FibroScan对原发性胆汁性肝硬化患者肝纤维化的诊断价值

目的探讨FibroScan对于原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）肝纤维化诊断的准确性。方法选择2009年10月—2013年12月经肝脏穿刺病理诊断的PBC患者56例,进行FibroScan检测得到肝脏硬度测量（liver stiffness measurement,LSM）值。以肝脏活组织检查结果作为＂金标准＂,计算受试者工作特征曲线下面积（AUROC）,评价FibroScan对PBC肝纤维化的诊断价值。结果 LSM值平均为（13.714±7.475）kPa,与肝脏病理分期呈正相关,Kendall相关系数为0.897,P〈0.01。FibroScan诊断PBC肝纤维化≥S2期、≥S3期、S4期的AUROC分别为0.897、0.959、0.989。纤维化分期为≥F2、≥F3、F4时对应的最佳截断值分别为12.9、16.1和19.7 kPa。肝硬度、血清透明质酸、AST/PLT（APRI）均为肝脏病理分期独立相关因素。结论 FibroScan是一项方便、准确的用于诊断PBC肝纤维化程度的方法。

Diagnostic value of FibroScan for liver fibrosis in patients with primary biliary cirrhosis

Objective To assess the diagnostic veracity of liver stiffness measurement（ LSM） for liver fibrosis stage in primary biliary cirrhosis（ PBC）. Methods Fifty-six patients with PBC,who were diagnosed definitely,were prospectively enrolled in this study from Oct. 2009 to Dec. 2013. All patients underwent liver biopsy（ LB） and LSM. The values of LSM were obtained by Fibroscan. Fibrosis stages were assessed based on liver biopsy（ LB） by two experienced pathologists. With liver biopsy as gold standard,receiver operating characteristic（ ROC） curves were drawn,and then areas under the receiver operating characteristic curves（ AUROC） were calculated to evaluate diagnostic accuracy of transient elastography for liver fibrosis in patients with PBC. Results Stiffness values of the patients enrolled were（ 13. 714 ± 7. 475） kPa. Liver stiffness was positively correlated with liver fibrosis stage with a Kendall＇ s coefficient of 0. 897（ P 〈0. 001）. Using FibroScan for the assessment of liver fibrosis in patients with PBC,AUROC was 0. 959 for the patients with ≥F2,0. 989 for those with ≥F3 and0. 993 for those with F4. Optimal stiffness cutoff values for fibrosis stage ≥F2,≥F3 and F4 were 12. 9 kPa,16. 1 kPa,and19. 7 kPa respectively. Moreover,LSM,serum hyaluronic acid level and APRI（ ast /platelet-count） were independent parameters associated with fibrosis stage based on LB. Conclusions FibroScan is a convenient and accurate noninvasive means for assessing liver fibrosis in PBC.