核素首次通过法测定肝动脉血流指数预测日本血吸虫病肝纤维化程度?  

Hepatic artery blood flow index measured by nuclide first pass method in prediction of the degree of liver fibrosis induced by Schistosoma japonicum

作　　者：吴一鸣 高树兴 殷新光 WU Yi-ming;GAO Shu-xing;YIN Xin-guang(Institute of Hepatology,Jiaxing First Hospital,Jiaxing 314000,Zhejiang Province,China)

机构地区：[1]嘉兴市第一医院肝病研究所,浙江嘉兴314000

出　　处：《中国肝脏病杂志（电子版）》2018年第2期49-54,共6页Chinese Journal of Liver Diseases：Electronic Version

基　　金：浙江省嘉兴市科技局资助项目(2014AY21030)

摘　　要：目的通过核素首次通过法测定肝动脉血流指数(hepatic artery blood flow index,HBI)预测日本血吸虫病肝纤维化程度。方法选取67例日本血吸虫病患者为研究对象,采用METAVIR评分系统评估纤维化程度。静脉注射二磷酸锝^(99)(^(99m)Tc-MDP)后,即刻采用首次通过法测定肝血流指数。采用受试者操作特征曲线下面积(area under receivers operating characteristic curve,AUROC)衡量肝血流指数预测肝纤维化的价值。结果肝血流指数与肝纤维化程度呈正相关(r=0.717,P<0.001)。肝血流指数预测显著肝纤维化的AUROC为0.916(95%CI:0.844~0.987,P<0.001),截止点为32.77时,敏感性为87.5%,特异性为62.5%,阳性预测值(positive predictive value,PPV)为70.0%,阴性预测值(negative predictive value,NPV)为83.3%。血流指数预测严重肝硬化的AUROC为0.832(95%CI:0.729~0.935,P<0.001),截止点为40.70时,敏感性为96.3%,特异性为58.8%,PPV为70.0%,NPV为96.5%。结论核素首次通过法测定肝动脉血流指数是一种新型评估日本血吸虫病肝纤维化程度的方法,有助于判断预后。Objective To predict the degree of liver fibrosis induced by Schistosoma japonicum according to hepatic artery blood flow index(HBI)measured by nuclide first pass method.Methods Total of 67 patients with Schistosomiasis japonicum were selected.The degree of liver fibrosis was assessed by METAVIR scoring system.HBI was measured by injection of nuclear isotope technetium-99-methylene diphosphate(99mTc-MDP).The area under the receiver’s operating characteristic curve(AUROC)was used to measure the diagnostic value.Results There was a positive correlation between hepatic blood flow index and the degree of liver fibrosis(r=0.717,P<0.001).The AUROC of hepatic blood flow index in predicting significant liver fibrosis was 0.916(95%CI:0.844~0.987,P<0.001),the cut-off value was 32.77,the sensitivity was 87.5%,the specificity was 62.5%,the positive predictive value(PPV)was 70.0%and the negative predictive value(NPV)was 83.3%.The AUROC of hepatic blood flow index in predicting severe liver cirrhosis was 0.832(95%CI:0.729~0.935,P<0.001),the cut-off value was 40.70,the sensitivity was 96.3%,the specificity was 58.8%,the PPV was 70.0%and the NPV was 96.5%.Conclusion HBI is a novel diagnostic tool for the assessment of liver fibrosis and is helpful for predicting prognosis.

关 键 词：肝纤维化 首次通过法 肝动脉血流指数 同位素 

分 类 号：R532.21[医药卫生—内科学] R575.2[医药卫生—临床医学]