FibroScan对低水平ALT乙肝患者肝纤维化程度的诊断价值

目的:探讨FibroScan对乙型肝炎病毒DNA>20 000 IU/mL但丙氨酸氨基转移酶（ALT）小于或等于正常上限2倍的慢性乙型肝炎患者肝纤维化程度的诊断价值。方法:选取2018年1月-2019年8月在苏州市第五人民医院肝病科确诊的乙型肝炎病毒DNA>20 000 IU/mL但ALT小于或等于正常上限2倍的慢性乙型肝炎患者57例,同时行FibroScan、声脉冲辐射力成像(ARFI)检测,测定血液生化指标计算天冬氨酸氨基转移酶与血小板比值指数(APRI),以肝组织病理结果为金标准,ROC曲线分析FibroScan、ARFI和APRI无创评估乙肝肝纤维化的价值。结果:肝纤维化分期≥S2、≥S3和S4时,FibroScan、ARFI、APRI的ROC曲线下面积（AUC）分别为0.88、0.89、0.98,0.86、0.82、0.89和0.69、0.70、0.73；两两比较结果显示,FibroScan评估各期的AUC与同期的ARFI无统计学差异；FibroScan评估各期的AUC均明显大于同期的APRI(Z=2.26,P=0.01；Z=2.33,P=0.01；Z=2.84,P<0.001) 。评估乙肝肝纤维化≥S2时,FibroScan、ARFI和APRI的约登指数分别为63.44％、67.77％和33.89％；评估乙肝肝纤维化≥S3时,FibroScan、ARFI和APRI的约登指数分别为65.79％、63.16％和31.57％；评估乙肝肝纤维化S4时,FibroScan的约登指数最大（93.75％）,远高于ARFI的72.22％和APRI的45.14％,且敏感性达到了100％。结论:对于乙型肝炎病毒DNA>20 000 IU/mL但ALT小于或等于正常上限2倍的慢性乙型肝炎患者,FibroScan评估肝纤维化严重程度的综合价值优于ARFI和APRI,尤其是评估S4时,可作为判断接受抗病毒治疗的依据。

Diagnostic value of FibroScan for hepatic fibrosis degree in patients with low levels of alanine aminotransferase hepatitis B

Objective:To investigate the diagnostic value of FibroScan in evaluating the degree of liver fibrosis in chronic hepatitis B patients with hepatitis B virus DNA>20 000 IU/mL but alanine aminotransferase (ALT) less than or equal to 2 times of the upper limit of normal. Methods:A total of 57 chronic hepatitis B patients with hepatitis B virus DNA>20 000 IU/mL but ALT less than or equal to 2 times of normal upper limit were selected from January 2018 to August 2019 in the Department of Hepatology of The Fifth People′s Hospital of Suzhou. At the same time, FibroScan, acoustic pulsed radiation force imaging (ARFI) and blood biochemical indexes were determined to calculate aspartic aminotransferase to platelet ratio index (APRI). With the pathological results of liver tissue as the gold standard, ROC curve analysis was performed to evaluate the value of FibroScan, ARFI and APRI in non invasive evaluation of hepatitis B fibrosis. Results:The area under ROC curve (AUC) of FibroScan, ARFI and APRI were 0.88,0.89,0.98,0.86,0.82,0.89 and 0.69,0.70,0.73 when liver fibrosis stage ≥S2, ≥S3 and S4, respectively. Pairwise comparison results showed that there was no statistical difference between the AUC of each stage assessed by FibroScan and the ARFI of the same period. The AUC of each stage assessed by FibroScan was higher than those in the APRI of the same period (Z=2.26, P=0.01; Z=2.33, P=0.01; Z=2.84, P<0.001). The Youden index (sensitivity+specificity-1) of FibroScan, ARFI and APRI were 63.44%, 67.77% and 33.89%, respectively, when evaluating hepatitis B fibrosis ≥S2. the Youden index of FibroScan, ARFI and APRI were 65.79%, 63.16% and 31.57%, respectively, when evaluating hepatitis B fibrosis ≥S3. In the evaluation of hepatitis B fibrosis in S4, FibroScan′s Youden index was 93.75%, much higher than ARFI′s 72.22% and APRI′s 45.14%, and the sensitivity reached 100%. Conclusion:For chronic hepatitis B patients with hepatitis B virus DNA>20 000 IU/mL but ALT less than or equal to 2 times of the upper limit of normal, the comprehensive value of FibroScan in evaluating the severity of liver fibrosis is better than that of ARFI and APRI, especially when evaluating S4, which can be used as a basis for judging the acceptance of antiviral therapy.