联合应用血清学指标和瞬时弹性成像技术预测肝纤维化可显著降低肝活检率

发布时间：2018-02-26 22:31

  本文关键词： 慢性乙型病毒肝炎 纤维化 算法 瞬时弹性成像 肝活检　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景近年来肝脏穿刺活检术一直被认为是诊断肝纤维化的金标准,但是它也有一定的局限性,比如费用高、有创性、出血等。这些局限性促使一些非侵入性检测方法的产生,比如FS、APRI、FIB 4等,这些非侵入性检测方法的联合应用首先被用于慢性丙型病毒性肝炎患者,但是很少有用这些联合算法检测慢性乙型病毒性肝炎患者肝纤维化的相关研究报道。抗病毒治疗可以减少慢性乙型病毒性肝炎患者肝硬化、肝癌的发生率,显著性肝纤维化是慢性乙型病毒性肝炎患者抗病毒治疗的一个指征,所以对慢性乙型病毒性肝炎的患者来说,显著性肝纤维化的诊断很重要。该研究的目的在于应用联合算法检测显著性肝纤维化、肝硬化,减少不必要的肝脏活检率。方法对于307位进行肝脏穿刺的慢乙肝患者,在进行肝脏穿刺术的同一天获得他们的APRI值、FIB 4值以及FS值。APRI、FIB 4以及FS的诊断临界值都来自于已发表的文献,APRI、FIB 4以及FS诊断显著性肝纤维化的临界值分别为0.25、1.45和9.4,APRI、FIB 4以及FS排除肝硬化的临界值分别为0.25、2.9和9.4,FS诊断肝硬化的临界值为13.1。本研究提出了分步联合算法,先用APRI或FIB 4进行初步筛选,再用FS对余下病人进行进一步筛选。对于APRI0.25(或FIB 41.45)的患者,可诊断为显著性肝纤维化,对于APRI≤0.25(或FIB 4≤1.45)的患者,若其FS9.4,则可诊断为显著性肝纤维化,而对于FS≤9.4的那一部分未明确诊断的患者则是需要进行肝脏穿刺术的。结果与单独应用APRI或FS检测显著性肝纤维化相比较,联合算法APRI+FS可显著降低肝活检率(65.1%比75.9%或78.5%,P=0.003或P0.001)。FIB 4+FS联合算法检测显著性肝纤维化与单独应用FIB 4或FS相比可显著降低肝活检率(58.3%比67.4%或78.5%,P=0.019或P0.001)。在大于50岁的患者中,联合算法FIB 4+FS检测显著性肝纤维化较APRI+FS可显著降低肝活检率,但准确率也有所下降,它们的肝活检率分别为22.6%和56.5%,P0.001,诊断的准确性分别为83.9%和98.4%,P=0.004.当联合算法用于检测肝硬化时,APRI+FS和FIB 4+FS的肝活检分别为3.6%和1.3%。结论联合算法APRI+FS和FIB 4+FS用于检测显著性肝纤维化和肝硬化可显著降低肝活检率,还具有高准确率、敏感性和阳性预测值。
[Abstract]:Background liver biopsy has been regarded as the gold standard for the diagnosis of liver fibrosis in recent years, but it also has some limitations, such as high cost and invasive. These limitations have led to the emergence of non-invasive testing methods, such as FSAPRII-FIB 4, which are first used in patients with chronic hepatitis C. However, there are few related studies using these combined algorithms to detect liver fibrosis in patients with chronic viral hepatitis B. Anti-viral therapy can reduce the incidence of liver cirrhosis and liver cancer in patients with chronic viral hepatitis B. Significant liver fibrosis is an indication of antiviral therapy in patients with chronic viral hepatitis B, so for patients with chronic viral hepatitis B, Diagnosis of significant liver fibrosis is important. The aim of the study was to detect significant liver fibrosis, cirrhosis and reduce unnecessary liver biopsy rates by using a combined algorithm. Methods 307 patients with chronic hepatitis B underwent liver puncture. On the same day the liver puncture was performed, their APRI value, FS value, FS value, FIB4 value and FS diagnostic critical value were obtained from the published literature, APRII FIB4 and FS, which were 0.251.45 and 0.251.45, respectively. The critical values of FIB 4 and FS for the diagnosis of liver cirrhosis were 0.252.9 and 9.4F, respectively. A step by step algorithm was proposed in this study. The patients with APRI 0.25 (or FIB 41.45) were diagnosed as significant hepatic fibrosis and those with APRI 鈮，

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