利用Mohamadnejad模型和FibroScan诊断HBeAg阴性慢性HBV携带者肝纤维化的临床价值  

Clinical value of diagnosing hepatic fibrosis by Mohamadnejad model and FibroScan in the HBeAg negative chronic hepatitis B virus carriers

作　　者：张孝盈[1] 钱静[1] 侯伟[1] 李萍[1] 宓余强[1] 徐亮[1] 王会清 Zhang Xiaoying, Qian Jing, Hou Wei, Li Ping, Mi Yuqiang, Xu Liang, Wang Huiqing(Department of Traditional Chinese and Western Medical Liver Diseases, Tianfin Second People＇ s Hospital, Tianjin Institute of Hepatology, Tianjin 300192, Chin)

机构地区：[1]天津市第二人民医院天津市肝病医学研究所,300192

出　　处：《中华实验和临床病毒学杂志》2018年第1期70-74,共5页Chinese Journal of Experimental and Clinical Virology

摘　　要：目的 探讨Mohamadnejad肝纤维化模型（M模型）及肝脏瞬时弹性探测仪（fibro scan, FS）诊断乙型肝炎e抗原（hepatitis B e antigen,HBeAg）阴性的慢性乙型肝炎病毒（hepatitis B virus, HBV）携带者肝纤维化的临床价值.方法 共选择217例HBeAg阴性慢性HBV携带者,运用M模型公式计算肝纤维化数值、用FS测定肝硬度（liver stiffness measurements,LSM）值;同期所有患者均进行肝活检,按Knodell肝组织纤维化程度设定显著纤维化（S≥2）为判定点.采用Spearman相关分析法分析指标相关性并绘制出M模型和FS的受试者工作特征曲线面积（area under receiver operator characteristic curve,AUROC）.结果 LSM值及M模型数值与肝活检纤维化分期均呈正相关（r=0.64、0.80,P均=0.000＜0.01）.M模型及FS对于HBeAg阴性慢性HBV携带者显著肝纤维化（S≥2）诊断的阴性预测值（negative predictive value,NPV）、特异性、阳性似然比（positive likelihood ratio, PLR）、敏感度分别为92.50％、93.23％、13.02、88.10％及88.20％、84.21％、5.20、82.14％;诊断显著肝纤维化的AUROC分别为0.927及0.858,差异具有统计学意义（Z =2.12,P＜0.05）.结论 M模型及FS是筛选HBeAg阴性慢性HBV携带者显著肝纤维化无创的、较为理想的工具,且M模型诊断此类患者显著肝纤维化的价值高于FS.Objective To investigate the clinical value of diagnosing hepatic fibrosis in the HBeAg negative chronic hepatitis B virus （HBV） carriers by hepatic fibrosis model of Mohamadnejad （M model） and the hepatic instantaneous elastic detector （FibroScan,FS）.Methods A total of 217 patients were included：they were diagnosed as the HBeAg negative chronic HBV carriers.The value of the hepatic fibrosis was calculated by M model formula,liver stiffness measurements （LSM） was surveyed by FS,and all patients underwent liver biopsy in the same period.According to the degree of hepatic fibrosis in Knodell,one decision point was set：significant hepatic fibrosis （S ≥ 2）.The Spearman correlation analysis method was used to analyze the correlation of indicators and the area under receiver operator characteristic curve （AUROC） of M model and FS was drawn.Results LSM and M model were positively correlated with the fibrosis stage of liver biopsy （r =0.64,0.80,P =O.000,0.000,〈 0.01）.The diagnostic sensitivity,positive likelihood ratio,specificity and negative predictive value of M model and FS for the HBeAg negative chronic HBV carriers with significant hepatic fibrosis were 88.10%,13.02,93.23%,92.50% and 82.14%,5.20,84.21%,88.20%,respectively.The diagnostic AUROC of significant hepatic fibrosis were 0.927 and 0.858,respectively.It had significant statistical difference （Z =2.12,P 〈 0.05）.Conclusions M model and FS are noninvasive and ideal tools for screening HBeAg negative chronic HBV carriers with significant hepatic fibrosis.The value of diagnosing significant hepatic fibrosis in the HBeAg negative chronic HBV carriers by M model was remarkably higher than that of FS.

关 键 词：慢性乙型肝炎病毒携带者 无创诊断 肝活检 

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