FibroTouch诊断乙型肝炎病毒携带者肝纤维化价值研究  

Diagnostic performance of FibroTouch scan in identifying liver fibrosis in hepatitis B virus carriers

作　　者：莫金英 余希[1] 余雪平[2] 吴丽华[1] 瞿志军[1] Mo Jinying;Yu Xi;Yu Xueping(Department of Infectious Diseases,Longgang Central Hospital,Shenzhen 518116,Guangdong Province,China)

机构地区：[1]广东省深圳市龙岗中心医院感染病科,518116 [2]福建医科大学附属泉州第一医院感染病科

出　　处：《实用肝脏病杂志》2022年第4期480-483,共4页Journal of Practical Hepatology

基　　金：国家自然科学基金资助项目(编号:81400625);广东省医学科学技术研究基金资助项目(编号:A2013624);深圳市龙岗区经济与科技发展专项资金-医疗卫生科技计划项目(编号:LGKCYLWS2019000121)。

摘　　要：目的探讨使用FibroTouch无创检测诊断乙型肝炎病毒(HBV)携带者肝纤维化程度的效能。方法2017年7月~2019年12月在深圳市龙岗中心医院感染病科住院的HBV携带者66例,所有患者均接受肝脏穿刺活检术。使用FibroTouch行肝脏硬度检测(LSM),常规计算基于4因子(FIB-4)指数,应用MedCalc软件绘制ROC曲线。结果肝组织病理学检查提示,无显著肝纤维化(S_(0)~S_(1))24例、进展期肝纤维化(S_(2)~S_(3))27例和肝硬化(S_(4))15例;无显著肝纤维化组LSM为(7.8±1.8)kPa,显著低于进展期肝纤维化组【(11.4±3.1)kPa,P<0.01】或肝硬化组【(18.2±6.2)kPa,P<0.01】患者,无显著肝纤维化组FBI-4指数为(1.0±0.5),与进展期肝纤维化组的(1.2±0.5)比,无显著性差异(P>0.05),但这两组FIB-4均显著低于肝硬化组[(2.0±1.0,P<0.01];LSM独立诊断S_(2)、S_(3)和S_(4)期肝纤维化的AUC分别为0.856(其敏感性为83.7%,特异性为52.6%)、0.938(其敏感性为92.3%,特异性为90.0%)和0.963(其敏感性为100.0%,特异性为90.2%),均显著高于FBI-4诊断的AUC(P<0.05),LSM联合FIB-4均不能提高诊断肝纤维化的效能(P>0.05)。结论使用FibroTouch诊断乙型肝炎毒携带者肝纤维化有很大的临床应用价值,可无创检测,方便动态检测,定期复查。Objective The aim of this study was to investigate the diagnostic performance of FibroTouch scan in predicting liver fibrosis in chronic hepatitis B virus(HBV)carriers.Methods 66 HBV carriers were encountered in Longgang Central Hospital,Shenzhen,between July 2017 and December 2019,and all underwent liver biopsy.The liver fibrosis based on four factors(FIB-4)was calculated routinely,and the liver stiffness measurement(LSM)was detected by FibroTouch.The ROC was drawn by MedCalc software.Results The liver histopathological examination showed S_(0)-S_(1) in 24 cases,S_(2)-S_(3) in 27 cases and liver cirrhosis(S_(4))in 15 cases in our series;the LSM in carriers with S_(0-1) was(7.8±1.8)kPa,significantly lower than[(11.4±3.1)kPa,P<0.01]in those with progressive liver fibrosis or[(18.2±6.2)kPa,P<0.01]in patients with liver cirrhosis,and the FBI-4 in carriers with S_(0-1) was(1.0±0.5),in those with S_(2-3)was(1.2±0.5),not significantly different between them(P>0.05),while both significantly lower than[(2.0±1.0,P<0.01]in patients with liver cirrhosis;the AUCs by LSM in predicting S_(2),S_(3) and S_(4) were 0.856 [with sensitivity(Se)of 83.7%and specificity(Sp)of 52.6%,0.938(Se of 92.3%and Sp of 90.0%,and 0.963(Se of 100.0%and Sp of 90.2%),all significantly higher than by FBI-4(P<0.05),while the combination of LSM and FIB-4 didn’t improve the diagnostic performance(P>0.05).Conclusion The non-invasive diagnosis of liver fibrosis by FibroTouch detection in chronic HBV carriers is efficacious,and warrants further clinical investigation.

关 键 词：乙型肝炎病毒携带者 瞬时弹性成像技术 肝纤维化 基于4因子的指数 诊断 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]