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目的评估肝脏瞬时弹性成像技术(Fibro Scan,FS)的应用价值,为肝纤维化的准确诊断提供安全、可靠的检测方法。方法选择2014年3月至2015年5月就诊于漯河市中心医院和郑州大学第一附属医院并经肝组织活检确定为慢性肝病患者168例,运用FS检测肝脏硬度(LSM);测定丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL);检测血小板计数,并计算AST/PLT比值(APRI)。以肝活组织检查病理结果为依据,分析LSM、APRI与肝纤维化程度的相关性。应用SPSS 17.1统计软件进行统计分析。绘制受试者工作特征曲线分析二者诊断慢性肝病肝纤维化的准确性,Spearman相关分析影响肝硬度值的相关因素。结果 168例慢性肝病患者LSM值中位数为10.8 k Pa;APRI中位数为0.71;LSM值与肝纤维化成正相关(r=0.832,P=0.000),LSM诊断肝组织病理学纤维化分期S≥2,S≥3及S=4的ROC曲线下面积分别为0.894,0.923和0.951,明显高于APRI(0.691,0.715及0.736)诊断的ROC曲线下面积。Spearman相关分析显示,LSM与年龄、ALT≥2倍正常上限值、AST、TBIL及肝组织炎症呈正相关,相关系数r分别为0.486、0.570、0.617、0.481及0.549(P<0.05),与PLT呈负相关(r=-0.527,P<0.05)。结论FS是一种简便、可靠的慢性肝病肝纤维化诊断方法,其灵敏度及特异度均优于APRI。年龄、高水平的ALT、AST和TBIL≥2×ULN是其独立的影响因素。
Objective To evaluate the value of Fibro Scan (FS) in liver biopsy and to provide a safe and reliable method for the accurate diagnosis of hepatic fibrosis. Methods From March 2014 to May 2015, 168 patients with chronic liver disease who were seen in Luohe Central Hospital and the First Affiliated Hospital of Zhengzhou University from the liver biopsy were enrolled in this study. FS was used to detect liver stiffness (LSM) Aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL); platelet count was measured and AST / PLT ratio (APRI) was calculated. Based on the pathological results of liver biopsy, the correlation between LSM, APRI and the degree of liver fibrosis was analyzed. Apply SPSS 17.1 statistical software for statistical analysis. Draw the working curve of the subjects to analyze the accuracy of diagnosing liver fibrosis in chronic liver disease, Spearman correlation analysis of factors affecting the value of liver cirrhosis. Results The median LSM of 168 patients with chronic liver disease was 10.8 kPa and the median of APRI was 0.71. LSM was positively correlated with liver fibrosis (r = 0.832, P = 0.000) The areas under the ROC curve of S≥2, S≥3 and S = 4 were 0.894, 0.923 and 0.951, respectively, which were significantly higher than those under the ROC curve of APRI (0.691, 0.715 and 0.736). Spearman correlation analysis showed that there was a positive correlation between LSM and age, ALT≥2 times upper limit of normal, AST, TBIL and liver inflammation, the correlation coefficients r were 0.486,0.570,0.617,0.481 and 0.549 respectively (P <0.05) Was negatively correlated (r = -0.527, P <0.05). Conclusion FS is a simple and reliable method for the diagnosis of liver fibrosis in chronic liver disease, its sensitivity and specificity are better than that of APRI. Age, high levels of ALT, AST and TBIL ≥ 2 × ULN are independent influencing factors.