5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较

张旭; 王煜; 马娟; 张爱芸; 马燕; 刘鑫

doi:10.3969/j.issn.1001-5256.2016.10.013

5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较

DOI: 10.3969/j.issn.1001-5256.2016.10.013

1. 宁夏医科大学总院感染疾病科
2. 宁夏医科大学

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中图分类号: R512.62;R575.2
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出版历程
- 出版日期: 2016-10-20

Value of five noninvasive diagnostic techniques and their combinations in diagnosis of liver fibrosis in patients with chronic hepatitis B

Department of Infectious Diseases, General Hospital of Ningxia Medical University

摘要

摘要:
目的通过分析AST与PLT比值（APRI）、FIB-4、Forns指数、S指数和Fibro Scan与肝纤维化程度的关系及其相关性,评价其单独、联合应用对肝纤维化的诊断价值,探讨其无创评估慢性乙型肝炎（CHB）患者肝纤维化程度的临床应用价值。方法回顾性收集2009年1月-2015年4月于宁夏医科大学总院就诊的行肝穿刺活组织检查,并经病理诊断证实为CHB的患者91例,根据Scheuer分级,按患者的肝纤维化程度（S）分为3组,即无肝纤维化组（纤维化分期为S0,n=32）,轻度肝纤维化组（纤维化分期<S2,n=30）,明显肝纤维化组（纤维化分期≥S2,n=29）。分别计算APRI、FIB-4、Forns指数、S指数,同时行Fibro Scan肝硬度值（LSM）检查。计量资料符合正态性分布的3组间比较采用方差分析,进一步两两比较采用Dunnett-t检验。相关性采用Spearman相关分析。用灵敏度、特异度、受试者工作特征曲线下面积（AUC）评价无创诊断技术对肝纤维化的诊断价值。结果在年龄、Alb、AST、ALT、PLT上,3组间比较差异均有统计学意义（F值分别为3.552、4.035...
- 肝硬化 /
- 肝炎,乙型,慢性 /
- 诊断技术和方法 /
- 对比研究
Abstract:
Objective To investigate the correlation of aspartate aminotransferase to platelet ratio index( APRI),FIB-4,Forns index,S index,and Fibro Scan with the degree of liver fibrosis,the diagnostic value of these techniques used alone or in combination,and the clinical value of these noninvasive techniques in the assessment of the degree of liver fibrosis in patients with chronic hepatitis B( CHB). Methods A retrospective analysis was performed for the clinical data of 91 patients with pathologically confirmed CHB who visited General Hospital of Ningxia Medical University and underwent liver biopsy from January 2009 to April 2015. According to the Scheuer pathological stage and liver fibrosis stage( S),the patients were divided into non-liver fibrosis group( a liver fibrosis stage of S0,32 patients),mild liver fibrosis group( a liver fibrosis stage of < S2,30 patients),and marked liver fibrosis group( a liver fibrosis stage of ≥S2,29 patients). The APRI,FIB-4,Forns index,and S index were calculated,and liver stiffness was measured by Fibro Scan. An analysis of variance was used for the comparison of normally distributed continuous data between three groups,and the Dunnett t-test was used for further comparison between any two groups. The Spearman correlation analysis was also performed. Sensitivity,specificity,and area under the receiver operating characteristic curve( AUC) were used to evaluate the value of these noninvasive techniques in the diagnosis of liver fibrosis. Results There were significant differences in age,albumin,aspartate aminotransferase,alanine aminotransferase,and platelet count between the three groups( F = 3. 552,4. 035,4. 374,and 5. 992,all P < 0. 05),and there were significant differences in these parameters between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05). There were significant differences in APRI,FIB-4,Forns index,S index,and Fibro Scan between the three groups( F = 4. 579,5. 728,10. 501,14. 118,and 30. 039,all P < 0. 05); there were significant differences in these indices between the non-liver fibrosis group and the mild and marked liver fibrosis groups( P < 0. 05),and there was a significant difference in Fibro Scan between the mild liver fibrosis group and the marked liver fibrosis group( P < 0. 05). APRI,FIB-4,Forns index,S index,and Fibro Scan were positively correlated with the pathological stage of liver fibrosis( r = 0. 499,0. 498,0. 402,0. 395,and 0. 739,all P < 0. 05). APRI,FIB-4,Forns index,S index,or Fibro Scan alone has certain value in the diagnosis of liver fibrosis,with an AUC( 95% CI) of 0. 786( 0. 679-0. 892),0. 818( 0. 717-0. 918),0. 770( 0. 661-0. 880),0. 718( 0. 599-0. 837),or 0. 919( 0. 864-0. 974)( all P < 0. 01). When APRI,FIB-4,Forns index,or S index was combined with Fibro Scan,the AUC( 95% CI) was increased to 0. 922( 0. 868-0. 976),0. 931( 0. 881-0. 981),0. 926( 0. 873-0. 979),and 0. 918( 0. 862-0. 974),respectively. A combination of APRI,FIB-4,Forns index,S index,and Fibro Scan increased the AUC( 95% CI) to 0. 927( 0. 875-0. 979). Conclusion APRI,FIB-4,Forns index,S index,and Fibro Scan are significantly positively correlated with liver fibrosis grade. A combination of these indices can increase the accuracy of the diagnosis of liver fibrosis and has a similar value as pathological diagnosis and a certain value in the early diagnosis of liver fibrosis. Moreover,it can guide the selection of the timing of antiviral therapy in clinical practice.
- liver cirrhosis /
- chronic hepatitis B /
- diagnostic techniques and procedures /
- comparative study

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