超声弹性成像组织弥散定量分析与综合评分对慢性肝炎肝纤维化的诊断价值研究

发布时间：2018-03-11 12:43

  本文选题：弹性成像技术　切入点：肝硬化　出处：《中国全科医学》2015年06期 　论文类型：期刊论文

【摘要】：背景肝纤维化是慢性肝病发展为肝硬化的可逆中间环节,早期诊断和及时干预对延缓疾病进展及改善预后极为重要。目的通过分析超声弹性成像组织弥散定量分析和天冬氨酸氨基转移酶(AST)与血小板计数(PLT)比值指数(APRI)、综合评分对慢性病毒性肝炎肝纤维化的诊断价值,为无创诊断肝纤维化提供临床依据。方法选取2012年2月—2013年12月在广东省人民医院感染科住院治疗的慢性乙型肝炎患者158例,其中F1期38例(F1期组)、F2期53例(F2期组)、F3期38例(F3期组)、F4期29例(F4期组),另选取同期本院体检的健康志愿者38例为对照组,检测AST、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、总胆红素、PLT等血清学指标,记录超声弹性成像组织弥散定量评分(ES),根据公式计算APRI及综合评分。分析APRI及综合评分诊断肝纤维化分期的ROC曲线下面积,综合评分截断值及灵敏度、特异度。结果对照组与不同肝纤维化分期组患者AST、ALT、GGT、总胆红素及PLT水平比较,差异均有统计学意义(P0.05)。F1期组、F2期组、F3期组、F4期组患者超声弹性成像组织弥散定量分析检测感兴趣区(ROI)的应变均值、标准偏差、蓝色区域(AREA)、复杂度比较,差异均有统计学意义(P0.05);组间两两比较,差异均有统计学意义(P0.05)。Spearman等级相关分析结果显示,APRI、ES、综合评分与肝纤维化分期均呈正相关(rs=0.646,P0.001;rs=0.739,P0.001;rs=0.830,P0.001)。APRI诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.86、0.88、0.89;综合评分诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.93、0.95、0.92。综合评分截断值为100分时,诊断≥F2期肝纤维化的灵敏度为84.6%、特异度为88.2%;综合评分截断值为100分时,诊断≥F3期肝纤维化的灵敏度为91.5%、特异度为81.3%;综合评分截断值为114分时,诊断≥F4期肝纤维化的灵敏度为48.2%、特异度为100.0%。结论超声弹性成像组织弥散定量分析可较好地用于慢性病毒性肝炎肝纤维化的诊断,并且结合血清学指标的综合评分能够更好地提高诊断准确度。
[Abstract]:Background liver fibrosis is a reversible intermediate link in the development of chronic liver disease into cirrhosis. Early diagnosis and timely intervention are very important to delay the progress of disease and improve prognosis. Objective to analyze the quantitative analysis of tissue diffusion and the ratio of aspartate aminotransferase (AST) to platelet count (PLT). The diagnostic value of combined score in liver fibrosis of chronic viral hepatitis. Methods from February 2012 to December 2013, 158 patients with chronic hepatitis B who were hospitalized in the Department of infection in Guangdong Provincial people's Hospital were selected. Among them, there were 38 cases of F _ 1 stage in F _ 1 stage and 53 cases of F _ 2 stage in F _ 2 stage. 38 cases of F _ 3 stage group and 29 cases of F _ 4 stage F _ 4 group were selected as control group, and 38 cases of healthy volunteers were selected as control group. Serum AST, alanine aminotransferase (alt), 纬 -glutamyl transpeptidase (GGT), total bilirubin (PLT) and so on were detected. The APRI and the comprehensive score were calculated according to the formula. The area under the ROC curve, the truncation value and the sensitivity of the comprehensive score were analyzed for the diagnosis of hepatic fibrosis stage by APRI and comprehensive score. Results the levels of GGTT, total bilirubin and PLT were compared between the control group and the patients with different stages of hepatic fibrosis. The differences were statistically significant in the strain mean, standard deviation, blue region of AREAA, and complexity comparison between F _ 2 and F _ 3, F _ 3, F _ 4, F _ 4, F _ 3, F _ 3, F _ 4, P _ (0.05), F _ (1), F _ (2), F _ (3) and F _ (4) groups. The difference was statistically significant (P 0.05), the difference was statistically significant (P 0.05). Spearman grade correlation analysis showed that APRI ESS was positively correlated with liver fibrosis stage, and the comprehensive score was positively correlated with liver fibrosis stage (P 0.001 rsl 0.739P 0.001rs0.830 P 0.001P 0.001). APRI was used to diagnose 鈮，

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