RTE联合APRI无创诊断肝纤维化的分析研究

发布时间：2018-09-05 06:55

【摘要】：目的: 目前，有关慢性肝病患者肝纤维化的快速非侵入性检查方法引起人们的广泛关注。本研究即旨在通过对慢性肝病患者进行肝脏实时组织弹性成像(real-timetissue elastograph, RTE)评分与APRI （AST to Platelet Ratio Index）的检测结合肝组织病理组织学检查，探讨影像学检测联合血清学检测对诊断肝组织慢性纤维化病变的临床应用价值。 方法: 本研究经郑大二附院伦理委员会批准。所有病人均签署知情同意书。60例确诊慢性乙型肝炎患者，活检病理组织学检查前进行彩超检查及肝功能和血常规检测，给予RTE评分，通过肝功能及血常规内指标血清天门冬氨酸氨基转移酶(AST)、血小板(PLT)，应用无创诊断模型（APRI=[{AST (IU/1)/ULN (IU/1)}×l00]/platelet count (109/L)计算APRI数值，同时进行肝脏组织活检评估，以肝组织穿刺活检病理结果为金标准，病理诊断分级按Metavir分期方法进行分期（无纤维化、轻、中、重度纤维化及肝硬化）。将所得数据运用SPSS19.0软件系统进行分析，非正态连续性数据以中位数（四分位数间距）表示，计量资料以（均数±标准差）表示，以≥F2为诊断标准绘制受试者，分析曲线下面积(Area underthe receiver operating characteristic curve AUROC)，得出最佳截断值，计算RTE及APRI的敏感度及特异度。P0.05为差异，表示有统计学意义。比较实时组织弹性成像(real-time tissue elastograph, RTE)单独诊断，APRI单独诊断，RTE联合APRI诊断不同程度肝纤维化的敏感度、特异度。 结果: 单独实时组织弹性成像(real-time tissue elastograph, RTE)，单独APRI诊断明显肝纤维化的敏感度较高分别为0.824、0.971；特异度分别为0.923、0.923。随着肝纤维化程度的加重，RTE评分和APRI参数皆随之增加，RTE评分和APRI参数皆与肝纤维化程度具有较强的正相关性（R分别为0.622，0.673）。肝纤维化各期APRI差异有统计学意义（P0.05）。以病理结果≥F2期作为诊断明显肝纤维化的标准，RTE及APRI的曲线下面积分别为0.948、0.947，，其诊断价值较高。RTE评分联合APRI诊断明显纤维化的敏感度和特异度分别为0.781、0.963，准确度为0.735。 结论： RTE联合APRI可明显提高对轻中重度肝纤维化及肝硬化的诊断，及对肝纤维化严重程度的判定，尤其是对早发现明显肝纤维化并准确诊断肝纤维化程度有重要作用。但是，对于纤维化的早期阶段之间的诊断区分还不够明确，还不能取代肝活检。
[Abstract]:Objective: at present, rapid non-invasive examination of liver fibrosis in patients with chronic liver disease has attracted wide attention. The purpose of this study was to perform real-time liver tissue elastography (real-timetissue elastograph, RTE) score and APRI (AST to Platelet Ratio Index) in patients with chronic liver disease, combined with histopathological examination. To evaluate the clinical value of imaging combined with serology in the diagnosis of chronic hepatic fibrosis. Methods: this study was approved by the Ethics Committee of the second affiliated College of Zheng University. All the patients signed the informed consent form. 60 patients with chronic hepatitis B were examined by color ultrasound, liver function and blood routine before biopsy and histopathological examination, and RTE score was given. The serum aspartate aminotransferase (AST),) platelet (PLT), was used to calculate the APRI value by using the APRI= [{AST (IU/1) / ULN (IU/1)} 脳 l00] / platelet count (109 / L), and the liver tissue biopsy was performed. According to the pathological results of liver biopsy as gold standard, the pathological diagnosis grading was performed according to Metavir staging (no fibrosis, mild, moderate, severe fibrosis and cirrhosis). The data were analyzed by SPSS19.0 software system. The non-normal continuity data were expressed as median (quartile spacing), the measurement data were expressed as mean 卤standard deviation, and the subjects were plotted using 鈮

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