ARFI联合AST/PLT对慢性乙型肝炎肝纤维化程度的诊断价值  

Acoustic radiation force impulse elastography with serum AST/PLT ratio in assess liver fibrosis in patients with chronic hepatitis B

作　　者：张伟 汪明[2] 朱先存[2] 左鲁生[2] 欧广超[2] 张兆昕 ZHANG Wei;WANG Ming;ZHU Xiancun(Graduate School,Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]蚌埠医学院研究生院,233030 [2]中国人民解放军第一二三医院特诊科

出　　处：《浙江医学》2018年第21期2339-2342,共4页Zhejiang Medical Journal

基　　金：原南京军区医学科技创新课题(12MA034)

摘　　要：目的探讨声脉冲辐射力成像技术(ARFI)联合AST/PLT(ARFI+AST/PLT)对慢性乙型肝炎肝纤维化程度的诊断价值。方法对146例慢性乙型肝炎患者进行ARFI检查、血清学分析和超声引导下经皮肝组织穿刺活检术。以肝组织穿刺活检结果为金标准,得出ARFI+AST/PLT的诊断效能,并与ARFI以及血清学诊断模型(APRI、FIB-4)等无创诊断模型进行比较。结果ARFI+AST/PLT、ARFI、APRI、FIB-4与肝纤维化程度均呈正相关(rs=0.74、0.69、0.54和0.57,均P<0.05)。ARFI+AST/PLT诊断显著肝纤维化(≥S2期)、进展期肝纤维化(≥S3期)均优于ARFI、APRI、FIB-4(均P<0.05);诊断肝硬化(S4期)优于APRI、FIB-4(均P<0.05),与ARFI比较差异无统计学意义(P>0.05)。结论 ARFI+AST/PLT诊断慢性乙型肝炎显著肝纤维化及进展期肝纤维化明显优于单独使用ARFI、FIB-4、APRI等无创诊断模型。Objective To explore the diagnostic value of acoustic radiation force impulse(ARFI)elastography with serum AST/PLT ratio(ARFI+AST/PLT)in assessment of liver fibrosis in patients with chronic hepatitis B(CHB).Methods Liver ARFI elastography,serum biochemical tests and ultrasound-guided percutaneous liver biopsy were performed,and AST/PLT ratio,APRI,FIB-4 indexes were calculated in 146 patients with CHB.With the liver biopsy results as the gold standard,the diagnostic values for liver fibrosis of ARFI+AST/PLT,ARFI,APRI and FIB-4 were analyzed and compared.Results ARFI+AST/PLT,ARFI,APRI and FIB-4 were positively correlated with fibrosis stages(rs=0.74,0.69,0.54,0.57,all P<0.05).Compared with ARFI,APRI and FIB-4,ARFI+AST/PLT had better diagnostic value for significant fibrosis(≥S2)and advanced fibrosis(≥S3)(P<0.05).ARFI+AST/PLT had better diagnostic value for cirrhosis(S4)than APRI and FIB-4(P<0.05),while there was no significant difference between ARFI+AST/PLT and ARFI(P>0.05).Conclusion Combination of ARFI with AST/PLT has better diagnostic value for significant fibrosis and advanced fibrosis than ARFI,APRI and FIB-4 alone.

关 键 词：声脉冲辐射力成像技术 慢性乙型肝炎 肝纤维化 声脉冲辐射力成像技术 FIB-4 

分 类 号：R512.62[医药卫生—内科学]