ARFI、Forns指数、FIB-4和APRI无创诊断慢性乙型病毒性肝炎肝纤维化的研究

目的声辐射力脉冲成像技术(ARFI)及血清学诊断模型(Forns指数、FIB-4、APRI)对慢性乙型病毒性肝炎肝纤维化评估的价值。方法 111例确诊为慢性乙型病毒性肝炎患者,根据肝组织活检病理分期结果分组:无明显肝纤维化组(S0、S1)40例,明显肝纤维化组(≥S2)48例、早期肝硬化组(S4)23例。每例患者同期进行ARFI、Forns指数、FIB-4、APRI的评估。比较无创诊断模型与肝脏病理的相关性,并根据受试者工作特征曲线(ROC)分析无创诊断模型对肝纤维化的诊断价值。结果ARFI、Forns指数、FIB-4、APRI 4种无创诊断方法与肝组织活检具有良好的一致性,其皮尔逊相关系数(Pearson correlation coefficient)分别为0.882、0.639、0.589、0.418。明显肝纤维化组(≥S2)及早期肝硬化组,ARFI的诊断价值均优于FIB-4(Z=2.882,P=0.004;Z=3.215,P=0.001)、APRI(Z=4.850,P0.001;Z=3.198,P=0.001)、Forns指数(Z=2.182,P=0.029;Z=2.798,P=0.005)。结论 ARFI对明显肝纤维化及早期肝硬化的诊断具有较高的价值,值得推广。

ARFI,Forns index,FIB-4 and APRI diagnosis liver ifbrosis in patients with chronic liver diseases

Objective To assessment the value of acoustic radiation force impulse （ARFI） and serological diagnosis model （Forns index, FIB-4, APRI） to liver fibrosis of chronic hepatic B. Methods Total of 111 patient confirmed as CHB, divided into groups according to the result of the liver biopsy： no significant liver ifbrosis group （S0, S1） 40 cases, signiifcantly ifbrosis group （≥S2） 48 cases, early cirrhosis group （S4） 23 cases. During the same period, each patient with the assessment of ARFI, Forns index, Fib-4 and APRI. Compared the correlation of noninvasive diagnosis model and liver biopsy. Moreover, analysis the diagnostic value of noninvasive liver ifbrosis model to the liver ifbrosis according to the receiver-operating characteristic curve. Results ARFI, Forns index, FIB-4, APRI, the four kinds of noninvasive diagnostic method has a good consistency with liver biopsy, and their Pearson correlation coefifcient were 0.882, 0.639, 0.589, 0.418. The assessment value of ARFI to signiifcantly ifbrosis group （≥S2） was superior to FIB-4 （Z=2.882, P=0.004;Z=3.215, P=0.001）, APRI （Z=4.850, P＆lt;0.001;Z=3.198, P=0.001）, Forns index （Z=2.182, P=0.029;Z=2.798, P=0.005）. Conclusions The assessment value to signiifcantly ifbrosis and early cirrhosis of ARFI is higher than others and worthy of promotion.