FibroScan在合并肝细胞脂肪变性的慢性乙型肝炎患者肝纤维化诊断中的作用

目的探讨肝脏瞬时弹性成像(FibroScan)在诊断合并肝细胞脂肪变性的慢性乙型肝炎(CHB)患者肝纤维化中的价值。方法选择2009年1月-2011年12月本院行经皮肝穿刺活组织检查的CHB患者418例,分为无肝细胞脂肪变性组(207例)和合并肝细胞脂肪变性组(211例),2组同期行FibroScan等检测,将FibroScan测定值与Ishak评分进行比对,组间比较采用成组t检验、Kruskal-Wallis H检验和Nemenyi检验。计数资料组间比较采用卡方检验。双变量相关性分析采用Spearman等级相关系数法。使用逐步回归的统计学方法从可能影响FibroScan检测结果的多种因素中筛选出有实际意义的影响因素。结果分别对2组内相同肝脏纤维化分期患者的肝硬度值(Stiffness值)进行比较,差异均无统计学意义(P0.05),且Stiffness值均与肝纤维化分期呈显著正相关,无肝细胞脂肪变性组,rs=0.650 35,P0.000 1;合并肝细胞脂肪变性组,rs=0.637 93,P0.000 1。逐步回归统计分析显示,无脂肪变性CHB组,AST、ALT、Alb、TBil、血小板(PLT)对Stiffness值有影响;合并脂肪变性CHB组,影响Stiffness值的因素有PLT、AST、年龄、Alb、体重指数。结论 FibroScan在评估CHB合并肝细胞脂肪变性患者肝脏纤维化程度上具有较好的应用价值。

Value of FibroScan in assessment of liver fibrosis in chronic hepatitis B patients with hepatocyte steatosis

ObjectiveTo evaluate the value of FibroScan in assessing liver fibrosis in chronic hepatitis B （CHB） patients with hepatocyte steatosis. MethodsFour hundred and eighteen CHB patients who had undergone liver biopsy in Shanghai Ruijin Hospital from January 2009 to December 2011 were enrolled in this study. These patients were divided into hepatocyte steatosis group （n=211） and non-hepatocyte steatosis group （n=207）. FibroScan was performed in both groups on the same day. Comparisons of liver stiffness measurement （LSM） and liver fibrosis stage determined by FibroScan and Ishak scoring system were made. Comparisons between groups were made by independent-samples t test, Kruskal-Wallis H test, and Nemenyi test. Comparison of categorical data was made by chi-square analysis. Bivariate correlation analysis was performed using the Spearman Rank Correlation coefficient. The influential factors for LSM were determined by stepwise regression analysis. ResultsThere was no significant difference in LSM between the patients of the same liver fibrosis stage in the two groups （P〉0.05）, and LSM had a significant positive correlation with liver fibrosis stage in the non-hepatocyte steatosis group （rs=0.650 35, P〈0.000 1） and hepatocyte steatosis group （rs=0637 93, P〈0.000 1）. The stepwise regression analysis showed that aspartate aminotransferase （AST）, alanine aminotransferase, albumin （Alb）, total bilirubin, and platelet （PLT） were significant influential factors for LSM in the non-hepatocyte steatosis group and that PLT, AST, age, Alb, and body mass index were significant influential factors for LSM in the hepatocyte steatosis group. ConclusionFibroScan can be used as a useful tool for assessing liver fibrosis in CHB patients with hepatocyte steatosis.