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FibroScan对慢性丙型肝炎进展期肝纤维化的诊断价值及其影响因素
Value of FibroScan in the diagnosis of progressive liver fibrosis in patients with chronic hepatitis C and related influencing factors
文章发布日期:2019年08月19日  来源:  作者:仇丽霞,梁珊,范作鹏,等  点击次数:122次  下载次数:13次

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【摘要】:目的分析FibroScan对慢性丙型肝炎进展期肝纤维化的诊断效能并探讨其影响因素。方法选取2015年6月-2018年6月于首都医科大学附属北京佑安医院就诊的慢性丙型肝炎患者,均完成肝穿刺病理检查。根据METAVIR评分系统进行纤维化分期,分为F1~F4期。收集患者一般资料,所有患者进行肝脏弹性检测和肝功能、血常规、病毒定量等检测,利用公式计算APRI及FIB-4。不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H秩和检验,进一步两两比较采用Wilcoxon秩和检验。相关性检验采用Spearman秩相关分析。利用受试者工作特征曲线(ROC曲线)分析3种无创诊断方法对肝纤维化的诊断价值,采用STATA验证3种无创诊断方法是否存在统计学差异。结果入组患者共131例,其中男60例(45.80%),女71例(54.20%),平均54.00(45.00~58.25)岁。FibroScan水平为7.80(5.60~1430)kPa,APRI水平为0.63(0.37~1.28),FIB-4水平为2.28(1.43~3.60)。随着肝纤维化分期的进展,各分期的肝脏硬度值逐渐升高,各组间比较差异均有统计学意义(H=47.83,P<0.01)。对于进展期肝纤维化(F≥3期),FibroScan的ROC曲线下面积(AUC)高于APRI及FIB-4,经STATA进一步验证,FibroScan与APRI的AUC比较差异有统计学意义(P<0.01),与FIB-4的AUC比较差异无统计学意义(P=0.07)。FibroScan与ALT、AST、GGT、PLT均存在相关性(r值分别为0.271、0.507、0444、-0.263,P值均<001)。但校正上述影响因素后并不能显著提高FibroScan的AUC。结论FibroScan对于丙型肝炎进展期肝纤维化,有着较好的诊断效能。其综合诊断效能优于APRI及FIB-4,且诊断的准确性不受ALT、AST、GGT等指标影响。
【Abstract】:ObjectiveTo investigate the diagnostic efficacy of FibroScan in the diagnosis of progressive liver fibrosis in patients with chronic hepatitis C and related influencing factors. MethodsA total of 131 patients with chronic hepatitis C who attended Beijing YouAn Hospital, Capital Medical University from June 2015 to June 2018 were enrolled, and all of them underwent liver biopsy. Fibrosis stage was defined as F1 to F4 stages according to the METAVIR scoring system. General information was collected, and liver stiffness measurement (LSM), liver function test, routine blood test, and viral quantification were performed for all patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) were calculated according to equations. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. A Spearman correlation analysis was performed. The receiver operating characteristic (ROC) curve was used to analyze the value of three noninvasive methods in the diagnosis of liver fibrosis, and STATA was used to investigate whether there was a significant difference between the three methods. ResultsA total of 131 patients were enrolled, with 60 male patients (45.80%) and 71 female patients (5420%), and the mean age was 54.00(45.00-58.25)years. The median values of FibroScan, APRI, and FIB-4 were 7.80 (5.60-14.30)kPa, 0.63(0.37-1.28), and 2.28(1.43-3.60), respectively. LSM gradually increased with the progression of liver fibrosis, and there was a significant difference between groups (H=47.83, P<0.01). For progressive liver fibrosis (≥F3 stage), FibroScan had a larger area under the ROC curve (AUC) than APRI and FIB-4, and further analysis based on STATA showed that there was a significant difference in AUC between FibroScan and APRI (P<001), while there was no significant difference in AUC between FibroScan and FIB-4 (P=0.07). FibroScan was correlated with alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), and platelet count (r=0.271, 0507, 0.444, and -0.263, all P<0.01). The AUC of FibroScan was not significantly improved after adjustment for the above influencing factors. ConclusionFibroScan has good diagnostic efficacy in the diagnosis of progressive liver fibrosis in patients with hepatitis C, with better comprehensive diagnostic efficacy than APRI and FIB-4. The accuracy of FibroScan in diagnosis is not affected by the indicators such as ALT, AST, and GGT.
【关键字】:丙型肝炎, 慢性; 肝硬化; 弹性成像技术; 诊断
【Key words】:hepatitis C, chronic; liver cirrhosis; elasticity imaging techniques; diagnosis
【引证本文】:QIU LX, LIANG S, FAN ZP, et al. Value of FibroScan in the diagnosis of progressive liver fibrosis in patients with chronic hepatitis C and related influencing factors[J]. J Clin Hepatol, 2019, 35(9): 1950-1953. (in Chinese)
仇丽霞, 梁珊, 范作鹏, 等. FibroScan对慢性丙型肝炎进展期肝纤维化的诊断价值及其影响因素[J]. 临床肝胆病杂志, 2019, 35(9): 1950-1953.

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