瞬时弹性成像联合APRI和FIB-4指数模型无创诊断慢性HBV感染者肝纤维化程度的临床价值

发布时间：2018-08-21 07:15

【摘要】：目的探讨瞬时弹性成像联合谷草转氨酶/血小板比值(APRI)和FIB-4指数无创诊断慢性乙型肝炎病毒(HBV)感染者肝纤维化程度的临床价值。方法对265例慢性HBV感染者进行肝脏穿刺病理学检查,并于穿刺当日检测患者相关临床指标,应用瞬时弹性成像技术(Fibro Touch)检测肝脏硬度(LSM),根据临床指标分别得出APRI和FIB-4指数结果。以肝脏病理结果为金标准,分别绘制LSM、APRI及FIB-4指数的受试者工作曲线(ROC),评价其对显著纤维化(S≥2)、严重肝纤维化(S≥3)和肝硬化(S=4)的预测价值,并将APRI、FIB-4指数分别与LSM值联合诊断慢性HBV感染者肝脏纤维化程度,并利用联合法计算诊断肝纤维化程度的灵敏度、特异度等。结果1.随着肝纤维化程度的加重,LSM值(rs=0.622,P0.001)与肝纤维化分期相关性明显高于APRI及FIB-4指数。2.在265例患者中,Fibro Touch在诊断慢性HBV感染者显著肝纤维化(S≥2)、严重肝纤维化(S≥3)、肝硬化(S=4)的AUC分别为0.810、0.881、0.961,明显高于APRI和FIB-4相应的ROC曲线下面积。据ROC曲线得出诊断显著肝纤维化(S≥2)、严重肝纤维化(S≥3)、肝硬化(S=4)的Fibro Touch、APRI和FIB-4各自截断值,得出在肝纤维化各分期的诊断中,Fibro Touch特异度及敏感度均高于APRI、FIB-4。3.将Fibro Touch分别与APRI、FIB-4联合诊断。并联诊断可提高诊断的敏感度。其与APRI并联时其敏感度可达到91.11%以上,与FIB-4并联时敏感度亦可明显上升。而串联诊断则可明显提高诊断的特异度,其中Fibro Touch与APRI串联时其特异度可达94.42%以上。结论Fibro Touch无创诊断肝纤维化的灵敏度及特异度均优于APRI及FIB-4指数。APRI、FIB-4分别与Fibro Touch结合共同诊断患者的肝纤维化程度的敏感性及特异性明显优于Fibro Touch、APRI、FIB-4单项指标。
[Abstract]:Objective to evaluate the clinical value of transient elastography combined with glutamic oxaloacetic transaminase / platelet ratio (APRI) and FIB-4 index in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) infection. Methods the pathological examination of liver puncture was performed in 265 patients with chronic HBV infection, and the relevant clinical indexes were detected on the same day. The results of APRI and FIB-4 index were obtained by using instantaneous elastic imaging (Fibro Touch) technique to detect liver hardness (LSM), according to the clinical indexes. According to the pathological results of liver as gold standard, the operating curves of LSM APRI and FIB-4 index were drawn to evaluate the predictive value of (ROC), for significant fibrosis (S 鈮，

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