FibroScan对慢性乙型肝炎肝纤维化诊断的临床价值

目的探讨肝脏瞬时弹性扫描仪(FibroScan)对慢性乙型肝炎(chronic hepatitis B,CHB)肝纤维化的诊断价值。方法对80例行肝脏穿刺检查的CHB患者进行FibroScan检测,记录所检测到的肝脏硬度值。肝纤维化程度分为无或轻度肝纤维化(S0~S1期)、显著肝纤维化(S2~S4期)、严重肝纤维化(S3~S4期)和早期肝硬化(S4期)。以肝脏活体组织检查病理结果为"金标准",绘制受试者工作特征曲线(receiver-operating characteristic curve,ROC曲线),计算ROC曲线下面积(area under ROC curve,AUROC),评价FibroScan对CHB患者肝纤维化的诊断价值。结果肝脏硬度值与肝脏病理分期呈正相关(rs=0.739,P0.01)。FibroScan对显著肝纤维化、严重肝纤维化和早期肝硬化的AUROC值分别为0.865、0.940和0.944。结论 FibroScan可以较准确地估计CHB患者的肝纤维化程度,部分替代有创性的肝脏活体组织检查,对CHB患者肝纤维化的诊断和治疗有指导意义。

Diagnostic value of FibroScan for liver fibrosis in patients with chronic hepatitis B

Objective To investigate the diagnostic value of FibroScan for liver fibrosis in patients with chronic hepatitis B （CHB）. Methods Liver stiffness measurement using FibroScan was performed on 80 CHB patients, who had undergone histologic examination, and the values of liver stiffness measurement were recorded. No or mild liver fibrosis was defined as stage score 0-1, significant fibrosis as stage score 2-4, severe fibrosis as stage score 3-4 and early cirrhosis as stage score 4. With the results of liver biopsy as gold standard, the receiver-operating characteristic （ROC） curves were drawn, and the areas under ROC curves （AUROC） were calculated, so as to assess the diagnostic value of FibroScan for liver fibrosis in CHB patients. Results The value of liver stiffness measurement was positively correlated to liver fibrosis stage （rs=0.739, P〈0.01）; the AUROC were 0.865 for significant fibrosis, 0.940 for severe fibrosis and 0.944 for early cirrhosis. Conclusions FibroScan examination can accurately estimate the degree of liver fibrosis in CHB patients, and partly substitute liver biopsy, which is invasive. It is of great importance in the diagnosis and treatment of liver fibrosis in CHB patients.