瞬时弹性成像在诊断HBeAg阴性慢性乙型肝炎肝纤维化中的价值

目的探讨肝脏瞬时弹性成像(FibroScan,FS)在HBeAg阴性慢性乙型肝炎(CHB)患者肝纤维化中的应用价值。方法选择2011年6月-2013年5月在湖北省中医院诊治的HBeAg阴性CHB患者104例,运用FS进行肝脏硬度(Stiffness值)测量,所有患者均行肝穿刺活组织检查。以肝活组织检查病理结果为标准,Stiffness值与之对比;同时绘制FS工作特征曲线,计算受试者工作特征曲线下面积(AUC)。组间比较采用Kruskal-Wallis H检验,两组比较采用Mann-Whitney U检验。双变量相关性分析采用Pearson相关和Spearman等级相关法。结果随肝纤维化程度的提高,Stiffness值逐渐增高,差异有统计学意义(P0.01或P0.05)。Stiffness值与肝纤维化分期呈正相关(r=0.810,P0.01)。FS检测肝硬化AUC为0.956,其中以13.1 kPa作为肝硬化的诊断界值,敏感度为92.7%,特异度为80%。结论 FS在HBeAg阴性CHB患者肝纤维化程度的评估中具有较好的应用价值,尤其诊断肝硬化的准确性较高,直接、间接标志物和FS的联合应用有助于肝纤维化患者的鉴别诊断及疗效评估。

Value of FibroScan in diagnosis of hepatic fibrosis in patients with HBeAg - negative chronic hepatitis B

Objective To evaluate the value of transient elastography （ FibroScan, FS） in predicting hepatic fibrosis in patients with HBeAg-negative chronic hepatitis B （CHB）. Methods One hundred and four patients with HBeAg-negative CHB, who were diagnosed and treated in Hubei Hospital of Traditional Chinese Medicine from June 2011 to May 2013, were enrolled in this study. All patients underwent FS for liver stiffness measurement before liver biopsy. Statistical analysis was applied to compare liver stiffness （kPa） with fibrosis stage （ determined by liver biopsy）. The receiver operating characteristic （ROC） curve of FS was constructed, and the area under the ROC curve （AUC） was calculated to analyze the accuracy of live stiffness in predicting significant fibrosis and cirrhosis. Comparison between groups was made by Kruskal - Wallis H test, followed by Mann - Whitney U test for multiple comparisons. The correlation between two variables was analyzed by Spearman rank and Pearson correlation test. Results Liver stiffness gradually rose as the degree of hepatic fibrosis increased, with significant differences between groups （ P 〈 0.01 or P 〈 0.05 ）. Liver stiffness was positively correlated with the stage of hepatic fibrosis （r = 0. 810, P 〈 0.01 ）. The AUC of liver stiffness for detecting liver cirrhosis was 0.956; the cut-off value for diagnosing liver cirrhosis was 13.1 kPa; the sensitivity was 92.7%, and the specificity was 80%. Conclusion FS is a promising noninvasive method for the assessment of hepatic fibrosis in patients with HBeAg - negative CHB ; particularly, it has high accuracy in the diagnosis of liver cirrhosis. FS combined with direct or indirect markers may play an important role in differential diagnosis and efficacy evaluation in patients with hepatic fibrosis.