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

发布时间：2018-03-02 10:03

  本文关键词： 瞬时弹性成像 FIB- APRI 肝纤维化 无创诊断　出处：《安徽医科大学学报》2017年03期 　论文类型：期刊论文

【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(FibroT ouch)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(≥S2)、严重肝纤维化(≥S3)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。在265例患者中,FibroT ouch在诊断慢性HBV感染者显著肝纤维化(≥S2)、严重肝纤维化(≥S3)、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(≥S2)、严重肝纤维化(≥S3)、肝硬化(S=4)的FibroT ouch、APRI和FIB-4各自截断值,得出在肝纤维化各分期的诊断中,FibroT ouch特异度及敏感度均高于APRI、FIB-4。同时将FibroT ouch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FibroT ouch与APRI串联时其特异度可达94.42%以上。结论 FibroT ouch无创诊断肝纤维化的灵敏度及特异度均优于APRI及FIB-4。APRI、FIB-4与FibroT ouch联合诊断肝纤维化的灵敏度及特异度明显优于FibroT ouch、APRI、FIB-4单项指标。
[Abstract]:Objective to evaluate the clinical value of transient elastography combined with glutamic oxaloacetic transaminase / platelet ratio (API) and FIB-4 index in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) infection. Pathological examination of visceral puncture, The clinical indexes of patients were detected on the day of puncture, and the liver hardness was detected by instantaneous elastic imaging technique. The results of APRI and FIB-4 index were obtained according to the clinical indexes. The pathological results of liver were regarded as gold standard. To evaluate the predictive value of LSM APRI and FIB-4 index in predicting significant fibrosis (鈮，

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