肝脏硬度与慢性乙型肝炎中医证型的关系及联合APRI、FIB-4、GP对肝纤维化的诊断价值  

Study on the Relationship between liver stiffness value and TCM Syndrome Types of Chronic Hepatitis B and Diagnostic Value of liver stiffness value combined with APRI,FIB4 and GP in Liver Fibrosis

作　　者：唐艳芳[1] 刘旭东[1] 赵晓芳[1] 赵壮志[1] 吕萍[1] 徐新杰[1] TANG Yan-fang;LIU Xu-dong;ZHAO Xiao-fang;LV Ping(Ruikang Hospital affiliated Guangxi university of chinese medicine,Nanning Guangxi,53000,China)

机构地区：[1]广西中医药大学附属瑞康医院肝病科,广西南宁530000

出　　处：《中西医结合肝病杂志》2021年第4期312-315,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金(No.81473532);广西一流学科建设重点课题(No.2018XK084)。

摘　　要：目的:探索瞬时弹性成像检测肝脏硬度值(LSM)与慢性乙型肝炎中医证型的关系以及联合血清模型APRI、FIB-4、GP是否提高慢性乙型肝炎患者肝纤维化的诊断率。方法:回顾收集2015年10月至2018年9月就诊于广西中医药大学附属瑞康医院肝病科的慢性乙型肝炎患者521例,并分析患者的中医证型、血清值指标值、肝脏硬度值、肝组织穿刺病理结果。结果:521例患者的中医证型分布为肝郁脾虚证占48.2%,湿热中阻证占27.1%,瘀血阻络证占15.4%,肝肾阴虚证占6.3%,脾肾阳虚证占3.1%。各组中医证型LSM值由低到高依次为:肝郁脾虚证、湿热中阻证、肝肾阴虚证、脾肾阳虚证、瘀血阻络证,各中医证型间LSM差异有统计学意义(P﹤0.01)。与肝组织穿刺病理结果对照,LSM联合纤维化指数(FIB-4)、天门冬氨酸氨基转移酶(AST)/血小板(PLT)比值(APRI指数)或球蛋白/血小板(GP)诊断轻微肝纤维化的AUROC分别为0.801、0.773、0.756;LSM联合APRI或FIB-4或GP与LSM单独诊断轻微肝纤维化的AUROC差异无统计学意义(P>0.05)。结论:LSM值在慢性乙型肝炎患者不同中医证型间存在差异,LSM值可能有助于慢性乙型肝炎的中医辨证。LSM值单独存在有诊断肝纤维化的价值,联合其他指标不能提高肝纤维化的诊断率。Objective:To explore the relationship between liver stiffness value and TCM syndrome types of chronic hepatitis B(CHB)and to explore whether liver stiffness value combined with serum model APRI/FIB4/GP could improve the diagnosis rate of liver fibrosis in patients with CHB.Methods:521CHB patients who met the inclusion criteria in the Hepatology Department of Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine hospital from October 2015 to September 2018,were collected and analyzed the basic information of patients,including TCM syndrome type,blood routine test,liver stiffness value(LSM)measured by FibroTouch,liver puncture pathological results,etc.Results:The distribution of TCM syndrome types in 521 patients was:liver depression and spleen deficiency syndrome accounted for 48.2%,damp heat syndrome accounted for 27.1%,blood stasis syndrome,accounted for 15.4%,liver and kidney yin deficiency syndrome accounted for 6.3%,spleen and kidney yang deficiency accounted for 3.1%.The LSM values of TCM syndrome types from low to high were:liver depression and spleen deficiency syndrome,damp-heat syndrome,liver and kidney yin deficiency syndrome,spleen and kidney yang deficiency syndrome,blood stasis syndrome,LSM of each TCM syndrome type was significant statistical difference(P<0.01).Compared with the results of liver biopsy,The AUROC for the diagnosis of mild liver fibrosis with LSM combined with APRI or FIB4 or GP were 0.801,0.773,and 0.756,respectively.There was no significant difference in the AUROC of LSM combined with APRI or FIB4 or GP and LSM alone in the diagnosis of mild hepatic fibrosis(P>0.05).Conclusion:The LSM value based on FibroTouch detection was different among different TCM syndrome types in CHB patients,and the LSM value may be helpful for TCM syndrome differentiation in CHB patients;LSM value alone has the value of diagnosing liver fibrosis,but it can not improve the diagnosis rate of liver fibrosis and cirrhosis combined with other indicators.

关 键 词：慢性乙型肝炎 肝脏硬度值 中医证型 肝纤维化 

分 类 号：R512.6[医药卫生—内科学]