本文關(guān)鍵詞： 瞬時(shí)彈性成像 FIB- APRI 肝纖維化 無(wú)創(chuàng)診斷　出處：《安徽醫(yī)科大學(xué)學(xué)報(bào)》2017年03期 　論文類(lèi)型：期刊論文

【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(wú)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)(FibroT ouch)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(≥S2)、嚴(yán)重肝纖維化(≥S3)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)。在265例患者中,FibroT ouch在診斷慢性HBV感染者顯著肝纖維化(≥S2)、嚴(yán)重肝纖維化(≥S3)、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(≥S2)、嚴(yán)重肝纖維化(≥S3)、肝硬化(S=4)的FibroT ouch、APRI和FIB-4各自截?cái)嘀?得出在肝纖維化各分期的診斷中,FibroT ouch特異度及敏感度均高于APRI、FIB-4。同時(shí)將FibroT ouch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FibroT ouch與APRI串聯(lián)時(shí)其特異度可達(dá)94.42%以上。結(jié)論 FibroT ouch無(wú)創(chuàng)診斷肝纖維化的靈敏度及特異度均優(yōu)于APRI及FIB-4。APRI、FIB-4與FibroT ouch聯(lián)合診斷肝纖維化的靈敏度及特異度明顯優(yōu)于FibroT ouch、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 (API) and FIB-4 index in the diagnosis of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) infection. Pathological examination of visceral puncture, The clinical indexes of patients were detected on the day of puncture, and the liver hardness was detected by instantaneous elastic imaging technique. The results of APRI and FIB-4 index were obtained according to the clinical indexes. The pathological results of liver were regarded as gold standard. To evaluate the predictive value of LSM APRI and FIB-4 index in predicting significant fibrosis (鈮，

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