肝脏瞬时弹性值评估慢性乙型肝炎肝纤维化程度及肝脏储备功能的临床研究

目的探讨慢性乙型肝炎(CHB)患者FibroScan与肝组织纤维化面积之间的相关性,以评价FS值对肝纤维化程度测定的意义,分析乙型肝炎后肝硬化患者的FS值变化与肝脏储备功能评价系统CTP分级的关系。方法前瞻性研究正常对照组30例、肝病组113例(CHB患者62例及其所致肝硬化患者51例)FS值,对研究对象行腹部B超检查后,应用肝脏瞬时弹性超声进行FS值测定,收集肝硬化患者入院24 h内的临床资料,计算CTP分值,根据评分分为A、B、C 3级,同时采用计算机辅助数字图像分析法检测肝组织标本的纤维化程度,分析肝病组FS值与肝纤维化面积之间的相关性以及肝硬化患者FS值变化与CTP分级的关系。结果 (1)CHB患者组的FS值与正常对照组比较,肝硬化患者的FS值与CHB组比较,差异均有统计学意义(P<0.05);(2)在肝硬化组中FS值随着CTP分级升高而升高,ChildA、B、C 3组之间FS值差异均有统计学意义(P<0.05);肝病组的FS值与肝纤维化面积有显著的线性正相关性,且相关系数较高(r=0.804,P<0.01)。结论 FS弹性值与肝纤维化面积有很好的相关性,肝硬化患者的FS值随着CTP分级的上升而增加,FS值可以评估CHB肝纤维化程度,在一定程度上可以评估肝硬化患者的肝脏储备功能。

Evaluation of degree of liver fibrosis and liver functional reserve in patients with chronic hepatitis B using FibroScan score

Objective To investigate the correlation between FibroScan(FS) score and liver fibrotic tissue area in patients with chronic hepatitis B and to assess the value of FS in detecting liver fibrosis,as well as analyze the relationship between change of FS in patients with liver cirrhosis due to HBV infection and liver CTP classification.Methods 30 healthy people(control group),113 patients including 62 patients with chronic HBV hepatitis(HBV group) and 51 patients with cirrhosis due to HBV infection(Cirrhosis group) were enrolled in this study.All patients were subjected to Abdominal Ultrasonography and FibroScan.Meanwhile,all the laboratory tests of patients were collect to evaluate the Child-Turcotte-Puge(CTP) score.Then the patients were divided into three groups according to CTP score(Child A,Child B,Child C group).In addition,liver specimens obtained via Percutaneous transhepatic biopsy was stained by Masson staining for detecting the fibrotic tissue.The fibrotic area was analyzed by computer-assisted digital image system.Finally,the correlation between the FibroScan(FS) score and fibrotic area in liver specimens and the relationship between change of FS score and CTP grade were assessed.Results The comparison in FS score between the HBV group and control group,and between the cirrhosis group and CHB group both were statistically significant(P<0.05).In cirrhosis group,the FS score increased corresponding to the increase of the CTP grade.The comparisons among the Child A,B,C groups all were statistically significant(P<0.05).The FS score was correlated with the fibrotic area in liver tissue and the correlation coefficient was 0.804(P<0.01).Conclusion FS score showed excellent correlation with the liver fibrotic area,and FS score in patients with cirrhosis increased corresponding to the increase of the CTP grade,which might be used to assess the degree of liver fibrosis and evaluate the liver reserve function to some extent.