瞬时弹性成像技术联合血清学指标对慢性乙型肝炎肝纤维化的诊断价值研究

目的 评估肝脏瞬时弹性成像技术(FibroTouch)联合血清学指标对慢性乙型肝炎肝纤维化的诊断价值。 方法 选取2015年1—11月在杭州市西溪医院就诊的慢性乙型肝炎患者145例，应用FibroTouch检测肝脏硬度（LSM），测定ALT、AST、总胆红素（TBIL）、凝血酶原时间（PT）、血小板计数（PLT）、肝纤四项〔透明质酸（HA）、层粘连蛋白（LN）、Ⅳ型胶原（CⅣ）、Ⅲ型前胶原（PⅢNP）〕，并计算AST/ALT、APRI、FIB-4。以肝组织病理学检测结果为金标准，评估FibroTouch和上述血清学指标对慢性乙型肝炎肝纤维化的诊断价值，采用多元Logistic回归法，筛选肝纤维化的影响因素，求出预测概率，并结合双正态模型建立受试者工作特征（ROC）曲线，评估联合诊断对慢性乙型肝炎肝纤维化的诊断价值。 结果 LSM、AST/ALT、HA、LN、CⅣ、PⅢNP、APRI、FIB-4对肝纤维化的影响有统计学意义（P＜0.05）；而ALT、AST、TBIL、PT、PLT对肝纤维化的影响无统计学意义（P＞0.05）。LSM、AST/ALT、HA、APRI、FIB-4与肝纤维化分期均呈正相关（rs值分别为0.735、0.246、0.560、0.238、0.378，P＜0.05）。LSM、AST/ALT、HA、APRI、FIB-4对肝纤维化S≥2期评估的ROC曲线下面积（AUC）分别为0.888、0.602、0.798、0.647、0.693；对肝纤维化S≥3期评估的AUC分别为0.881、0.637、0.819、0.654、0.702；对肝纤维化S4期评估的AUC分别为0.876、0.647、0.735、0.609、0.739。多元Logistic回归分析结果显示，LSM、HA是肝纤维化的影响因素（P＜0.05）。由此得出的预测概率与肝纤维化分期呈正相关（rs=0.890，P＜0.05），且其对肝纤维化S≥2期、S≥3期及S4期评估的AUC分别为0.934、0.938、0.981。 结论 FibroTouch联合HA可以明显提高慢性乙型肝炎肝纤维化的临床诊断，是一种简便、无创、高效的诊断方法。

Diagnostic Value of Transient Elastography Technology Combined with Serological Indicator for Liver Fibrosis in Patients with Chronic Hepatitis B

Objective To evaluate the diagnostic value of transient elastography technology(FibroTouch) combined with serological indicator in liver fibrosis of patients with chronic hepatitis B. Methods 145 patients with chronic hepatitis B were selected from January to November in 2015 in Xixi Hospital of Hangzhou.Liver stiffness(LSM) was detected by using FibroTouch,and alanine aminotransferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),prothrombintime(PT),blood platelet(PLT),four indicators of hepatic fibrosis 〔hyalaronic acid(HA),laminin(LN),type Ⅳ collagen(CⅣ),type Ⅲ collagen(PⅢNP)〕 were detected,and AST/ALT,APRI,FIB-4 were also calculated.With the results of hepatic pathology as the golden standard,the diagnostic value of FibroTouch and the above indicators in liver fibrosis of patients with chronic hepatitis B was evaluated;the influencing factors of hepatic fibrosis were screened out by using multiple Logistic regression method,and the prediction probability was obtained,and the receiver operating characteristic(ROC) curve was established by combining with double normal model to evaluate the diagnostic value of combined diagnosis of liver fibrosis in patients with chronic hepatitis B. Results LSM,AST/ALT,HA,LN,CⅣ,PⅢNP,APRI and FIB-4 had significant influence on liver fibrosis(P＜0.05);but ALT,AST,TBIL,PT,PLT had no significant on liver fibrosis(P＞0.05).LSM,AST/ALT,HA,APRI and FIB-4 were positively correlated with the stages of liver fibrosis(the values of rs was 0.735,0.246,0.560,0.238 and 0.378 respectively;P＜0.05).The area under the curve(AUC) of ROC curve of the evaluation of LSM,AST/ALT,HA,APRI and FIB-4 on liver fibrosis phase(S≥2) was 0.888,0.602,0.798,0.647 and 0.693 respectively;the AUC of liver fibrosis phase(S≥3) was 0.881,0.637,0.819,0.654 and 0.702 respectively;the AUC of liver fibrosis phase(S4) was 0.876,0.647,0.735,0.609 and 0.739 respectively.Multiple Logistic regression analysis showed that LSM and HA were the influencing factors of liver fibrosis.Therefore,the prediction probability was positively correlated with liver fibrosis staging(rs=0.890,P＜0.05),and the AUC of their evaluation on liver fibrosis staging(S≥2,S≥3,S4) was 0.934,0.938 and 0.981 respectively. Conclusion FibroTouch combined with HA is a simple and convenient,noninvasive and efficient diagnostic method,which can significantly improve the clinical diagnosis of liver fibrosis in chronic hepatitis B.