肝硬度检测联合APRI指数对慢性乙型肝炎患者肝纤维化程度的诊断价值

冯菲; 马苏美; 陈飞; 杨东红; 姚亚宁; 王蕊; 张晓媛

doi:10.3969/j.issn.1001-5256.2013.10.008

肝硬度检测联合APRI指数对慢性乙型肝炎患者肝纤维化程度的诊断价值

DOI: 10.3969/j.issn.1001-5256.2013.10.008

兰州大学第一医院超声科

基金项目:

兰大一院院内基金项目；甘肃省科技厅资助资金项目(1107RJZA226)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 4118
- HTML全文浏览量: 10
- PDF下载量: 758
- 被引次数: 0
出版历程
- 收稿日期: 2013-03-15
- 出版日期: 2013-10-20

Diagnostic value of LSM combined with APRI for liver fibrosis due to chronic hepatitis B

Department of Ultrasound, The First Hospital of Lanzhou University

Research funding:

摘要

摘要:
目的评价肝硬度（LS）联合APRI指数对慢性乙型肝炎肝纤维化的诊断价值。方法收集2009年8月-2013年1月本院收治的慢性乙型肝炎患者147例,按肝纤维化病理分期分组,利用声脉冲辐射力技术（ARFI）检测LS,并化验肝功能及血常规计算APRI指数。组间比较采用方差分析,采用Spearman相关性进行相关性检验。利用受试者工作特征曲线（ROC）分析LS对肝纤维化程度的诊断价值,并比较LS、APRI及两者联合诊断S≥1（存在肝纤维化）及S≥2（显著肝纤维化）的ROC曲线下面积。结果不同分组之间年龄、LS、AST、血小板（PLT）、APRI各组差异均有统计学意义（P<0.05）,LS及APRI与病理分期具有良好的相关性,相关系数（r s）分别为0.793,0.699（P<0.05）;病理分期与AST,PLT的r s分别为0.292,-0.230（P<0.05）。单独LS、APRI、联合LS与APRI评价S≥1及S≥2的ROC曲线下面积分别为0.843、0.818、0.909和0.916、0.846、0.943;联合诊断ROC曲线下面积均大于单独LS或APRI诊断（P<...
- 肝炎,乙型,慢性 /
- 肝硬化 /
- 弹性成像技术 /
- ROC曲线
Abstract:
Objective To evaluate the diagnostic value of liver stiffness ( LS) combined with aspartate aminotransferase- to- platelet ratio index ( APRI) for liver fibrosis due to chronic hepatitis B. Methods One hundred and forty- seven patients with chronic hepatitis B admitted to our hospital from August 2009 to January 2013 were staged and grouped according to liver fibrosis pathology. LS was determined with acoustic radiation force impulse, and APRI was calculated from the results of liver function test and routine blood examination. Comparisons between groups were conducted using the analysis of variance. Correlation analysis was performed with the Spearman test. The diagnostic value of LS for liver fibrosis was assessed with the receiver operating characteristic ( ROC) curve. The areas under the ROC curve ( AUC) of LS and APRI, either alone or in combination, for diagnoses of S ≥1 ( presence of liver fibrosis) and S ≥2 ( significant liver fibrosis) were compared. Results Age, LS, aspartate aminotransferase ( AST) , platelet count ( PLT) , and APRI differed significantly across the groups ( P<0. 05) . LS and APRI were strongly correlated with pathological stages, with correlation coefficients of 0. 793 and 0. 699 ( P <0. 05) .The correlation coefficients of AST and PLT with pathological stages were 0. 292 and- 0. 230 ( P < 0. 05) . The AUCs of LS, APRI, and LS plus APRI were 0. 843, 0. 818, and 0. 909, respectively, for diagnosis of S ≥1 and 0. 916, 0. 846, and 0. 943, respectively, for diagnosis of S ≥2, suggesting that the joint use of LS and APRI outperforms LS or APRI alone in the diagnosis of liver fibrosis ( P < 0. 05) . Conclusion LS combined with APRI improve the diagnosis of early- stage liver fibrosis.
- hepatitis B, chronic /
- liver cirrhosis /
- elastography imaging techniques /
- ROC curve

HTML全文

参考文献(19)

[1]SPOREA L, BOTA S, PECK-RADOSAVLJEVIC M, et al.Acoustic radiation force impulse elastography for fibrosis evaluation in patients with chronic hepatitis c:an international multicenter study[J].Eur J Radiol, 2012, 81 (12) :4112-4118.

[2]FRIEDRICH-RUST M, NIERHOFF J, LUPSOR M, et al.Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis:a pooled meta-analysis[J].J Viral Hepat, 2012, 19 (2) :e212-e219.

[3]XU QC, YE Z.Ultrasound elastography applied to evaluate the degree of liver fibrosis on research[J].Chin J Med Imaging, 2011, 19 (3) :174-176. (in Chinese) 徐秋晨, 叶真.超声弹性成像应用于评价肝纤维化程度上的研究现状[J].中国医学影像学杂志, 2011, 19 (3) :174-176.

[4] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B (2010 version) [J].J Clin Hepatol, 2011, 27 (1) :Ⅰ-ⅩⅥ. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2010年版) [J].临床肝胆病杂志, 2011, 27 (1) :Ⅰ-ⅩⅥ.

[5]ZHANG DK, ZHAO YY, LI ZY, et al.The initial study of quantitative evaluation of the degree of non-alcoholic fatty liver disease by acoustic radiation force impulse imaging[J].J Clin Hepatol, 2011, 27 (5) :518-520. (in Chinese) 张大鹍, 赵媛媛, 李志艳, 等.非酒精性脂肪性肝病患者肝脏声辐射力脉冲成像的临床观察[J].临床肝胆病杂志, 2011, 27 (5) :518-520.

[6]BOTA S, SPOREA L, SIRLI R, et al.Factars which influence the accuracy of acoustic radiation force impulse (Arfi) elastography for the diagnosis of liver fibrosis in patients with chronic hepatitis C[J].Ultrasound Med Biol, 2013, 39 (3) :407-412.

[7]WAI C, GREENSON JK, FONTANA RJ, et al.A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C[J].Hepatology, 2003, 38 (2) :518-526.

[8]Chinese Society of Infectious Diseases and Parasitdogy, Chinese Society of Hepatology, Chinese Medical Association Prevention and treatment of viral hepatitis[J].Chin J Infect Dis, 2001, 19 (1) :56-62. (in Chinese) 中华医学会传染病与寄生虫病学分会、肝病学分会.病毒性肝炎防治方案[J].中华传染病杂志, 2001, 19 (1) :56-62.

[9]JI D, SHAO Q, HAN P, et al.Analysis of the efficiency of FibroScan combined with sero logic markers for diagnosing liver fibrosis[J].Med J Chin PLA, 2011, 36 (11) :1136-1138. (in Chinese) .纪冬, 邵清, 韩萍, 等.瞬时弹性成像联合血清学标志物检测对肝纤维化的诊断效能分析[J].解放军医学杂志, 2011, 36 (11) :1136-1138.

[10]MAYO M, PARKS J, HUET B, et al.Serum fibrosis markers predict future clinical decompensation in primary biliary cirrhosis better than liver biopsy, bilirubin, or mayo risk score[J].Hepatology, 2006, 630A.

[11]LIU YP, ZHANG L.Clinical study of FibroScan on the diagnosis of liver fibrosis in patients with hepatitis B virus[J].China Med Herald, 2011, 8 (11) :42-44. (in Chinese) 刘勇鹏, 张琳.Fibroscan对HBV感染者肝纤维化诊断的临床研究[J].中国医药导报, 2011, 8 (11) :42-44.

[12]HUANG ZL, PENG L, ZHENG YB, et al.Scoring system composed of albumin, collagenⅣand longitudinal diameter of spleen for diagnosis of liver fibrosis in hepatitis B patients[J/CD].Chin J Exp Clin Infect Dis (Electronic Edition) , 2011, 5 (4) :423-429. (in Chinese) 黄湛镰, 彭亮, 郑玉宝, 等.白蛋白和Ⅳ型胶原及脾长径评分系统对慢性乙型肝炎肝纤维化分期的诊断意义[J/CD].中华实验和临床感染病杂志 (电子版) , 2011, 5 (4) :423-429.

[13]JAFFER O, LUNG P, BOSANAC D, et al.Acoustic radiation force impulse quantification:repeatability of measurements in selected liver segments and influence of age, body mass index and liver capsule-to-box distance[J].Br J Radiol, 2012, 85 (1018) :e858-e863.

[14]SUN DS, MENG FS, WANG JR, et al.Correlativity analysis between liver shear wave speed and fibrosis grades in chronic hepatic diseases[J].Chin J Med Imaging, 2009, 4 (17) :241-245. (in Chinese) 孙德胜, 孟繁坤, 王金锐, 等.慢性肝病肝剪切波速与纤维化分级的相关性研究[J].中国医学影像学杂志, 2009, 4 (17) :241-245.

[15]SHI LJ, BAI Z.Research progress of nontraumatic diagnosis of liver fibrosis[J].Chin J Gastroenterol Hepatol, 2012, 21 (10) :912-915. (in Chinese) 史立军, 白臧.肝纤维化非创性诊断的研究进展[J].胃肠病学和肝病学杂志, 2012, 21 (10) :912-915.

[16]LIN ZH, XIN YN, DONG QJ, et al.Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis:an updated meta-analysis[J].Hepatology, 2012, 53 (3) :726-736.

[17]CRISAN D, RADU C, LUPSOR M, et al.Two or more synchronous combination of noninvasive tests to increase accuracy of liver fibrosis assessement in chronic hepatitis C;results from a cohort of446 patients[J].Hepat Mon, 2012, 12 (3) :177.

[18]WAHL K, ROSENBERG W, VASKE B, et al.Biopsy-controlled liver fibrosis staging using the enhanced liver fibrosis (Elf) score compared to transient elastography[J].PLoS One, 2012, 7 (12) :e51906.

[19]SPOREA I, SIRLI R.Hepatic elastography for the assessment of liver fibrosis-present and future[J].Ultraschall Med, 2012, 33 (6) :550-558.

施引文献

资源附件(0)

访问统计