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目的探讨磁共振表观扩散系数(ADC)值联合血液生化学指标诊断肝纤维化的临床价值。资料与方法利用扩散成像技术检测41例慢性肝病患者磁共振ADC值(b=600s/mm2),同时测量透明质酸(HA)并计算肝纤维化诊断预测模型Forns和APRI指数。以肝纤维化病理分期作为金标准,应用受试者工作特征(ROC)曲线分析以上指标诊断肝纤维化的价值。用Logistic回归综合两指标信息,根据ROC曲线确定诊断界值,分析其诊断肝纤维化的价值。结果在判断S≥2肝纤维化时,ADC值、HA、Forns和APRI的曲线下面积(Az)分别为0.88、0.80、0.72和0.76;在判断S≥3肝纤维化时,Az分别为0.93、0.84、0.77和0.74。而在判断S≥2肝纤维化时ADC+HA、ADC+Forns和ADC+APRI两两联合诊断时的Az分别为0.93、0.93和0.92;在判断S≥3肝纤维化时,Az分别为0.96、0.95和0.94,且Logistic回归方法的诊断敏感性和特异性比单个指标诊断均有所提高。结论ADC值与血液生化学多指标联合建立Logistic回归模型,和单独检测相比诊断准确性提高,可供临床参考。
Objective To investigate the clinical value of magnetic resonance apparent diffusion coefficient (ADC) combined with blood biochemical markers in the diagnosis of liver fibrosis. Materials and Methods Magnetic resonance ADC value (b = 600s / mm2) was measured in 41 patients with chronic liver disease by diffusion imaging. Hyaluronic acid (HA) was also measured and Forns and APRI indices of liver fibrosis diagnosis were calculated. The liver fibrosis pathological staging as the gold standard, the application of receiver operating characteristic (ROC) curve analysis of the above indicators in the diagnosis of liver fibrosis. Logistic regression combined with the two indicators of information, according to the ROC curve to determine the diagnostic threshold, analysis of its value in the diagnosis of liver fibrosis. Results The area under the curve (Az) of ADC value, HA, Forns and APRI were 0.88, 0.80, 0.72 and 0.76 respectively when S ≧ 2 hepatic fibrosis was judged. Az was 0.93 , 0.84, 0.77 and 0.74. Az and Az of ADC + HA, ADC + Forns and ADC + APRI were 0.93, 0.93 and 0.92 respectively when judging S≥2 hepatic fibrosis, Az was 0.96 , 0.95 and 0.94 respectively, and the diagnostic sensitivity and specificity of Logistic regression method were higher than the single index diagnosis. Conclusion Logistic regression model was established by combining ADC value with multiple biochemical markers of blood biochemistry. Compared with the single detection, the diagnostic accuracy was improved, which could be used for clinical reference.