FibroScan 诊断慢性乙肝患者肝脏纤维化的临床应用研究

目的：评估瞬时弹性超声成像（FibroScan）在慢性乙型肝炎（CHB）患者肝脏纤维化诊断中的临床应用价值。方法选取进行肝脏穿刺活检的 CHB 患者185例，收集血常规、肝功能等血清学指标。同时患者应用 FibroScan 进行肝脏弹性测量值（LSM）测量，分析 LSM 与肝纤维化的相关性及其影响因素。结果以肝脏穿刺病理结果为金标准， Spearman 等级相关性分析提示 LSM 与肝纤维化呈显著相关性（P <0.05）。单因素方差分析提示天门冬氨酸氨基转移酶、碱性磷酸酶、血小板、凝血酶原时间百分活动度与 LSM值呈相关性。受试者工作特性曲线（ROC）分析，S2~ S4期诊断界值依次为6.0、9.75、14.2 kPa，各阶段曲线下面积均>0.95。双变量分析提示 LSM 值与升高的转氨酶呈显著相关性（P <0.05）。ROC 分析转氨酶升高组 S1~ S2期界值为6.25 kPa，S3~ S4期界值为15.3 kPa。结论 FibroScan 诊断CHB 患者肝脏纤维化有较高的临床应用价值，但是受转氨酶影响大。

Evaluation of FibroScan in the diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective To evaluate the clinical value of FibroScan in the diagnosis of liver fibrosis in patients with chronic hepatitis B(CHB). Methods A total of 185 patients diagnosed with CHB based on pathological examina-tions were collected,while other biochemical markers were determined as well. Besides,FibroScan was used for all patients to detect liver stiffness measurement(LSM). The receive operating characteristic(ROC)curve was used to analyze the accuracy of FibroScan in the diagnosis of liver fibrosis in CHB patients. The relationships of LSM and biochemical markers were also analyzed. Results Compared with pathological examinations,FibroScan value was closely related with liver fibrosis(P < 0. 05). One-way ANOVA analysis indicated that AST,ALP,PLT and PT%were related with LSM value. ROC curve indicated the AUCs were all above 0. 95 for CHB patients with liver fibro-sis stages S2 ~ S4 and the cut-off values were 6. 0,9. 75 and 14. 2 kPa,respectively. Bivariate analysis indicated LSM value was related to up-regulated transaminase(P < 0. 05). ROC curve revealed the cut-off values of stage S1~ S2 was 6. 25 and 15. 3 kPa for stage S3 ~ S4 in CHB patients with transaminase abnormality. Conclusion Fi-broScan is valuable for the diagnosis of liver fibrosis in CHB patients,but limited by transaminase abnormality.