瞬时弹性扫描仪测量肝硬度值对慢性乙型肝炎患者肝组织纤维化程度的评估价值  

Evaluation Value of Liver Stiffness Measurement by Fibroscan on the Degree of Liver Fibrosis in Patients with Chronic Hepatitis B

作　　者：李文征 谢平安[2] Li Wenzheng;Xie Ping'an(Functional Examination Department,Tianjin Second People's Hospital,Tianjin 300192,China;Department of Geriatrics,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300073,China)

机构地区：[1]天津市第二人民医院功能检查科,天津300192 [2]天津中医药大学第一附属医院老年病科,天津300073

出　　处：《医疗装备》2022年第9期123-127,共5页Medical Equipment

摘　　要：目的探讨瞬时弹性扫描仪(FS)测量肝硬度值(LSM)对慢性乙型肝炎(简称“乙肝”)患者肝组织纤维化程度的评估价值。方法选取2019年6月至2021年5月天津市第二人民医院收治的140例慢性乙肝患者,征得患者同意后,在1周内完成肝穿刺活检及LSM检查(采用FS测量),以肝穿刺活检病理结果为金标准,将入选患者分为无纤维化组(肝组织纤维化分期为S0期)和纤维化组(肝组织纤维化分期为S1~S4期),进一步将纤维化组分成早期纤维化组(S1期)、中度纤维化组(S2~S3期)和重度纤维化组(S4期)。比较不同组间LSM,采用Spearman等级相关分析法分析LSM与慢性乙肝患者肝组织纤维化程度的关系,绘制受试者工作特征(ROC)曲线评价LSM对慢性乙肝患者肝组织纤维化程度及中重度纤维化的诊断价值。结果肝穿刺活检病理结果显示,140例患者中,肝组织纤维化分期为S0、S1、S2、S3、S4期的患者数分别为19、26、39、32和24例。纤维化组LSM为(10.07±2.65)kPa,高于无纤维化组的(4.36±1.08)kPa,差异有统计学意义(P<0.05);早期、中度和重度纤维化组的LSM依次升高,3组间比较,差异有统计学意义(P<0.05),且两两比较,差异亦有统计学意义(P<0.05)。Spearman相关分析结果显示,LSM与慢性乙肝患者肝组织纤维化程度分期成高度正相关(r=0.831,P<0.05)。ROC曲线分析结果显示,LSM诊断慢性乙肝患者肝组织纤维化(≥S1期)、中重度纤维化(S2~S4期)的曲线下面积(AUC)分别为0.851(95%CI为0.789~0.964)、0.893(95%CI为0.809~0.978),诊断界值分别为5.18、7.85 kPa,灵敏度分别为85.12%、88.42%,特异度分别为78.95%、77.78%,准确度分别为84.29%、85.00%。结论采用FS测量LSM对临床诊断慢性乙肝患者肝组织纤维化及评估纤维化程度具有重要价值,可作为理想的无创检查手段。Objective The evaluation value of liver stiffness measurement(LSM)by Fibroscan(FS)on the degree of liver fibrosis in patients with chronic hepatitis B was investigated.Methods 140 patients with chronic hepatitis B admitted to Tianjin Second People's Hospital from June 2019 to May 2021 were selected.After receiving the consent of the patients,the liver biopsy and LSM examination by FS were performed within 1 week.Taken the pathological results of liver biopsy as the gold standard,the enrolled patients were divided into a non-fibrosis group(liver fibrosis was classified as S0 stage)and a fibrosis group(liver fibrosis was classified as S1~S4 stage),and then the fibrosis group was further divided into an early fibrosis group(S1 stage),moderate fibrosis group(S2~S3 stage)and severe fibrosis group(S4 stage).The LSM was compared among different groups.The relationship between LSM and liver fibrosis degree was analyzed by Spearman rank correlation analysis.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of LSM for liver fibrosis and moderate and severe liver fibrosis in patients with hepatitis B.Results The pathological results of liver biopsy showed that among 140 patients,there were 19,26,39,32 and 24 cases of liver fibrosis patients from S0 to S4 stage,respectively.The LSM of the fibrosis group was(10.07±2.65)kPa,which was higher than that of the non-fibrosis group for(4.36±1.08)kPa,and the difference was statistically significant(P<0.05);The LSM of the early,moderate and severe fibrosis group showed a upward trend in turn,and the difference was statistically significant when the three groups were compared(P<0.05),besides,when any two of the three groups were compared,the differences were also statistically significant(P<0.05).The Spearman correlation analysis showed that LSM were highly positively correlated with liver fibrosis stage in patients with hepatitis B(r=0.831,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of hepatitis B patients with liver f

关 键 词：慢性乙型肝炎 瞬时弹性扫描仪 肝硬度值 肝组织纤维化 

分 类 号：R575.2[医药卫生—消化系统]