脾脏硬度评估慢性乙型肝炎纤维化程度的价值

发布时间：2019-03-15 16:13

【摘要】：目的利用声脉冲辐射力(ARFI)技术测量脾脏硬度,探讨脾脏硬度评估慢性乙型肝炎纤维化程度的临床价值。方法利用ARFI技术检测184例慢性乙型肝炎患者及74例健康人群脾脏硬度、肝脏硬度,并化验肝功及血常规,计算天冬氨酸转氨酶/血小板比值指数(APRI),以病理检查为金标准,分析脾脏硬度与肝脏硬度、APRI、肝纤维化病理分期的相关性。通过受试者工作特征(ROC)曲线对脾脏硬度进行评价,多元线性回归分析脾脏硬度影响因素。结果测定脾脏硬度无效数据1例,测定肝脏硬度无效数据27例,χ2=26.060,P=0。脾脏硬度随着肝脏纤维化程度加重而增高;脾脏硬度与肝脏纤维化分期、肝脏硬度、APRI均有相关性(P0.05);脾脏硬度诊断肝纤维化ROC曲线下面积均0.7,与肝脏硬度诊断S0—S2期与S3—S4期,S0—S3期与S4期及各期APRI的ROC曲线下面积比较,差异无统计学意义(P0.05)。多元线性回归分析显示血小板、总胆红素、天冬氨酸转氨酶为脾脏硬度的影响因素。结论脾脏硬度可作为一种有效无创评估肝纤维化程度的方法,尤其在肝脏弹性测量值不稳定及肝脏存在明显纤维化时诊断意义更大,是对肝脏硬度评估肝纤维化的良好补充。
[Abstract]:Objective to evaluate the clinical value of spleen hardness in evaluating the degree of fibrosis of chronic hepatitis B (CHB) by acoustic pulse radiative power (ARFI). Methods spleen hardness, liver function and blood routine were measured by ARFI in 184 patients with chronic hepatitis B and 74 healthy people. The (APRI), of aspartate transaminase / platelet ratio index was calculated by pathological examination as the gold standard. The correlation between spleen hardness and liver hardness and pathological stages of APRI, liver fibrosis was analyzed. The spleen hardness was evaluated by (ROC) curve, and the influencing factors of spleen hardness were analyzed by multiple linear regression. Results the spleen hardness data were ineffectual in 1 case and liver hardness data in 27 cases (蠂 2, 26.060, P < 0.01). Spleen hardness increased with the severity of liver fibrosis, and there was a correlation between spleen hardness and hepatic fibrosis stage, liver hardness and APRI (P0.05). The area under ROC curve of hepatic fibrosis diagnosed by spleen hardness was 0.7, and there was no significant difference in the area under ROC curve between S0-S2 and S3-S4 phase, S0-S3 phase and S4 phase and APRI in each phase of liver hardness diagnosis (P0.05). Multiple linear regression analysis showed that platelet, total bilirubin and aspartate transaminase were the influencing factors of spleen hardness. Conclusion spleen hardness can be used as an effective and non-invasive method to evaluate the degree of liver fibrosis, especially when the measurement value of liver elasticity is unstable and there is obvious fibrosis in the liver. It is a good supplement to evaluate the degree of liver fibrosis.
【作者单位】：兰州大学第一医院超声科;
【基金】：甘肃省自然科学基金项目(1107RJZA226)
【分类号】：R575.2;R512.62

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