实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (5): 652-655.doi: 10.3969/j.issn.1672-5069.2019.05.010

• 病毒性肝炎 • 上一篇    下一篇

肝脏硬度值检测诊断慢性乙型肝炎患者肝组织纤维化的效能分析*

高伟, 侯勇   

  1. 237005安徽省六安市中医院肝病科(高伟); 安徽中医药大学第一附属医院感染病科(侯勇)
  • 收稿日期:2018-09-25 出版日期:2019-09-10 发布日期:2019-09-16
  • 作者简介:高伟,男,33岁,大学本科,主治医师。E-mail:fy11725@foxmail.com
  • 基金资助:
    安徽省自然科学基金资助项目(编号:2789378)

Diagnostic efficacy of hepatic fibrosis by liver stiffness measurement in patients with chronic hepatitis B

Gao Wei, Hou Yong   

  1. Department of Liver Diseases,Traditional Chinese Medicine Hospital,Lu’an 237005,Anhui Province,China
  • Received:2018-09-25 Online:2019-09-10 Published:2019-09-16

摘要: 目的 探讨采用肝脏硬度测定(LSM)诊断慢性乙型肝炎(CHB)患者肝纤维化分期的效能。方法 2016年1月~2018年7月我院收治的112例CHB患者和选择同期健康志愿者30例,使用肝脏瞬时弹性检测仪(FT)检测LSM,所有患者均接受肝活检,采用Ishak评分系统行肝组织纤维化分期。结果 本组112例CHB患者经Ishak评分诊断为肝组织无肝纤维化(S0期)16例(14.3%),轻度肝纤维化(S1期)40例(35.7%),中度肝纤维化(S2~S3期)40例(35.7%),重度肝纤维化和肝硬化(S4期)16例(14.3%);肝组织纤维化S0期、S1期、S2~S3期和S4期LSM值分别为(5.4±0.8) kPa、(7.1±2.1) kPa、(9.9±2.5) kPa和(15.8±3.4) kPa,而正常志愿者LSM值为(5.3±0.9)kPa;分别以LSM=5.90、LSM=7.61、LSM=9.25和LSM=14.84为诊断S0期、S1期、S2~S3和S4期的截断点,诊断的曲线下面积分别为0.943、0.800、0.568和1.000,其诊断的灵敏度和特异度分别为100.0%和89.6%、100.0%和69.4%、100.0%和52.1%,和100.0%和100.0%。结论 使用FT检测LSM值对CHB患者肝组织纤维化分期有一定的诊断价值,值得在临床上进一步验证。

关键词: 慢性乙型肝炎, 肝纤维化, 肝脏瞬时弹性检测仪, 肝脏硬度检测, Ishak评分, 诊断

Abstract: Objective To analyze the diagnostic efficacy of hepatic fibrosis by liver stiffness measurement (LSM) in patients with chronic hepatitis B(CHB). Methods 112 patients with CHB and 30 healthy volunteers were recruited between January 2016 and July 2018,and LSM was detected by FibroTouch. The liver biopsies were conducted in all patients with CHB and the hepatic fibrosis staging were performed by Ishak scoring system. The diagnostic efficacy of hepatic fibrosis by LSM was analyzed by area under the receiver operating characteristic (AUC). Results Out of the 112 patients with CHB,the hepatic fibrosis stage S0 was found in 16(14.3%),mild hepatic fibrosis stage S1 was found in 40(35.7%),moderate hepatic fibrosis S2 to S3 was found in 40(35.7%), and significant hepatic fibrosis stage S4,e.g. liver cirrhosis,was found in 16(14.3%) by Ishak scoring system; the LSM were (5.4±0.8) kPa,(7.1±2.1) kPa,(9.9±2.5) kPa and (15.8±3.4) kPa,respectively,in patients with hepatic fibrosis S0,S1,S2 to S3 and S4,while it was (5.3±0.9) kPa in healthy volunteers;by setting the LSM=5.90,LSM=7.61,LSM=9.25 and LSM=14.84,respectively,as the cut-off-value for diagnosing hepatic fibrosis S0,S1,S2 to S3 and S4,the AUC were 0.943,0.800,0.568 and 1.000,respectively,and their sensitivities and specificities were 100.0% and 89.6%,100.0% and 69.4%,100.0% and 52.1%,and 100.0% and 100.0%,respectively. Conclusion The application of LSM by FibroTouch examination in diagnosing hepatic fibrosis in patients with CHB is efficacious, which should be further validated in clinical practice.

Key words: Chronic hepatitis B, Liver fibrosis, FibroTouch, Liver stiffness measurement, Ishak scoring system, Diagnosis