosis in patients with chronic hepatitis B

作　　者：丁荣蓉[1] 陆伟[1] 王雁冰[1] 周新兰[1] 李秀芳 黄丹[1] 张占卿[1] 施光峰 

机构地区：[1]上海市公共卫生临床中心肝炎二科,201508 [2]复旦大学附属华山医院感染科

出　　处：《中华传染病杂志》2017年第8期467-471,共5页Chinese Journal of Infectious Diseases

摘　　要：目的探讨肝脏硬度值（LSM）和AST与血小板比值指数（APRI）评估ALT≤5×正常值上限（uLN）的cHB患者肝纤维化程度的临床应用价值。方法对383例ALT≤5×ULN的CHB患者肝脏活组织检查前一天或当天行FibroScan检查，以及血常规、肝脏生物化学指标检测，依据Scheuer方法进行肝组织病理学评价，并计算APRI。以肝组织病理结果为标准，比较LSM值与APRI诊断肝纤维化分期的受试者工作特征（ROC）曲线下面积（AUC）。结果肝纤维化分期（S）0、S1、S2、S3、S4患者的LSM中位值分别为5．10、5．20、6．60、10．10和18．80kPa，APRI中位值分别为0．36、0．38、0．63、0．61及1．27。LSM谭估纤维化≥S2、≥S3、≥S4的Auc分别为0．817、0．891、0．913，APRI分别为0．717、0．7111、0．746；LSM区分≥S2、≥S3、≥S4的界值分别为6．8、8．7、10．9kPa。结论LSM能准确地评估ALT≤5×ULN的CHB患者的肝纤维化程度，其临床应用价值优于APRI。Objective To assess the clinical diagnostic performance of liver stiffness measurement （LSM） and aspartate transaminase （AST）-to-platelet （PLT） ratio index （APRI） for liver fibrosis in chronic hepatitis B （CHB） patients with alanine aminotransferase （ALT） less than or equal to five times of the upper limit of normal （45 X upper limit of normal [ULN]）. Methods FibroScan, blood routine and liver function test were conducted at the day or one day before liver biopsy in 383 CHB patients with ALT~ 5）〈 ULN. The Scheuer scoring system was used for liver histologic assessment. APRI was calculated. Based on the results of liver pathology, the areas under receiver operating characteristic curve （AUC） of LSM and APRI for diagnosis of liver fibrosis stage were compared. Results The median LSM were 5.10 kPa for SO fibrosis stage, 5.20 kPa for S1, 6.60 kPa for ≥2, 10.10 kPa for ≥3, and 18.80 kPa for ≥4. The median APRI values were 0.36, 0.38, 0.63, 0.61 and 1.27, respectively. The AUC of LSM were 0. 817 for ≥2, 0. 891 for ≥3 and 0. 913 for ≥4. And the AUC of APRI were 0. 717 for ≥2, 0. 711 for ~S3 and 0. 746 for≥4. The cut-offs of LSM values were 6.8 kPa for ≥S2, 8.7 kPa for ≥3, and 10.9 kPa for ≥4. Conclusion LSM can accurately assess the degree of liver fibrosis in CHB patients with ALT 45 × ULN, which is superior to APRI in clinical utility.

关 键 词：肝炎 乙型 慢性 肝硬度值 AST与血小板比值指数 肝纤维化 

分 类 号：R512.62[医药卫生—内科学]