Diagnostic value of serum protein profiling by SELDI-TOF ProteinChip compared with a biochemical marker, FibroTest, for the diagnosis of advanced fibrosis in patients with chronic hepatitis C

BACKGROUND: FibroTest has been validated for the diagnosis of liver fibrosis in patients with chronic hepatitis C. AIM: To compare FibroTest with a new proteome-based model for the prediction of advanced liver fibrosis. METHODS: Sera from 191 consecutive patients with simultaneous liver biopsy and FibroTest on fresh sera were used for retrospective mass spectrometry analysis. A new fibrosis index was constructed combining proteomic peaks, selected on differential expression according to fibrosis stages in logistic regression analyses. The main end point was the diagnosis of advanced fibrosis on liver biopsy. RESULTS: Eight out of 1000 peaks were selected for the construction of the proteomic index. The area under the receiver operating curve (AUROC) of the proteomic index was 0.88 (95% CI: 0.82-0.92), significantly greater than the FibroTest AUROC of 0.81 (95% CI: 0.74-0.86; P = 0.04); the AUROC of the proteomic and FibroTest combination was 0.88 (95% CI: 0.83-0.92). Seven of the eight selected peaks were highly associated with the FibroTest score, with different patterns of association with the five components of FibroTest. CONCLUSIONS: A proteomic index combining eight peaks had an excellent accuracy value for the diagnosis of advanced fibrosis in patients with chronic hepatitis C. However, despite a statistical significance, the small improvement delivered by proteomics impairs clinical applications because of its cost and its variability compared with the well validated FibroTest.     

The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B

Background  The Fib-4 index is a simple and inexpensive biomarker to delineate liver fibrosis in chronic hepatitis C.
Aim  To assess the accuracy of the FIB-4 index in chronic hepatitis B.
Methods  We compared the FIB-4 index with 138 synchronous liver biopsies and with 372 synchronous FibroTest performed either in France or in an endemic area (Mayotte, an overseas collectivity of France).
Results  The FIB-4 index allowed the correct identification of patients with nil-to-moderate fibrosis with an area under the receiving operating characteristic curve of 0.81 ( P  < 0.001), increasing as a function of the length of the liver biopsy (up to 0.94 for liver biopsies ≥20 mm). A cut-off value ≤1.45 differentiated moderate fibrosis from severe fibrosis with a negative predictive value of 86%, a sensitivity of 71.1% and a specificity of 73.1%. Beyond 1.45, the FIB-4 index was not informative. The FIB-4 index was more precise than the AST-to-platelet ratio index and correlated with the FibroTest in 89% of the cases (κ = 0.27, P  < 0.001) to exclude severe fibrosis.
Conclusion  The FIB-4 index is a simple, accurate and inexpensive method to exclude significant liver fibrosis in chronic hepatitis B, a major advantage in HBV-endemic developing countries.     

Novel tests for evaluating two ROC curves under paired samples

Disease prevention is important and can be accomplished by developing diagnostic tests. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) are used to assess the accuracy of diagnostic tests. The assessment for the superiority between evaluating two diagnostic tests is needed when comparing two diagnostic tests. Existing tests are constructed by comparing two AUCs under the paired samples. Nevertheless, it is problematic when two ROC curves are crossing. This article proposes a test that takes into account the possible correlation between pairs. Simulations are conducted to evaluate the feasibility of the test.     

Comparison of Paired ROC Curves through a Two-Stage Test

The area under the receiver operating characteristic (ROC) curve (AUC) is a popularly used index when comparing two ROC curves. Statistical tests based on it for analyzing the difference have been well developed. However, this index is less informative when two ROC curves cross and have similar AUCs. In order to detect differences between ROC curves in such situations, a two-stage nonparametric test that uses a shifted area under the ROC curve (sAUC), along with AUCs, is proposed for paired designs. The new procedure is shown, numerically, to be effective in terms of power under a wide range of scenarios; additionally, it outperforms two conventional ROC-type tests, especially when two ROC curves cross each other and have similar AUCs. Larger sAUC implies larger partial AUC at the range of low false-positive rates in this case. Because high specificity is important in many classification tasks, such as medical diagnosis, this is an appealing characteristic. The test also implicitly analyzes the equality of two commonly used binormal ROC curves at every operating point. We also apply the proposed method to synthesized data and two real examples to illustrate its usefulness in practice.     

利用联合诊断评价慢性乙型肝炎患者肝纤维化程度

目的了解实验室检测指标的平行和系列联合在判断慢性乙型肝炎患者肝纤维化程度的作用。方法调查322例乙型肝炎表面抗原(HBsAg)阳性的乙型肝炎患者,利用ROC曲线计算曲线下面积(AUROC),判断最优截断点并计算各指标的平行联合和系列联合时的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)、Youden指数。结果AUROC>0.7的有谷氨酸转肽酶(GGT)、天冬氨酸转氨酸(AST)和血小板(PLT)的比值(APRI)、年龄和PLT的比值(AGE-PLT)和AST,分别为0.772、0.769、0.748和0.700。AGE-PLT和AST平行联合时灵敏度和阴性预测值最高(89.36%,92.06%),GGT和AGE-PLT系列联合时特异度和阳性预测值最高(96.05%,85.25%)。结论对于HBsAg阳性的慢性乙型肝炎患者,可以尝试用实验室的直接或间接指标的平行联合和系列联合来诊断肝纤维化的程度。     

MELD-Na、MELD及Child-Pugh评分系统预测人工肝治疗的肝衰竭预后价值的探讨

目的:评价MELD-Na、终末期肝病模型(MELD)及Child-Pugsh评分系统对预测人工肝治疗的肝衰竭预后的价值.方法:使用受试者工作特征(ROC)曲线对Child-Push、MELD-Na及MELD评分系统的诊断价值进行评估.结果:ROC曲线评估Child-Push,MELD,MELD-Na评分系统预测预后的能力,显示Child-PUsh评分系统的曲线下面积(AUC)为0.794,显著高于MELD(Auc为0.664)和MELD-Na(AUC为0.724),差异均有统计学意义,其各自的临界值(cut-off值)分别是10.5、24.8、26.4.对于不同肝衰竭分型3种评分系统的比较发现亚急性和慢加急性肝衰竭3种评分系统的预测性差异无统计学意义,而慢性肝衰竭的Child-Push评分系统的预测性更高.结论:Child-Push、MELD和MELD-Na评分系统对于肝衰竭的诊断均有较好的预测性,Child-PIlsh评分系统对肝衰竭预后判断的价值更高.     

Use of the AST to platelet ratio index in HCV/HIV co-infected patients

Aliment Pharmacol Ther 2011; 33: 566–577

Summary

Background The AST to platelet ratio index (APRI), a non‐invasive marker of liver fibrosis, has not been well studied in HCV/HIV (hepatitis C virus/human immunodeficiency virus) co‐infected patients with advanced HIV. Aim To compare the accuracy of APRI in HCV/HIV co‐infected patients to that in HCV mono‐infected patients and to determine the impact of CD4+ T‐cell counts on its performance. Methods We identified 106 consecutive HCV/HIV co‐infected patients and 105 matched HCV mono‐infected patients who underwent liver biopsy at Harborview Medical Center over a 5‐year period. Performance characteristics were calculated and receiver operating characteristic (ROC) analysis conducted. Results The area under the ROC curve (AUROC) of APRI for predicting significant fibrosis was similar when comparing those with and without HIV co‐infection (0.77 vs. 0.86, P = 0.18), but was lower in HIV co‐infected patients with CD4 counts <250 cells/mm³ (0.64 vs. 0.86, P = 0.05). In HIV co‐infected patients with CD4 counts ≥250, APRI had higher negative predictive value (93% vs. 88%, P = 0.57), positive predictive value (63% vs. 40%, P = 0.43) and specificity (95% vs. 88%, P = 0.05) than in those with lower CD4 counts. Conclusions The AST to platelet ratio index (APRI) performance characteristics appear to be suboptimal in HCV/HIV co‐infected patients with CD4 counts <250 and they require further study in this population at increased risk for advanced liver disease.     

磁共振成像及超声检查诊断子宫腺肌症价值的ROC曲线分析

目的用受试者操作特性(ROC)分析方法评价磁共振成像(MRI)、超声检查(US)对子宫腺肌症的诊断价值。方法回顾性分析经手术与病理证实的子宫腺肌症(78例)和子宫肌瘤(122例)的MRI和US资料,以五级法判读,采用Windows95版ROCKIT软件进行ROC曲线分析,使用微软Excel8.0软件绘制ROC曲线图。结果MRI和US检查的ROC曲线分析显示,MRI曲线的截距(a值)为5.17,斜率(b值)为1.63,曲线下面积(Az)为0.9966;US曲线的a值为1.78,b值为0.82,Az值为0.9157。两种方法的Az值明显不同,差异有统计学意义(P=0.000)。结论MRI诊断子宫腺肌症较US具有优势。     

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AUROC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。     

Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests

Background Systematic screening for liver fibrosis in heavy‐drinking patients is a challenge. Aims To assess Fibroscan for non‐invasive diagnosis of asymptomatic liver fibrosis in alcohol abuse patients, to determine diagnostic liver stiffness cut‐off values and to compare performance of Fibroscan with seven non‐invasive laboratory tests. Methods One hundred and three alcoholic patients were studied. Liver fibrosis was staged by METAVIR system. Fibroscan, Fibrotest, Fibrometer, Hepascore, APRI, PGA, PGAA and hyaluronic acid tests were performed. Liver stiffness cut‐offs were determined using receiver‐operating characteristic (ROC) curves. Results Liver stiffness was correlated with fibrosis (r = 0.72, P < 0.014), with median at 5.7, 6.3, 8.4, 15 and 47.3 kPa for F0 (n = 8), F1 (n = 18), F2 (n = 24), F3 (n = 20) and F4 (n = 33) stage fibrosis respectively. For Fibroscan, areas under ROC curves (AUROCs) were 0.84 (95% CI: 0.73–0.95) (F ≥ 1), 0.91 (0.85–0.98) (F ≥ 2), 0.90 (0.82–0.97) (F ≥ 3) and 0.92 (0.87–0.98) (F = 4), yielding diagnostic stiffness cut‐offs of 5.9 (F ≥ 1), 7.8 (F ≥ 2), 11 (F ≥ 3) and 19.5 (F4) kPa. Sensitivity, specificity, PPV and NPV were 80%, 90.5%, 93% and 70% for F ≥ 2, and 85.7%, 84.2%, 68.6% and 87.9% for F = 4. Performance of Fibroscan was higher than seven laboratory tests, for which AUROCs ranged from 0.66 to 0.77 (F ≥ 1), from 0.54 to 0.82 (F ≥ 2), from 0.43 to 0.88 (F ≥ 3) and from 0.56 to 0.89 (F = 4), with significant difference only vs. APRI (P < 0.001) and Hepascore (P = 0.04). Combining Fibroscan with each tests did not improve performance. Conclusions Fibroscan is effective to assess liver fibrosis in alcoholic patients. Instant screening of liver fibrosis in heavy drinkers is feasible without liver biopsy.     

Fibroscan对慢性乙型肝炎肝脏纤维化的诊断价值

目的:探讨肝脏瞬时弹性探测仪(Fibroscan,FS)对慢性乙型肝炎肝脏纤维化的诊断价值。方法:对88例慢性乙型肝炎患者行FS检查,记录所检测到的肝硬度值。所有受试者均于同期行肝穿刺活检。以肝活检病理结果为金标准绘制FS工作特征曲线,计算曲线下面积(AUC),评价其对慢性乙型肝炎肝脏纤维化的诊断价值。结果:肝硬度检测值与肝脏病理分期呈正相关(r=0.747,P<0.01)。FS对显著纤维化(S2~S4期)、严重纤维化(S3~S4期)和早期肝硬化(S4期)的AUC值分别为0.857、0.934和0.948,以灵敏度和特异度之和的最大值选定的最优cut-off值分别为7.25、9.25和12.4kPa。结论:FS可以较准确地估计慢性乙型肝炎患者纤维化程度,对乙型肝炎的诊断和治疗有指导意义。     

Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis

Background  Liver stiffness measurements may have potential for detecting and monitoring hepatic fibrosis in chronic liver disease.
Aim  To study the detection, quantification and progression of hepatic fibrosis in primary biliary cirrhosis by liver stiffness measurements.
Methods  Liver stiffness measurements were generated in 80 patients with primary biliary cirrhosis by applying transient elastography; however, as there were 55 with liver biopsy, histological stage (METAVIR) and liver stiffness measurements were compared only in these 55 patients. The efficiency of liver stiffness measurements in predicting stage of fibrosis was determined from the area under receiver operating characteristics curve analysis.
Results  Of the 80 patients included, 91, 4% were women and their mean age was 56 ± 12 (s.d.) years. A significant correlation was found ( P  < 0.05) between histological fibrosis stage (METAVIR) and liver stiffness measurements. The values obtained from area under receiver operating characteristic curve analysis of liver stiffness measurement data were 0.89 for F  > 2 and 0.96 for F  = 4. Liver stiffness measurements were 9.0 ± 5.3 and 7.9 ± 6.0 kPa for patients followed up more than 5 years and less than 5 years, respectively ( P  > 0.05).
Conclusions  In patients with primary biliary cirrhosis, median values of liver stiffness measurements correlated with histological severity of hepatic fibrosis. Liver stiffness measurements appear to be promising for liver fibrosis detection and quantification, as well as monitoring its progression, in patients with primary biliary cirrhosis. The progression rate of hepatic fibrosis in our primary biliary cirrhosis patients appears to be slow.     

超声检测慢性肝病患者肝中静脉的临床意义

目的 探讨B型超声检测肝中静脉内径在慢性肝病患者中的临床应用价值.方法 80例慢性肝病患者在接受肝穿刺活组织检查的同时,采用B型超声检测肝中静脉内径,用ROC曲线分析肝中静脉内径诊断肝硬化的强度.结果 肝硬化患者肝中静脉内径[(3.82±1.84)mm]小于慢性肝炎患者[(6.15±1.67)mm](P＜0.01),失代偿性肝硬化患者肝中静脉内径[(2.98±1.15)mm]小于代偿性肝硬化患者[(4.42±2.20)mm](P＜0.05);随着肝纤维化分期的增加,肝中静脉内径逐渐缩小,两者呈负相关关系(rs=-0.465),肝中静脉内径诊断肝硬化的截断点为4.7 mm,ROC曲线下面积(AUC)达到0.813(P＜0.01),其灵敏度为67.5%,特异度为90.0%,阳性预测值为88.0%,阴性预测值为73.5%,Youden指数为57.5%.结论 B型超声检测肝中静脉内径对慢性肝病有一定的辅助诊断价值.     

高敏肌钙蛋白T诊断急性冠脉综合征及其危急值医学决定水平的研究

目的：探讨高敏肌钙蛋白T对急性冠脉综合征（ACS）诊断及其危急值的的临界值（cutoff）。方法采用化学发光法检测857例研究对象,其中307例ACS患者和550例正常对照者血浆高敏心肌肌钙蛋白T（cTnT-hs）和高敏心肌肌钙蛋白I（cTnI-hs）,应用受试者工作特征曲线（ROC）进行分析。结果cTnT-hs为0.030ng/mL时,其诊断ACS的ROC曲线下面积为0.912,敏感度为89.6%,特异度为83.8%,阴性预测值为92.6%,阳性预测值为94.4%,正确诊断指数为0.734。当以cTnT-hs为0.10ng/mL作为ACS危急界限值时,ROC曲线下面积为0.927,敏感度为90.9%,特异度为87.9%,阴性预测值为89.3%,阳性预测值为86.5%,正确诊断指数为0.788。结论cTnT-hs是诊断ACS敏感而特异的指标,当cutoff值分别为0.03ng/mL、0.10ng/mL时,cTnT-hs诊断ACS及其危急值的cutoff值综合评价最佳。     

Assessment of liver fibrosis before and after antiviral therapy by different serum marker panels in patients with chronic hepatitis C

Aliment Pharmacol Ther 2011; 33: 138–148

Summary

Background Liver biopsy is the reference standard to assess liver fibrosis in chronic hepatitis C. Aim To validate and compare the diagnostic performance of non‐invasive tests for prediction of liver fibrosis severity and assessed changes in extracellular matrix markers after antiviral treatment. Methods The performances of Forns’ score, AST to platelet ratio index (APRI), FIB‐4 index and Enhanced Liver Fibrosis (ELF) score were validated in 340 patients who underwent antiviral therapy. These scores were determined 24 weeks after treatment in 161 patients. Results Forns’ score, APRI, FIB‐4 and ELF score showed comparable diagnostic accuracies for significant fibrosis [area under the receiver operating characteristic curve (AUROC) 0.83, 0.83, 0.85 and 0.81, respectively]. To identify cirrhosis, FIB‐4 index showed a significantly better performance over APRI and ELF score (AUROC 0.89 vs. 0.83 and 0.82, respectively). ELF score decreased significantly in patients with sustained virological response (SVR) (P < 0.0001) but remained unchanged in nonresponders. Non‐1 hepatitis C virus (HCV) genotype, baseline lower HCV RNA, glucose, hyaluronic acid and higher cholesterol levels were independently associated with SVR. Conclusions Simple panel markers and ELF score are accurate at identifying significant fibrosis and cirrhosis in chronic hepatitis C. A decrease in ELF score after antiviral treatment reflects the impact of viral clearance in hepatic extracellular matrix and probably in the improvement of liver fibrosis.     

残总比对慢性阻塞性肺疾病诊断的临床意义

目的:探讨残气容积/肺总量比值(RV/TLC)对慢性阻塞性肺疾病(COPD)辅助诊断的临床意义,寻求以RV/TLC用于诊断COPD的最适参考值。方法:回顾性分析我院2010年5—12月行肺功能检查的209例肺功能检查患者,其中:COPD患者组130例,非COPD患者组79例。记录性别、年龄等一般情况以及RV、TLC、1秒率等指标,以1秒率作为"金标准"计算RV/TLC诊断COPD的敏感度、特异度、阳性似然比、阴性似然比、Youden指数,并绘制ROC曲线。结果:ROC曲线下面积为0.792,其最佳诊断临界点52.8%,敏感度为73.1%,特异度为73.4%。结论:RV/TLC在COPD诊断、鉴别诊断、初筛中有临床意义。     

The C-caffeine breath test distinguishes significant fibrosis in chronic hepatitis B and reflects response to lamivudine therapy

BACKGROUND: The 13C-caffeine breath test is a non-invasive, quantitative test of liver function. AIM: To determine the utility of the 13C-caffeine breath test in chronic hepatitis B virus and its ability to monitor response to lamivudine. METHODS: Forty-eight chronic hepatitis B virus patients and 24 controls underwent the 13C-caffeine breath test. In 28 patients commenced on lamivudine, 13C-caffeine breath tests were performed at 1 week (n = 12) and after 1 year of therapy. RESULTS: Patients with Metavir F0-1 fibrosis (2.30 +/- 1.02 Delta per thousand per 100 mg caffeine) had a 13C-caffeine breath test similar to controls (2.31 +/- 0.85, P = 0.96). However, patients with F2-3 fibrosis (1.59 +/- 0.78, P = 0.047) and cirrhotic patients (0.99 +/- 0.33, P = 0.001) had a decreased 13C-caffeine breath test. Fibrosis correlated best with the 13C-caffeine breath test (r(s) = -0.62, P < 0.001). The 13C-caffeine breath test independently predicted significant (F > or = 2) and advanced (F > or = 3) fibrosis and yielded the greatest area under the receiver operating characteristic curve (0.91 +/- 0.04) for predicting advanced fibrosis. The 13C-caffeine breath test was unaltered by 1 week of lamivudine but improved by 61% (P < 0.001) in responders to long-term lamivudine, whereas in those with viraemia and elevated alanine aminotransferase, values remained stable or deteriorated. CONCLUSION: The 13C-caffeine breath test distinguishes chronic hepatitis B virus-related fibrosis and detects improvement in liver function in response to long-term lamivudine.     

Relationship between the Fibrotest and portal hypertension in patients with liver disease

BACKGROUND: The best technique to estimate portal hypertension (PHT) is to measure the hepatic venous pressure gradient (HVPG), which is an invasive method. AIM: To assess the relationship between the Fibrotest (Biopredictive, Paris, France) and the presence and degree of PHT in patients with liver disease, and to determine if the Fibrotest can diagnose severe PHT, defined by HVPG >or= 12 mmHg, in cirrhotic patients. METHODS: Patients who underwent a transjugular liver biopsy were prospectively included. HVPG was measured, and classification of histological lesions assessed. The same day, blood samples for Fibrotest were performed. RESULTS: A total of 130 patients were included (no or minimal fibrosis: 12%, moderate fibrosis 17%, cirrhosis 71%). There was a significant correlation between Fibrotest and HVPG (Pearson correlation coefficient = 0.58, P < 0.0001), also weaker in cirrhotic patients (Pearson correlation coefficient = 0.24, P = 0.02). In cirrhotic patients, Fibrotest was significantly higher when there was a severe PHT (0.87 +/- 0.15 vs. 0.73 +/- 0.14, respectively, P = 0.02). The areas under the receiver operating characteristic curves for the diagnosis of severe PHT was 0.79 +/- 0.07, not different from that of platelets and Child-Pugh score. CONCLUSION: In patients with liver disease or cirrhosis, Fibrotest is correlated with the presence and degree of PHT. Other studies are needed to confirm these results, especially in non-decompensated cirrhotic patients.     

血清胱抑素C在原发性高血压早期肾损伤中的价值探讨

目的探讨血清胱抑素C（CysC）在原发性高血压早期肾损伤中的价值。方法选择原发性高血压肾病患者104例（研究组）和120例健康对照者（正常对照组）进行血清CysC、尿肾功能[尿微量白蛋白（mAlb）、尿N-乙酰-β-D氨基葡萄糖苷酶（NAG）、尿β2-微球蛋白（β2-MG）]检测,建立受试者工作特征曲线（ROC）评价系统进行分析。结果研究组患者血CysC、尿mAlb、NAG、β2-MG水平与正常对照组比较差异均有统计学意义[1．22（0．90～1．51）mg／L比0．73（0．62～0．79）mg／L,24．35（17．40～42．80）mg／gCr比12．95（7．50．～19．80）mg／gCr,7．7（3．13～12．35）U／gCr比6．2（5．30～7．70）U／gCr,0．25（0．09～0．31）mg／gCr比0．13（0．07～0．21）mg／gCr（Z=9．47、9．03、2．24、4．61,P〈0．0l或P〈0．05]。研究组患者CysC的ROC曲线下面积为0．87,与NAG、β2．MG曲线下面积（0．59,0．68）比较差异具有统计学意义（P〈0．01）;CysC约登指数为0．69,对应的特异度为93％,敏感度为76％。结论血清CysC在原发性高血压早期肾损伤的诊断价值优于尿NAG、β2-MG,与尿mAlb具有同样重要的价值,联合检测CysC和mAlb可早期发现原发性高血压患者肾功能的改变,对原发性高血压早期肾损伤诊治及预后估计具有重要意义。     

超声弹性成像及超声造影技术评估慢性乙肝肝纤维化程度的临床研究

目的　探讨声触诊组织量化（VTQ）及超声造影（CEUS）技术对慢性乙肝肝纤维化程度的诊断价值。方法　65例慢性乙肝患者分别进行VTQ、CEUS技术检查及肝穿刺活检,获取剪切波速度（SWV）及造影参数：门静脉到达时间（PVAT）、肝动脉到达时间（HAAT）、肝静脉到达时间（HVAT）、肝实质达峰时间（TTP）、肝动脉-肝静脉渡越时间（HV-HAAT）、肝动脉-门静脉渡越时间（PV-HAAT）。根据病理结果分为轻度组12例、中度组23例和重度组30例,比较各组SWV和CEUS参数差异,分析SWV、CEUS参数与肝纤维化程度的相关性,绘制受试者工作特征（ROC）曲线,寻找SWV、CEUS参数诊断重度肝纤维化的截断值,计算曲线下面积（AUC）,评价SWV、CEUS参数对重度肝纤维化的诊断效能,采用DeLong法比较不同检测方法的AUC差异。结果　与轻度组比较,中度组和重度组SWV增大,重度组HVAT、HV-HAAT减小（P＜0.05）;与中度组比较,重度组SWV增大,HVAT、HV-HAAT减小（P＜0.05）。SWV与肝纤维化严重程度呈正相关（rs=0.713,P＜0.05）,HVAT、HV-HAAT与肝纤维化严重程度呈负相关（rs分别为 -0.437、-0.620,P＜0.05）;SWV、HVAT、HV-HAAT诊断重度组肝纤维化（肝硬化）的AUC（95%CI）分别为0.925（0.832~0.976）、0.734（0.610~0.836）、0.804（0.687~0.892）,截断值分别为1.92 m/s、21.02 s、8.23 s;SWV的诊断效能优于HVAT、HV-HAAT（Z分别为2.817和1.987,均P＜0.05）。结论　与CEUS相比,VTQ技术对慢性乙肝肝纤维化程度的诊断效能更佳。