瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价

发布时间：2018-02-06 05:58

本文关键词： 瞬时弹性测定乙型肝炎慢性肝硬化门静脉高压　出处：《首都医科大学学报》2017年02期 　论文类型：期刊论文

【摘要】：目的研究瞬时弹性测定与肝纤维化病理分期以及门静脉自由压的关系,探讨瞬时弹性测定对早期乙型肝炎相关肝硬化诊断的价值及影响因素。方法 2014年1月至2016年5月于首都医科大学附属佑安医院接受脾切+断流术+肝活检术的60例病人术前进行瞬时弹性测定检测肝脏硬度值(liver stiffness measurement,LSM),术中测量门自由压(free portal pressure,FPP)及取肝组织活检,并结合临床资料及病理进行分析。结果 LSM为(17.6±13.9)k Pa,切脾前门静脉压力为(34.99±6.52)cm H2O(1cm H2O=0.098 k Pa),切脾后门静脉压力为(25.52±4.50)cm H2O,断流后门静脉压力为(26.28±4.36)cm H2O,3组差异有统计学意义(P0.05)。活体组织病理诊断S0 3例,S1 7例,S2 8例,S3 6例,S4 36例。G1 45例,G1~G2 9例,G2 6例。瞬时弹性测定诊断早期肝硬化的曲线下面积(area under the curve,AUC)为0.876,cut-off值7.7 k Pa,敏感度和特异度分别为100%、66.67%。LSM与肝脏病理分期呈正相关(r=0.684,P0.05)。多元线性回归发现AFP为LSM的独立影响因素。结论瞬时弹性测定对肝硬化失代偿期早期、无创诊断有重要的考参价值。
[Abstract]:Objective to study the relationship between transient elasticity and pathological stage of hepatic fibrosis and portal vein free pressure. To investigate the value and influencing factors of instantaneous elasticity determination in the diagnosis of early hepatitis B related cirrhosis methods from January 2014 to May 2016, the patients underwent splenectomy and liver biopsy in Youan Hospital affiliated to Capital Medical University. In 60 patients, the liver hardness was measured by transient elastic measurement before operation and the liver stiffness measurement was performed. The free portal pressure and biopsy of liver tissue were measured during the operation. Results LSM was 17.6 卤13.9kPa, portal vein pressure before splenectomy was 34.99 卤6.52cm H _ 2O 1 cm H _ 2O 0.098k Pag, post-splenectomy portal vein pressure was 25.52 卤4.50 cm H _ 2O, post-splenectomy portal vein pressure was 26.28 卤4.36 cm H _ 2O _ 2O, there were significant differences among three groups (P 0.05). Histopathological diagnosis of S03 cases, S 1, 7 cases, S 2, 8 cases, S 36, S 46, G 1, 45, G 1, G 2, 9, G 2, 6. The area under curve area under the curveoff AUC for the diagnosis of early liver cirrhosis was 0.876U cut-off value, the sensitivity and specificity were 0.876U cut-off, respectively. There was a positive correlation between LSM and liver pathological stage. Multivariate linear regression analysis showed that AFP was an independent factor of LSM. Conclusion transient elasticity is an important factor in the early stage of liver cirrhosis decompensation. Non-invasive diagnosis has important value in examination.
【作者单位】：首都医科大学附属北京佑安医院普通外科中心;首都医科大学附属北京佑安医院超声与功能诊断中心;承德医学院附属医院普通外科;
【基金】：国家科技重大专项(2015ZX10004801-001) 首都医科大学基础与临床合作基金(14GL.71)~~
【分类号】：R512.62;R575.2

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