能谱CT基物质分离技术在肝硬化与正常肝脏血流定量研究中的应用

目的:探讨能谱CT基物质分离技术在Child-Pugh A级肝硬化与正常肝脏血流动力学定量研究中的应用价值。方法:收集临床确诊肝硬化Child-Pugh A级并行上腹部增强CT检查患者30例作为肝硬化组,同时收集肝脏及门静脉增强CT检查无异常患者30例作为正常肝脏组。两组均采用能谱CT扫描并重建70 keV单能量图像、碘基物质分离图像,在70 keV、碘基图像上分别测量动脉期（AP）和门静脉期（PV）肝脏五叶（肝尾状叶、肝左外叶、肝左内叶、肝右前叶、肝右后叶）CT值和碘浓度（IC）,计算动脉期碘分数(AIF)和门静脉期碘含量（PVIC）。采用独立样本t检验比较两组能谱参数,并运用ROC曲线分析各参数诊断效能。结果:肝硬化组动脉期CT值和碘浓度与正常肝脏组无统计学差异（P>0.05）,而门静脉期CT值和碘浓度显著低于正常肝脏组（P<0.05）。肝硬化组肝脏AIF稍高于正常肝脏组（P>0.05）,而肝脏PVIC均显著低于正常肝脏组（P<0.05）。以门静脉期肝脏平均碘浓度21.47 mg/mL为阈值评价肝硬化与正常肝脏血流时,ROC曲线下面积（AUC）为0.790,敏感度为77.8%,特异度为83.3%,显著高于肝脏CT值和PVIC。结论:能谱CT基物质分离技术可以用来评价肝硬化与正常肝脏血流动力学的改变和差异,为肝硬化的早期诊断提供更多依据。     

肺栓塞肺动脉能谱CT胸部扫描影像学特征及其诊断价值

目的：探讨肺栓塞（PE）肺动脉能谱CT胸部扫描影像学特征及其诊断价值。方法：回顾性分析53例高度疑似PE患者,获取单能量能谱CT肺动脉造影（CTPA）图像和碘基肺灌注图,记录CTPA图像和碘基肺灌注图检出的肺动脉栓子数目及其分布、分型情况;分析肺动脉能谱CT胸部扫描影像学特征;比较不同栓塞程度及类型能谱CT扫描碘基值;比较栓塞区与对照区能谱CT扫描碘基值、水基值和CT值等能谱CT扫描参数。结果：以CTPA为金标准,53例高度疑似PE的患者中确诊32例。能谱CTPA检出162个栓子,完全型栓子37个,非完全型栓子125个;碘基肺灌注图检出171个栓子,完全型栓子49个,非完全型栓子122个。中心型、偏心型和完全型栓子栓塞区能谱CT扫描碘基值均明显低于对照区（P<0.05）;附壁型栓子栓塞区能谱CT扫描碘基值与对照组无显著差异（P>0.05）;完全型栓塞区碘基值显著低于中心型、偏心型和附壁型等非完全型栓塞区（P<0.05）。结论：PE肺动脉能谱CT胸部扫描影像学特征主要表现为肺动脉内充盈缺损、肺动脉扩张、肺动脉高压、马赛克征、轨道征等征象,肺动脉能谱CT胸部扫描碘基肺灌注...     

能谱CT扫描在周围型肺癌分型中的应用

目的:探讨能谱CT不同扫描方式在周围型肺癌分型诊断的应用价值。方法:回顾性分析2018 年2 月至2018 年 10 月在山西省肿瘤医院收集的90 例经由病理证实的周围型肺癌患者的影像学资料，根据最终病理结果的不同分为肺 腺癌（ADC）、肺鳞癌（SC）、小细胞肺癌（SCLC）3 组，所有病例通过能谱CT平扫和能谱模式下的增强扫描，记录并检验 平扫形态学征象及能谱模式定量参数，通过所得征象及参数对周围型肺癌分型的结果与病理结果进行比较。结果:病 灶边缘分叶/毛刺征、支气管截断征、肿大淋巴结伴融合改变及标准化碘浓度值（NIC）、能谱曲线斜率在3 组肺癌有显 著差异（P<0.05）。组间比较结果显示边缘分叶征在SCLC与ADC组有差异；边缘毛刺征在SCLC与ADC、SC组有差 异；支气管截断征在SC与ADC、SCLC组有差异；肿大淋巴结融合在SCLC与ADC组有差异。NIC和能谱曲线斜率在 SCLC与ADC、SC组均有差异。能谱平扫和能谱模式下扫描对周围型肺癌的分型与病理结果比较显示在对ADC的灵 敏度及特异度、SCLC的灵敏度上二者有显著差异（P<0.05）。结论:ADC边缘毛刺征常见；SC边缘毛刺征、支气管截断 征常见；SCLC边缘分叶征、纵膈内淋巴结肿大伴融合改变常见。SC的NIC、能谱曲线斜率高于SCLC。ADC的NIC、 能谱曲线斜率最高；能谱模式扫描对ADC灵敏度、特异度及SCLC灵敏度高于能谱平扫扫描。     

3D可视化联合3D打印在肝癌大部分肝切除术中的应用

目的:探讨基于3D重建系统软件的肝体积评估和3D可视化、3D打印辅助肝癌大部分肝切除术的应用价值。方法:将符合要求的肝癌行大部分肝切除术患者46例,随机分为观察组和对照组,每组23例。观察组（3D组）患者采用3D可视化技术和3D打印模型进行围手术期规划和指导,主要基于肝体积评估等术前规划和3D可视化分析、3D打印指导肝切除术手术;对照组（CT组）患者采用传统CT资料进行肝体积评估等术前规划、CT二维影像资料指导肝切除术。观察指标:虚拟切除肝体积、实际切除肝体积、残肝体积、标准残肝体积比、手术时间、术中出血量、术后并发症、患者满意度等。结果:3D组与CT组虚拟切除肝体积与实际切除肝体积、虚拟（术前）残肝体积与实际（术后）残肝体积比较,差异均无统计学意义（P>0.05）,相关性分析显示虚拟切除肝体积与实际切除肝体积呈正相关性（3D组r=0.990, P<0.001;CT组r=0.943, P<0.001）。3D组与CT组虚拟残肝体积比、实际残肝体积比比较,差异均无统计学意义（P>0.05）,且相关性分析显示呈正相关性（3D组r=0.931, P<0.001;CT组r=0.902, P<0.001)。3D组术中出血量少于CT组（P<0.05）,3D组患者满意度优于CT组（P<0.05）。两组患者手术时间、术后并发症等比较,差异无统计学意义（P>0.05）。结论:3D重建系统软件和CT软件在评估肝癌大部分肝切除术的肝体积均可行、准确,具有很好的临床应用价值,有助于肝切除术的安全实施。3D可视化联合3D打印在围手术规划可减少手术出血,提高患者满意度,在临床应用中具有潜在优势。     

慢性乙型肝炎患者肝组织p53的表达及其影响因素

目的探讨慢性乙型肝炎患者肝组织抑癌基因p53的表达及其影响因素。方法符合诊断标准的HBeAg阴性慢性乙型肝炎患者17例、HBeAg阳性慢性乙型肝炎患者31例。行血清学标志物及肝组织病理学检查。结果（1）HBeAg阴性组患者年龄较大、男性居多、HBVDNA水平偏低,三项指标均与HBeAg阳性组有统计学差异。血清学指标除Glo外,均无统计学差异。（2）两组患者肝脏病理学炎症及纤维化分期差异均无统计学意义;肝组织中p53阳性率及p53计分无统计学差异。（3）Logisticregression分析表明,只有肝脏纤维化分期（s）是p53阳性表达的危险因素,与S0-1相比,S≥2患者出现p53阳性的风险增高3．9倍。结论慢性乙型肝炎患者肝脏纤维化分期是其肝组织p53阳性表达的危险因素。     

APRI 对慢性乙型肝炎肝脏炎症和纤维化程度的预测性能评价

目的:分别在HBeAg阳性与阴性慢性乙型肝炎(CHB)框架内,调查天冬氨酸转移酶/血小板比值(APRI)对肝脏炎症和纤维化程度的预测效能差异。方法:纳入初治CHB患者485例,其中HBeAg阳性281例,阴性204例,所有病例进行肝组织活检病理检查,同时检测血清天冬氨酸转移酶(AST)、血小板(PLT)水平,计算出APRI,评估APRI预测CHB肝脏炎症和肝纤维化程度的价值。结果:ROC曲线分析显示,HBeAg阳性患者,APRI预测炎症分级≥G2的AUROC显著大于PLT(P0.001 0);预测炎症分级≥G3的AUROC显著大于AST和PLT(P=0.002 9和P=0.005 7);预测纤维化分期≥S2、≥S3和≥S4的AUROC和显著大于AST和PLT(P=0.000 8、P0.001 0和P0.001 0)。HBeAg阴性患者,APRI预测炎症分级≥G2和≥G3的AUROC显著大于PLT(P0.001 0和P=0.000 4);预测纤维化分期≥S2的AUROC显著大于PLT(P=0.003 7);预测纤维化分期≥S3和≥S4的AUROC显著大于AST和PLT(P=0.004 0和P=0.000 7)。结论:APRI在HBeAg阳性患者中预测炎症分级≥G3时占主要优势,APRI在阴性HBeAg患者中预测纤维化分期≥S3和≥S4时占主要优势。     

能谱CT评估生物力学的初步研究

目的:通过分析能谱CT定量参数与生物力学的相关性,探讨能谱CT定量参数评估骨强度的价值。方法:采用能谱CT成像扫描36个羊腰椎椎体,测定每个椎体的骨松质、骨皮质及皮质+松质的能谱CT基物质对(铁-水、钙-水、羟基磷灰石-水)密度,然后将各个椎体去除附件对应编号,行腰椎压缩实验。将能谱不同基物质对(铁-水、钙-水、羟基磷灰石-水)密度值与生物力学测得的最大载荷和最大应力进行相关性分析。结果:能谱CT基物质对密度值与生物力学相关性分析可得,在松质+皮质时钙-水、羟基磷灰石-水与最大应力呈强相关(R~2=0.508,P0.05;R~2=0.507,P0.05),与最大载荷呈中等程度相关(R~2=0.454,P0.05;R~2=0.451,P0.05),而铁-水相关性较低;皮质、松质的3个基物质对密度值与生物力学值相关性较差。结论:能谱CT定量参数可以用来评价骨强度。     

慢性乙型肝炎患者肝功能及血清HBeAg和HBV DNA载量与肝组织病理相关性的研究

目的 探讨慢性乙型肝炎患者肝功能、HBeAg及HBV DNA水平与肝组织病理炎症分级和纤维化分期的关系.方法 选择233例慢性乙型肝炎患者进行肝穿病理学检查,同时所有患者检测HBV DNA、HBeAg及肝功能,比较患者的肝功能、HBeAg及HBV DNA水平在不同病理炎症分级及纤维化分期中的差异情况.结果 不同的炎症分级患者中,ALT以C3组最高,G0～1组最低,各组间比较差异有统计学意义(P =0.016);TBil以G4组最高,G0～1组最低,各组间比较差异有统计学意义(P=0.000);HBV DNA载量各组间差异无统计学意义.不同的纤维化分期患者中,ALT各组间比较差异无统计学意义;TBil以S4组最高,S2组最低,各组间比较差异有统计学意义(P=0.039);HBV DNA载量各组间差异无统计学意义.炎症分级为G3～4的患者比例在HBeAg阳性组与阴性组差异无统计学意义.纤维化分期S3～4的患者比例在HBeAS阳性组(38%)比HBeAg阴性组(53%)低,两组差异有统计学意义(P=0.025).结论 慢性乙型肝炎患者血清HBV DNA水平的高低不能反映其肝脏炎症及纤维化程度,HBeAg阴性慢乙肝患者肝组织纤维化程度较高,TBil水平与肝组织炎症分级及纤维化分期均有良好的相关性,ALT水平与炎症分级有一定的关联性,但与纤维化分期无关.     

能谱CT与DXA测量骨密度准确性的比较研究

目的:以羊腰椎体骨煅烧后的灰重密度为标准,比较能谱CT与双能X线骨密度仪（DXA）测量椎体骨密度（BMD）的准确性,探讨能谱CT对BMD的测量价值。 方法:选取36节新鲜市售羊腰椎椎体作为研究对象,清除椎体周围软组织及其附件后,分别采用能谱CT与DXA测量BMD,然后煅烧椎体得到灰重密度。将两种方法测量所得BMD值与灰重密度值进行比较,同时分析两种方法测量所得BMD值与灰重密度值的相关性;最后将能谱CT测得BMD的偏离度与DXA测得体积BMD的偏离度进行比较。 结果:能谱CT、DXA测得BMD值与灰重密度值差异有统计学意义（P<0.05）;相关性分析可得,能谱CT与DXA测得BMD值与灰重密度值均有显著相关性（P<0.05）,但能谱CT相关性更高;能谱CT测得BMD的偏离度（平均值为0.288）低于DXA测得BMD的偏离度（平均值为0.372）（P<0.05）。结论:能谱CT测量椎体BMD值更接近灰重密度值,准确性及相关性均优于DXA测量方法,能够更好、更精确地反映BMD变化。     

腓骨远端CT值在评价老年人踝关节骨折骨密度中的应用

目的 通过计算机断层扫描 （CT） 扫描测量腓骨远端的CT值 （Houndsfield Unit,HU）,评估老年踝关节骨折患者的骨密度,并探讨骨密度与踝关节骨折的相关性。方法 纳入74例老年踝关节骨折患者,根据骨密度分为骨质疏松组、骨质减少组和正常组。测量腓骨远端的CT值,利用受试者工作特征 （Receiver Operating Characteristic,ROC） 曲线计算出区分组间差异的最佳 CT值,并分析腓骨远端 CT值与腰椎及股骨近端骨矿物质密度 （Bone Mineral Density,BMD） 和 T值之间的相关性。结果 腓骨远端CT值与除L1至L3整体BMD外的其他部位均显著相关,尤其与L2 BMD相关性最高 （r=0.555, P＜0.001）。各组间 CT值差异有统计学意义。根据 ROC曲线,当 CT值为 157.43 HU时,区分骨质疏松组和骨质减少组的曲线下面积为 0.808 （P＜0.001）,当 CT 值为 218.47 HU 时,区分骨质减少的曲线下面积与正常值的差异为 0.698 （P＜0.001）。 结论 腓骨远端HU的测量可以有效地反映BMD,腓骨远端CT值与腰椎、股骨近端BMD及T值显著相关。CT值可以潜在预测踝关节骨折患者骨质疏松风险的指标。     

HBeAg阴性慢性乙型肝炎患者血清病毒载量与肝组织学改变的关系

目的 探讨HBeAg阴性慢性乙型肝炎患者血清HBV DNA水平与肝组织损害的关系.方法 以HBeAg阳性慢性乙型肝炎病例为对照,回顾分析HBeAg阴性慢性乙型肝炎患者血清HBVDNA水平与肝组织病理炎症分级、纤维化分期之间的关系.结果 HBeAg阴性与阳性组HBV DNA 平均含量分别为（5.38±1.27）log10拷贝/ml和（6.80±1.18）log10拷贝/ml,差异有统计学意义（P〈0.01）.与HBeAg阳性组比较,HBeAg阴性组肝组织炎症分级及纤维化分期较高（P〈0.01）.HBeAg 阴性患者HBV DNA水平与肝组织炎症分级及纤维化分期呈正相关（P〈0.01）.结论 HBeAg阴性慢性乙型肝炎病毒载量低,乙肝病毒载量与肝损害呈正相关.     

Longitudinal monitoring of liver fibrosis status by transient elastography in chronic hepatitis B patients during long-term entecavir treatment

The correlation between improvement in longitudinal liver stiffness and fibrosis regression has not been properly evaluated during long-term antiviral therapy in chronic hepatitis B (CHB) patients. In this study, liver stiffness was serially performed by FibroScan^® every 26 weeks in a prospective cohort of CHB patients receiving entecavir. Results were compared with liver biopsies at baseline and week 78. A total of 120 treatment-naïve CHB patients were analyzed, in which 54 (45%) patients had fibrosis regression at 78 weeks of antiviral therapy. Liver stiffness measurement presented as a rapid-to-slow decline pattern and decreased more significantly in patients with fibrosis regression than those without improvement in fibrosis at week 78 (? 46.4 vs. ? 28.6%, P?<?0.001). Multivariate analysis revealed that percentage decline of 52-week and 78-week liver stiffness from baseline was independent predictive factors for fibrosis regression (OR?=?46.6, P?<?0.001; OR?=?17.8, P?=?0.002, respectively). Moreover, percentage decline of 78-week liver stiffness was moderately predictive of fibrosis regression (AUROC?=?0.694, P?<?0.001), while the optimal cutoff values were different between non-cirrhosis and cirrhosis patients (38 vs. 45%). Fibrosis regression could be predicted with a high positive predictive value (96%) in non-cirrhosis patients and could be excluded with a high negative predictive value (94%) in cirrhosis patients. In conclusion, serial liver stiffness measurement could be applied for longitudinal monitoring of fibrosis status in CHB patients. Continuous decline of liver stiffness after effective antiviral treatment could partially reflect fibrosis regression at an optimal cutoff value.     

High prevalence of significant liver fibrosis and cirrhosis in chronic hepatitis B patients with normal ALT in central Europe

The indication for antiviral treatment of patients with chronic hepatitis B is based on serum HBV DNA levels, transaminases, and histological grade and stage. The relation of liver fibrosis and inflammation to ALT activity in chronic hepatitis B infection was investigated in a nonendemic, European setting. A total of 253 patients with chronic hepatitis B who had undergone liver biopsy at the Clinic of Gastroenterology, Hepatology, and Infectious Diseases, Düsseldorf,Germany over the past 19 years (1990–2009) were evaluated. Thirty-nine patients had persistently normal transaminases, 86 patients had ALT with 1–2 x ULN (upper limit of normal) and 128 patients had ALT >2 x ULN. Liver fibrosis or inflammation was defined as significant for stages or grades ≥ 2 according to the Desmet/Scheuer score. Significant liver fibrosis (F ≥ 2)was found in 36%, cirrhosis in 18%, and significant inflammation (G ≥ 2) in 27% of patients with normal transaminases. There was no difference in the stage of liver fibrosis and the frequency of cirrhosis between patients with normal and elevated transaminases. The most important factor associated with the presence of cirrhosis in multivariate analysis was age ≥ 40 years (P < 0.003). If concomitant factors like elevated GGT or male sex were furthermore present high prevalences of significant liver disease were found. The data indicate that, in a European setting, patients with chronic hepatitis B infection, and normal transaminases frequently have significant liver fibrosis or cirrhosis.Therefore, liver biopsy or liver stiffness measurement (LSM) should be performed in these patients to determine the stage of liver fibrosis.     

Assessment of hepatic fibrosis by transient elastography in patients with chronic hepatitis B

Hepatic ultrasonic transient elastography (FibroScan) is a new diagnostic method for the assessment of hepatic fibrosis. There are limited data available on its use as a follow‐up tool for patients with chronic hepatitis B. In this study, 134 patients were enrolled. Hepatic fibrosis was evaluated by liver stiffness measurement and biopsy. The biopsy criteria of the Chinese Program of Prevention and Cure for Viral Hepatitis, Metavir classification, and the modified Chevalier's semiquantitative system were used for histological assessment. The liver stiffness value was correlated with fibrosis stage (r = 0.565, P < 0.001) and fibrosis semiquantitative score (r = 0.727, P < 0.001). The liver stiffness value of G2 was significantly higher than that of G1 within the same fibrosis stage for S1, S3, and S4, respectively. Three patients were graded as G1S1, and had moderate steatosis without distinct fibrosis in the portal area and lobule, while their liver stiffness values were higher than 6.2 kPa. Although belonging to the same fibrosis stage, for thinner thicknesses of the fibrous septa, the liver stiffness value and semiquantitative score were correspondingly lower. Liver stiffness values had a good correlation with hepatic collagen content. However, inflammatory activity and steatosis can influence liver stiffness values to some extent. Transient elastography may be useful as an ideal non‐invasive post‐treatment follow‐up tool.     

Development and validation of a potential biomarker to improve the assessment of liver fibrosis progression in patients with chronic hepatitis B

We aimed to develop and validate a novel combined score to improve the assessment of liver fibrosis progression in patients with chronic hepatitis B (CHB). In this study, a total of 331 CHB patients from three cohorts who underwent liver biopsy were enrolled, and the Scheuer system was used for liver fibrosis classification. The combined score was derived by principal component analysis of key differentially expressed genes. For significant liver fibrosis (≥S2), the areas under the receiver operating characteristics curves (AUROCs) of the combined score were 0.838, 0.842, and 0.881 in the three cohorts, respectively. And for advanced liver fibrosis (≥S3), the AUROCs were 0.794, 0.801, and 0.901, respectively. Compared with the results of AUROCs for aspartate aminotransferase≥to≥platelet ratio (APRI) and fibrosis index based on four factors (FIB-4) in the validation cohorts, better clinical diagnostic value for assessing the progression of liver fibrosis was found in the combined score. Additionally, univariate ordered logistic regression analysis indicated that the combined score could serve as a more superior and stable risk factor than APRI and FIB-4 in the assessment of liver fibrosis. For CHB patients with normal alanine aminotransferase (ALT), our results further emphasized the diagnostic value of the combined score for significant fibrosis (≥S2) and advanced fibrosis (≥S3). Moreover, it was found that patients with the high combined score, who were associated with the advanced fibrosis stage, had higher levels of drug sensitivity and immune checkpoint expression. In conclusion, the novel combined score could serve as a potential biomarker and contribute to improving the assessment of fibrosis stage in CHB patients.     

FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化(S2～S4期),严重纤维化(S3～S4期)和肝硬化(S4期).以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例(1.4%),S1期49例(23.1%),S2期66例(31.1%),S3期50例(23.6%),S4期44例(20.8%),即显著纤维化者(S2～S4期)160例(75.5%),严重纤维化者(S3～S4期)94例(44.3%),肝硬化者(S4期)44例(20.8%).FIB-4指数对3个判定点的AUC值分别为0.733(95%(CI:0.660～0.806,P<0.01)、0.746(95%CI:0.679～0.813,P<0.01)、0.756(95%CI:0.687～0.825,P<0.01).结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.     

FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化(S2～S4期),严重纤维化(S3～S4期)和肝硬化(S4期).以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例(1.4%),S1期49例(23.1%),S2期66例(31.1%),S3期50例(23.6%),S4期44例(20.8%),即显著纤维化者(S2～S4期)160例(75.5%),严重纤维化者(S3～S4期)94例(44.3%),肝硬化者(S4期)44例(20.8%).FIB-4指数对3个判定点的AUC值分别为0.733(95%(CI:0.660～0.806,P<0.01)、0.746(95%CI:0.679～0.813,P<0.01)、0.756(95%CI:0.687～0.825,P<0.01).结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.     

FIB-4指数对慢性乙型肝炎患者肝纤维化的诊断价值

目的 探讨FIB-4指数对慢性乙型肝炎肝纤维化的诊断价值.方法 212例慢性乙型肝炎患者行肝活检并同时留取血清标本,检测ALT、AST、PLT等指标,并根据其结果结合患者的年龄计算出FIB-4的数值.根据肝纤维化分期设定3个判定点,分别为显著纤维化（S2～S4期）,严重纤维化（S3～S4期）和肝硬化（S4期）.以肝活检病理结果为金标准绘制出FIB-4的受试者工作特征曲线（ROC）,计算曲线下面积（AUC）,评价其对慢性乙型肝炎肝纤维化的诊断价值.结果 212例肝活检患者中S0期3例（1.4%）,S1期49例（23.1%）,S2期66例（31.1%）,S3期50例（23.6%）,S4期44例（20.8%）,即显著纤维化者（S2～S4期）160例（75.5%）,严重纤维化者（S3～S4期）94例（44.3%）,肝硬化者（S4期）44例（20.8%）.FIB-4指数对3个判定点的AUC值分别为0.733（95%（CI：0.660～0.806,P〈0.01）、0.746（95%CI：0.679～0.813,P〈0.01）、0.756（95%CI：0.687～0.825,P〈0.01）.结论 FIB-4指数是一种简单的、准确的、经济的非创性诊断方法,可以较准确地估计慢性乙型肝炎患者有无显著纤维化,使多数患者避免肝穿刺活检.