声触诊组织量化联合天门冬氨酸氨基转移酶/血小板比值对慢性乙型肝炎患者肝纤维化分期的诊断价值研究*

doi:10.3969/j.issn.1672-5069.2018.02.015

摘要/Abstract

摘要： 目的探讨声触诊组织量化（VTQ）联合天门冬氨酸氨基转移酶/血小板比值（APRI）对慢性乙型肝炎患者肝纤维化分期的诊断价值。方法 2014年11月~2016年12月我院收治的慢性乙型肝炎患者103例,行肝穿刺活检病理学检查,另选同期在我院健康体检者36例作为对照组。两组均进行VTQ检查,同时计算APRI值,分析VTQ和APRI值与肝纤维化的相关性,观察联合检测对F2期以上肝纤维化的诊断价值。结果 35例F4组患者年龄为（44.10±8.89）岁,明显大于健康人的（33.15±8.08）岁、20例F1组的（34.02±7.36）岁和19例F3组的（38.55±9.39）岁（P<0.05）;F4组患者右肝斜径（ODRL）为（121.51±8.61） mm,明显短于健康人的（126.61±8.54） mm、F1组的（126.59±8.71） mm、29例F2组的（128.96±9.01） mm和F3组的（128.88±8.66） mm（P<0.05）;F4组VTQ值为（1.89±0.39） m/s,明显大于健康人的（1.11±0.14） m/s、F1组的（1.29±0.26） m/s、F2组的（1.35±0.25 m/s）和F3组的（1.55±0.24） m/s,VTQ值随患者肝纤维化程度的升高而增高（P<0.05）;健康人APRI值为（0.16±0.06）,明显小于F1组的（0.23±0.15）、F2组的（0.30±0.18）、F3组的（0.36±0.34）、F4组的（0.45±0.46）,APRI值随患者肝纤维化程度的升高而上升（P<0.05）;肝纤维化病理学分期与VTQ呈正相关（95%CI: 0.715~0.893,r=0.804,P<0.001）,与APRI呈负相关（95%CI: 0.583~0.781,r=0.681,P<0.001）;经分析VTQ与APRI诊断肝纤维化的ROC曲线,发现它们诊断F1期的AUC分别为0.873 对 0.811,诊断F2期的AUC分别为0.882 对0.861,诊断F3期的AUC分别为0.941 对0.861,诊断F4期的AUC分别为0.940 对0.817,显示VTQ诊断的AUC均大于APRI。以肝纤维化程度大于F2期为诊断显著肝纤维化的标准,发现VTQ诊断的特异度和阳性预测值均明显高于VTQ/APRI比值或APRI。结论 VTQ和APRI与慢性乙型肝炎患者肝纤维化分期相关,VTQ联合APRI检测F2级以上肝纤维化诊断效能更佳。

关键词: 慢性乙型肝炎, 肝纤维化, 声触诊组织量化, 天门冬氨酸氨基转移酶/血小板比值, 诊断

Abstract: Objective To investigate the diagnostic value of liver fibrosis staging in patients with chronic hepatitis B by acoustic palpation tissue quantification （VTQ） and aspartate aminotransferase/platelet ratio （APRI）. Methods 103 patients with chronic hepatitis B between November 2014 and December 2016 in our hospital were included and all of them received liver biopsies. 36 healthy subjects were selected as controls. VTQ was performed in both groups, and APRI was calculated. The diagnostic efficacy was evaluated by ROC curve. Results The ages of 35 patients with F4 liver fibrotic staging was significantly older than those of healthy persons,20 with F1 and 19 with F3 liver fibrotic staging [（44.10±8.89） yr vs. （33.15±8.08） yr,（34.02±7.36） yr,（38.55±9.39） yr,P<0.05];the oblique diameter of right liver in patients with F4 staging was（121.51±8.61） mm,significantly shorter than（126.61±8.54） mm in healthy persons,（126.59±8.71） mm in with F1,（128.96±9.01） mm in with F2 and （128.88±8.66） mm in with F3 staging （P<0.05）;the VTQ in F4 group was（1.89±0.39） m/s,much faster than（1.11±0.14） m/s in healthy persons,（1.29±0.26） m/s in F1,[（1.35±0.25） m/s in F2,（1.55±0.24） m/s in F3 staging（P<0.05）;VTQ increased as the liver fibrosis got severe;the APRI in healthy persons was （0.16±0.06）,significantly less than （0.23±0.15） in F1,（0.30±0.18） in F2,（0.30±0.18） in F3 and（0.45±0.46） in F4,and APRI increased as the liver fibrosis got severe（P<0.05）;the stage of liver fibrosis was positively correlated with VTQ （95%Cl: 0.715~0.893,r=0.804,P<0.001）,and was negatively correlated with APRI（95% Cl:0.583~0.781,r=0.681,P<0.001）;the ROC analysis showed that the AUCs of VTQ and APRI in diagnosis of F1 were 0.873 and 0.811,of F2 were 0.882 and 0.861,and of F3 were 0.941 and 0.861,and of F4 were 0.940 and 0.817,suggesting that VTQ was superior to APRI,and the specificity and positive predictive value of VTQ were superior to the VTQ/APRI ratio or APRI in diagnosis of greater than F2 liver fibrosis. Conclusion The VTQ and APRI are associated with the staging of hepatic fibrosis in patients with chronic hepatitis B,and the VTQ and APRI have a good diagnostic efficacy for detecting liver fibrosis greater than F2 staging.

Key words: Hepatitis B, Liver fibrosis, Acoustic tissue quantification, Aspartate aminotransferase/platelet ratio, Diagnosis

田婧, 何岩莉, 骈林萍, 陈安萌, 李墨航. 声触诊组织量化联合天门冬氨酸氨基转移酶/血小板比值对慢性乙型肝炎患者肝纤维化分期的诊断价值研究*[J]. 实用肝脏病杂志, 2018, 21(2): 216-219.

Tian Jing, He Yanli, Pian Linping, et al. Diagnosis of liver fibrosis in patients with chronic hepatitis B by acoustic palpation tissue quantification and aspartate aminotransferase/platelet ratio[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(2): 216-219.

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