FibroTouch检测肝硬度值及脂肪衰减值的稳定性分析

目的探讨FibroTouch(FT)检测肝硬度值(LSM)及脂肪衰减值(CAP)的稳定性。方法选择2018年11月20日-2019年1月14日安徽医科大学第二附属医院肝病科门诊行FT检测的慢性HBV感染者(n=177)、非酒精性脂肪性肝病(NAFLD)患者(n=56)、肝功能异常患者(n=34)以及其他疾病患者(n=42)共309例,对同一受检者的3个不同测量点进行FT检测,运用组内相关系数(ICC)、Bland-Altman法评价测量值的稳定性;运用Kendall’s W检验、饼状图评价诊断结果的稳定性。结果同一受测者的3个不同测量点检测的LSM值和CAP值在不同疾病组的ICC均>0.75(P值均<0.001),其中慢性HBV感染者组的LSM值ICC最大,为0.905;其他疾病组的CAP值的ICC最大,为0.805;而NAFLD组的LSM值和CAP值的ICC均最小,分别为0.785、0.780;3个测量点之间分别绘制Bland-Altman图,一致性限度内的点均维持在95%左右。通过分析,3个测量点的LSM分期及CAP分期的诊断结果的Kendall’s W系数分别为0.825、0.858(P值均<0.001);3个测量点独立诊断F≥2期(LSM>7.3 kPa)和至少达到轻度脂肪肝分期水平(CAP>240 dB/m)与其均值诊断结果完全一致的占比均>60%,仅有1个测量点诊断结果与均值诊断结果一致的占比均<10%。结论FT检测数值及诊断结果均具有很好的稳定性,但为了提高其诊断F≥2期和至少达到轻度脂肪肝分期的稳定性,建议多点测量取平均值进行诊断。

Stability of FibroTouch in determining liver stiffness measurement and controlled attenuation parameter

Objective To investigate the stability of FibroTouch(FT)in the determination of liver stiffness measurement(LSM)and controlled attenuation parameter(CAP).Methods A total of 309 patients with chronic hepatitis B virus(HBV)infection,nonalcoholic fatty liver disease(NAFLD),liver function abnormalities,or other diseases who underwent FT in the outpatient service of Department of Hepatology,The Second Affiliated Hospital of Anhui Medical University,were enrolled.FT was performed at three different measurement points for the same subject,and intraclass correlation coefficient(ICC)and the Bland-Altman method were used to evaluate the stability of measured values.The Kendall’s W test and pie charts were used to evaluate the stability of diagnostic results.Results LSM and CAP values of the three different measurement points for the same subject had an ICC of>0.75 in different disease groups(all P<0.001),among which the chronic HBV infection group had the highest ICC of LSM of 0.905,the other disease group had the highest ICC of CAP of 0.805,the NAFLD group had the lowest ICC of LSM of 0.785 and the lowest ICC of CAP of 0.780.The Bland-Altman plots were generated for the three measurement points,and the dots within the limits of agreement accounted for about 95%.The diagnostic results of LSM and CAP staging of the three measurement points had a Kendall’s W coefficient of 0.825 and 0.858,respectively(all P<0.001).The proportion of patients with consistency between the diagnostic results for F≥2 stage(LSM>7.3 k Pa)and mild(or more severe)fatty liver stage(CAP>240 dB/m)based on mean value of measurement points and all three measurement points was>60%,while the proportion of patients with consistency between the diagnostic results based on mean value of measurement points and only one measurement point was<10%.Conclusion The values and diagnostic results of FT measurement have good stability;however,in order to improve its stability in diagnosing F≥2 stage and mild(or more severe)fatty liver,it is suggested to use the mean value of multiple measurement points for diagnosis.