FibroTouch与6种肝纤维化血清学模型评估慢性乙型肝炎患者肝纤维化程度的临床研究  

Clinical study of FibroTouch and six serological models for assessing the degree of liver fibrosis in patients with chronic hepatitis B

作　　者：左中宝 崔怀中[1] 黄从想[1] 郭毅 潘克女[1] 王妙婵[1] 杜炜 黄斌 徐爱芳[1] Zuo Zhongbao;Cui Huaizhong;Huang Congxiang;Guo Yi;Pan Kenü;Wang Miaochan;Du Wei;Huang Bin;Xu Aifang(Hangzhou Sixth People’s Hospital,Hangzhou 310014,China)

机构地区：[1]杭州市第六人民医院,310014

出　　处：《中华肝脏病杂志》2019年第6期430-435,共6页Chinese Journal of Hepatology

基　　金：杭州市科技发展计划项目(20160533B55);杭州市科技局重点专病专科项目(20160533B53).

摘　　要：目的评估慢性乙型肝炎患者FibroTouch与六种肝纤维化血清学模型检测肝纤维化程度的应用价值,为肝纤维化的准确诊断提供参考。方法选择2015年9月1日-2017年9月1日就诊于杭州市西溪医院的慢性乙型肝炎患者258例,所有患者均接受肝组织病理学检查和FibroTouch测定肝脏硬度(LSM),检测血清学生物化学指标并计算六种血清学模型的评分值。使用SAS9.4统计软件进行分析,FibroTouch与六种血清学模型的相关性采用Spearman相关分析。以肝组织病理学结果为标准,利用受试者工作特征曲线(ROC)分析FibroTouch与六种血清学模型的诊断价值。结果258例慢性乙型肝炎患者LSM中位数为9.4(6.5~13.8)kPa,六种血清学模型中,天冬氨酸氨基转移酶/血小板比值指数(APRI)中位数为0.42(0.28~0.62),纤维化指数模型(FIB)-4为1.27(0.78~2.03),S指数为0.11(0.07~0.20),Forns指数为6.95(5.89~8.51),PRP指数为0.000 8(0.000 6~0.000 9),FIB-5为38.59(36.28~40.97);FibroTouch与肝纤维化分期呈正相关(r=0.73,P<0.001),FibroTouch与APRI、FIB-4、S指数、Forns指数、PRP指数、纤维化分期和炎症分级正相关,与FIB-5呈负相关,均有统计学意义;FT-LSM在S≥2、S≥3和S=4的曲线下面积(AUC)分别为0.89、0.90和0.85,显著高于血清学模型(P<0.001),S指数模型的在S≥2、S≥3和S=4的AUC均高于其余五种血清学模型。结论FibroTouch的诊断效能显著优于血清学模型,S指数模型的诊断效能在血清学模型中表现最好,联合S指数+FT-LSM指标可以更好地判断肝纤维化分级,在临床中可以加以应用和推广。Objective To evaluate the using value of FibroTouch and six serological models in detecting the degree of liver fibrosis in patients with chronic hepatitis B,in an attempt to provide reference for accurate diagnosis.Methods Two hundred and fifty-eight cases with chronic hepatitis B admitted to Xixi Hospital of Hangzhou from September 1,2015 to September 1,2017 were selected.All patients underwent liver histopathological examination and FibroTouch measurement to determine liver stiffness(LSM).Serum biochemical parameters were detected and the scoring values of six serological models were calculated.SAS 9.4 statistical software was used for statistical analysis,and the correlation between FibroTouch and the six serological models was analyzed by Spearman correlation.The diagnostic value of FibroTouch and six serological models was analyzed by receiver operating characteristic curve(ROC)based on liver histopathological findings.Results The median LSM of 258 cases with chronic hepatitis B was 9.4(6.5-13.8)kPa.In the six serological models,the median value of aspartate transaminase to platelet ratio index(APRI),FIB-4 index,S-index,Forn’s index,PRPindex,and FIB-5 were 0.42(0.28-0.62),1.27(0.78-2.03),0.11(0.07-0.20),6.95(5.89-8.51),0.000 8(0.000 6-0.000 9),and 38.59(36.28-40.97).FibroTouch had positive correlation with APRI,FIB-4,S-index,Forn’s index,PRP,fibrosis stage(r=0.73,P<0.001)and inflammation grade,and had negative correlation with FIB-5,and both had statistical significance.The area under curve(AUC)of FT-LSM at S≥2,S≥3,S=4 were 0.89,0.90 and 0.85,respectively,which was significantly higher than serological models(P<0.001).The AUC of S-index model at S≥2,S≥3,S=4 were higher than other five serological models.Conclusion The diagnostic performance of FibroTouch is significantly better than serological model.S-index model has the best diagnostic performance in the six serological models,and the combination of S-index and FT-LSM may better diagnose the grading of liver fibrosis,and thus can be applied an

关 键 词：肝炎 乙型 慢性 肝纤维化 瞬时弹性超声技术 肝组织病理活检 血清多参数肝纤维化模型 

分 类 号：R575.2[医药卫生—消化系统]