瞬时弹性成像联合APRI在慢性乙型肝炎肝纤维化诊断中的应用价值

目的 评价瞬时弹性成像(FibroScan)联合天冬氨酸转移酶(AST)与血小板指数(PLT)的比值(APRI)在判断慢性乙型肝炎患者肝纤维化程度中的作用.方法 选择152例临床确诊为慢性乙型肝炎患者,进行常规实验室检查、FibroScan检查和肝脏活组织检查,探究FibroScan及APRI的诊断价值,并绘制FibroScan、APRI以及联合诊断模型的受试者工作特征曲线(ROC曲线),分析三者与肝脏纤维化病理分期的相关性.结果 FibroScan与APRI对显著纤维化(S2～S4期)的曲线下面积(AUROC值)和95％可信区间(95％CI)分别为0.752(0.672～0.832),0.717(0.630～0.805),对S3～S4期的 AUROC值分别为0.937(0.890～0.985), 0.911(0.836～0.986),对S4期的AUROC值分别为0.973(0.947～0.998),0.934(0.862～1.000);两者联合后对S2～S4期的AU-ROC值为0.811(0.732～0.890).结论 FibroScan联合APRI诊断模型可以进一步提高对显著期肝纤维化的诊断效能,对临床选择抗病毒治疗,干预肝纤维化进程具有一定的指导意义.

Application of FibroScan combined with APRI for liver fibrosis in patients with chronic hepatitis B

Objective To evaluate the value of non-invasive detection-hepatic fibrosis ( FibroScan) combined with the ratio of AST and PLT ( APRI) in judging the degree of liver fibrosis in chronic hepatitis B patients. Methods A total of 152 cases of clinically diagnosed chronic hepatitis B patients were chosen;routine laboratory tests, FibroScan examination and liver biopsy were carried out, and the diagnostic value of FibroScan and APRI was explored;receiver operating characteristic curve( ROC curve) of FibroScan, APRI and combined diagnosis model were drawn out, and the relevance of these three and liver fibrosis stage was analysed. Results The area under the ROC curve ( AU-ROC value) of FibroScan and APRI for significant fibrosis(S2-S4 stage) was 0. 752 (0. 672~0. 832), 0. 717 (0. 630~0. 805), respec-tively, the AUROC values was 0. 937 (0. 890~0. 985), 0. 911 (0. 836~0. 986), respectively for S3-S4 stage, and the AUROC value was 0. 973 (0. 947~0. 998), 0. 934 (0. 862~1. 000), respectively for S4 stage. The AUROC value of combination FibroScan with APRI was 0. 811 (95％ CI:0. 732-0. 890) for S2-S4. Conclusion FibroScan combined with APRI diagnostic model can significantly improve the diagnosis effectiveness of liver fibrosis, and thus help clinicians choose antiviral therapy and early intervention in treating liver fibrosis.