瞬时弹性成像联合APRI和FIB-4指数模型无创诊断慢性HBV感染者肝纤维化的临床价值

目的 探讨瞬时弹性成像联合谷草转氨酶/血小板比值(APRI)和FIB-4指数无创诊断慢性乙型肝炎病毒(HBV)感染者肝纤维化程度的临床价值.方法 对265例慢性HBV感染者进行肝脏穿刺病理学检查,并于穿刺当日检测患者相关临床指标,应用瞬时弹性成像技术(FibroTouch)检测肝脏硬度(LSM),根据临床指标分别得出APRI和FIB-4指数结果.以肝脏病理结果为金标准,分别绘制LSM、APRI及FIB-4指数的受试者工作曲线(ROC),评价其对显著纤维化(≥S2)、严重肝纤维化(≥S3)和肝硬化(S=4)的预测价值,并将APRI、FIB-4指数分别与LSM值联合诊断慢性HBV感染者肝脏纤维化程度,并利用联合法计算诊断肝纤维化程度的灵敏度、特异度等.结果 随着肝纤维化程度的加重,LSM值(rs=0.622,P<0.001)与肝纤维化分期相关性明显高于APRI及FIB-4指数.在265例患者中,FibroTouch在诊断慢性HBV感染者显著肝纤维化(≥S2)、严重肝纤维化(≥S3)、肝硬化(S=4)的AUC分别为0.810、0.881、0.961,明显高于APRI和FIB-4相应的ROC曲线下面积.据ROC曲线得出诊断显著肝纤维化(≥S2)、严重肝纤维化(≥S3)、肝硬化(S=4)的FibroTouch、APRI和FIB-4各自截断值,得出在肝纤维化各分期的诊断中,FibroTouch特异度及敏感度均高于APRI、FIB-4.同时将FibroTouch分别与APRI、FIB-4联合诊断,并联诊断可提高诊断的敏感度.其与APRI并联时其敏感度可达到91.11%以上,与FIB-4并联时敏感度亦可明显上升.而串联诊断则可明显提高诊断的特异度,其中FibroTouch与APRI串联时其特异度可达94.42%以上.结论 FibroTouch无创诊断肝纤维化的灵敏度及特异度均优于APRI及FIB-4.APRI、FIB-4与FibroTouch联合诊断肝纤维化的灵敏度及特异度明显优于FibroTouch、APRI、FIB-4单项指标.

Diagnostic value of transient elastography (FibroTouch) combined withAPRI and FIB-4 on liver fibrosis in patients with chronic hepatitis B

Objectives To explore the clinical value of transient elastography (FibroTouch) combined with aspartame aminotransferase to platelet ratio index (APRI) and fibrosis index based on the 4 factor (FIB-4) on liver fibrosis in patients with chronic hepatitis B.Methods The severity of liver fibrosis in 265 chronic hepatitis B patients was assessed by liver biopsy and liver stiffness measurement(LSM) was checked by FibroTouch;routine laboratory indicators were examined to calculate APRI and FIB-4 index.The diagnostic value of FibroTouch, APRI and FIB-4 index in significant fibrosis, advanced fibrosis and cirrhosis were assessed according to the area under the receiver operating characteristic curves (ROC).APRI and FIB-4 index were combined with LSM to evaluate the liver fibrosis degree of patients with chronic hepatitis B respectively and calculated the sensitivity(SN), specificity(SP) et al.Results With the increase of liver fibrosis, the value of LSM (rs=0.622, P<0.001) had higher correlation than APRI and FIB-4 indexes in liver fibrosis stage.Diagnosis of 265 chronic HBV patients, the area under ROC curve of FibroTouch for significant fibrosis(≥S2), advanced fibrosis(≥S3) and cirrhosis(S=4) were 0.810, 0.881 and 0.961 respectively, which were significantly higher than APRI and FIB-4 index.The cutoff value of FibroTouch, APRI and FIB-4 index in significant fibrosis(≥S2), advanced fibrosis(≥S3) and cirrhosis(S=4) were obtained according to the area under the ROC cure.The sensitivity and specificity of FibroTouch on any hepatic fibrosis stage were all better than APRI and FIB-4.FibroTouch was combined with APRI or FIB-4 indexs respectively;parallel test improved the sensitivity of diagnosis.The value of sensitivity was more than 91.11% when FibroTouch combined with APRI by the parallel test respectively and the sensitivity also increased obviously when combined with FIB-4.However, the specificity of diagnosis had a significant improvement by serial test.The value of specificity was more than 94.42% when FibroTouch was combined with APRI by the serial test respectively.Conclusion The sensitivity and specificity of FibroTouch on diagnosis of hepatic fibrosis are all better than APRI and FIB-4.In the noninvasive diagnosis of liver fibrosis, each of their combinations is better than that of the individual.