首 页   本刊简介  编委会  审稿专家  在线期刊  写作规范  广告合作  联系我们
您现在的位置:首页 => 在线期刊 => 2016年 10期 肝病免疫和自身免疫性肝病 => 肝纤维化及肝硬化 =>5种无创诊断技术单独..
5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较
Value of five noninvasive diagnostic techniques and their combinations in diagnosis of liver fibrosis in patients with chronic hepatitis B
文章发布日期:2016年09月07日  来源:  作者:张旭,王煜,马娟,等  点击次数:1434次  下载次数:306次

调整字体大小:

(此处下载失败可以在在线预览处保存副本或者右键另存为)

【摘要】:目的通过分析AST与PLT比值(APRI)、FIB-4、Forns指数、S指数和FibroScan与肝纤维化程度的关系及其相关性,评价其单独、联合应用对肝纤维化的诊断价值,探讨其无创评估慢性乙型肝炎(CHB)患者肝纤维化程度的临床应用价值。方法回顾性收集2009年1月-2015年4月于宁夏医科大学总院就诊的行肝穿刺活组织检查,并经病理诊断证实为CHB的患者91例,根据Scheuer分级,按患者的肝纤维化程度(S)分为3组,即无肝纤维化组(纤维化分期为S0,n=32), 轻度肝纤维化组(纤维化分期<S2,n=30),明显肝纤维化组(纤维化分期≥S2,n=29)。分别计算APRI、FIB-4、Forns指数、S指数,同时行FibroScan 肝硬度值(LSM)检查。计量资料符合正态性分布的3组间比较采用方差分析,进一步两两比较采用Dunnett-t检验。相关性采用Spearman相关分析。用灵敏度、特异度、受试者工作特征曲线下面积(AUC)评价无创诊断技术对肝纤维化的诊断价值。结果在年龄、Alb、AST、ALT、PLT上,3组间比较差异均有统计学意义(F值分别为3.552、4.035、5.992、4.374、3473,P值均<0.05),无肝纤维化组患者与轻度肝纤维化组、明显肝纤维化组比较,差异均有统计学意义(P值均<0.05)。在APRI、FIB-4、Forns指数、S指数、LSM上,3组间比较差异均有统计学意义(F值分别为4.579、5.728、10.501、14.118、30.039,P值均<0.05),无肝纤维化组患者分别与轻度肝纤维化组、明显肝纤维化组比较差异均有统计学意义(P值均<0.05);轻度肝纤维化组与明显肝纤维化组间的LSM比较差异有统计学意义(P<0.05)。APRI、FIB-4、Forns指数、S指数、LSM值与肝纤维化病理分期均呈正相关性(r值分别为0499、0498、0.402、0.395、0.739,P值均<0.05)。 APRI、FIB-4、Forns指数、S指数与LSM单独诊断肝纤维化均有一定的价值, AUC[95%可信区间(95%CI)]分别为0786(0.679~0.892)、0.818(0.717~0.918)、0.770(0.661~0.880)、0.718(0.599~0837),0919(0.864~0.974),P值均<001; APRI、FIB-4、Forns指数、S指数分别与LSM联合,AUC(95%CI)分别提高到0.922(90.868~0.976)、0.931(0.881~0981)、0.926(0.873~0.979)、0.918(0.862~0.974);APRI、FIB-4、Forns指数、S指数与LSM同时联合诊断肝纤维化的准确度,AUC(95%CI)提高到0.927(0.875~0.979)。结论APRI、FIB-4、Forns指数、S指数、LSM与肝纤维化程度均呈明显正相关, 5种指标联合可提高肝纤维化的诊断准确度,与病理诊断价值趋近,对肝纤维化有早期诊断价值,对临床抗病毒治疗时机的选择有一定的指导意义。
【Abstract】:ObjectiveTo investigate the correlation of aspartate aminotransferase to platelet ratio index (APRI), FIB-4, Forns index, S index, and FibroScan with the degree of liver fibrosis, the diagnostic value of these techniques used alone or in combination, and the clinical value of these noninvasive techniques in the assessment of the degree of liver fibrosis in patients with chronic hepatitis B (CHB). Methods A retrospective analysis was performed for the clinical data of 91 patients with pathologically confirmed CHB who visited General Hospital of Ningxia Medical University and underwent liver biopsy from January 2009 to April 2015. According to the Scheuer pathological stage and liver fibrosis stage (S), the patients were divided into non-liver fibrosis group (a liver fibrosis stage of S0, 32 patients), mild liver fibrosis group (a liver fibrosis stage of <S2, 30 patients), and marked liver fibrosis group (a liver fibrosis stage of ≥S2, 29 patients). The APRI, FIB-4, Forns index, and S index were calculated, and liver stiffness was measured by FibroScan. An analysis of variance was used for the comparison of normally distributed continuous data between three groups, and the Dunnett t-test was used for further comparison between any two groups. The Spearman correlation analysis was also performed. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were used to evaluate the value of these noninvasive techniques in the diagnosis of liver fibrosis. ResultsThere were significant differences in age, albumin, aspartate aminotransferase, alanine aminotransferase, and platelet count between the three groups (F=3.552, 4.035, 4.374, and 5.992, all P<0.05), and there were significant differences in these parameters between the non-liver fibrosis group and the mild and marked liver fibrosis groups (P<0.05). There were significant differences in APRI, FIB-4, Forns index, S index, and FibroScan between the three groups (F=4.579, 5.728, 10.501, 14.118, and 30.039, all P<0.05); there were significant differences in these indices between the non-liver fibrosis group and the mild and marked liver fibrosis groups (P<0.05), and there was a significant difference in FibroScan between the mild liver fibrosis group and the marked liver fibrosis group (P<0.05). APRI, FIB-4, Forns index, S index, and FibroScan were positively correlated with the pathological stage of liver fibrosis (r=0.499, 0.498, 0.402, 0395, and 0.739, all P<0.05). APRI, FIB-4, Forns index, S index, or FibroScan alone has certain value in the diagnosis of liver fibrosis, with an AUC (95% CI) of 0.786 (0.679-0.892), 0.818 (0.717-0.918), 0.770 (0.661-0.880), 0.718 (0.599-0837), or 0.919 (0.864-0.974) (all P<0.01). When APRI, FIB-4, Forns index, or S index was combined with FibroScan, the AUC (95% CI) was increased to 0.922 (0.868-0.976), 0.931 (0.881-0.981), 0.926 (0.873-0.979), and 0.918 (0.862-0974), respectively. A combination of APRI, FIB-4, Forns index, S index, and FibroScan increased the AUC (95% CI) to 0.927 (0875-0.979). ConclusionAPRI, FIB-4, Forns index, S index, and FibroScan are significantly positively correlated with liver fibrosis grade. A combination of these indices can increase the accuracy of the diagnosis of liver fibrosis and has a similar value as pathological diagnosis and a certain value in the early diagnosis of liver fibrosis. Moreover, it can guide the selection of the timing of antiviral therapy in clinical practice.
【关键字】:肝硬化; 肝炎, 乙型, 慢性; 诊断技术和方法; 对比研究
【Key words】:liver cirrhosis; chronic hepatitis B; diagnostic techniques and procedures; comparative study
【引证本文】:张旭, 王煜, 马娟, 等. 5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较[J]. 临床肝胆病杂志, 2016, 32(10): 1888-1893.

地址:长春市东民主大街519号《临床肝胆病杂志》编辑部 邮编:130061 电话:0431-88782542/3542
临床肝胆病杂志 版权所有 Copyright © 2009 - 2013 Lcgdbzz.org. All Rights Reserv 吉ICP备10000617号

吉公网安备 22010402000041号