【摘要】：目的探討瞬時(shí)彈性成像聯(lián)合谷草轉(zhuǎn)氨酶/血小板比值(APRI)和FIB-4指數(shù)無創(chuàng)診斷慢性乙型肝炎病毒(HBV)感染者肝纖維化程度的臨床價(jià)值。方法對(duì)265例慢性HBV感染者進(jìn)行肝臟穿刺病理學(xué)檢查,并于穿刺當(dāng)日檢測(cè)患者相關(guān)臨床指標(biāo),應(yīng)用瞬時(shí)彈性成像技術(shù)(Fibro Touch)檢測(cè)肝臟硬度(LSM),根據(jù)臨床指標(biāo)分別得出APRI和FIB-4指數(shù)結(jié)果。以肝臟病理結(jié)果為金標(biāo)準(zhǔn),分別繪制LSM、APRI及FIB-4指數(shù)的受試者工作曲線(ROC),評(píng)價(jià)其對(duì)顯著纖維化(S≥2)、嚴(yán)重肝纖維化(S≥3)和肝硬化(S=4)的預(yù)測(cè)價(jià)值,并將APRI、FIB-4指數(shù)分別與LSM值聯(lián)合診斷慢性HBV感染者肝臟纖維化程度,并利用聯(lián)合法計(jì)算診斷肝纖維化程度的靈敏度、特異度等。結(jié)果1.隨著肝纖維化程度的加重,LSM值(rs=0.622,P0.001)與肝纖維化分期相關(guān)性明顯高于APRI及FIB-4指數(shù)。2.在265例患者中,Fibro Touch在診斷慢性HBV感染者顯著肝纖維化(S≥2)、嚴(yán)重肝纖維化(S≥3)、肝硬化(S=4)的AUC分別為0.810、0.881、0.961,明顯高于APRI和FIB-4相應(yīng)的ROC曲線下面積。據(jù)ROC曲線得出診斷顯著肝纖維化(S≥2)、嚴(yán)重肝纖維化(S≥3)、肝硬化(S=4)的Fibro Touch、APRI和FIB-4各自截?cái)嘀?得出在肝纖維化各分期的診斷中,Fibro Touch特異度及敏感度均高于APRI、FIB-4。3.將Fibro Touch分別與APRI、FIB-4聯(lián)合診斷。并聯(lián)診斷可提高診斷的敏感度。其與APRI并聯(lián)時(shí)其敏感度可達(dá)到91.11%以上,與FIB-4并聯(lián)時(shí)敏感度亦可明顯上升。而串聯(lián)診斷則可明顯提高診斷的特異度,其中Fibro Touch與APRI串聯(lián)時(shí)其特異度可達(dá)94.42%以上。結(jié)論Fibro Touch無創(chuàng)診斷肝纖維化的靈敏度及特異度均優(yōu)于APRI及FIB-4指數(shù)。APRI、FIB-4分別與Fibro Touch結(jié)合共同診斷患者的肝纖維化程度的敏感性及特異性明顯優(yōu)于Fibro Touch、APRI、FIB-4單項(xiàng)指標(biāo)。
[Abstract]:Objective to evaluate the clinical value of transient elastography combined with glutamic oxaloacetic transaminase / platelet ratio (APRI) and FIB-4 index in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) infection. Methods the pathological examination of liver puncture was performed in 265 patients with chronic HBV infection, and the relevant clinical indexes were detected on the same day. The results of APRI and FIB-4 index were obtained by using instantaneous elastic imaging (Fibro Touch) technique to detect liver hardness (LSM), according to the clinical indexes. According to the pathological results of liver as gold standard, the operating curves of LSM APRI and FIB-4 index were drawn to evaluate the predictive value of (ROC), for significant fibrosis (S 鈮，

本文編號(hào)：2194952