【摘要】：目的: 目前，有關慢性肝病患者肝纖維化的快速非侵入性檢查方法引起人們的廣泛關注。本研究即旨在通過對慢性肝病患者進行肝臟實時組織彈性成像(real-timetissue elastograph, RTE)評分與APRI （AST to Platelet Ratio Index）的檢測結(jié)合肝組織病理組織學檢查，探討影像學檢測聯(lián)合血清學檢測對診斷肝組織慢性纖維化病變的臨床應用價值。 方法: 本研究經(jīng)鄭大二附院倫理委員會批準。所有病人均簽署知情同意書。60例確診慢性乙型肝炎患者，活檢病理組織學檢查前進行彩超檢查及肝功能和血常規(guī)檢測，給予RTE評分，通過肝功能及血常規(guī)內(nèi)指標血清天門冬氨酸氨基轉(zhuǎn)移酶(AST)、血小板(PLT)，應用無創(chuàng)診斷模型（APRI=[{AST (IU/1)/ULN (IU/1)}×l00]/platelet count (109/L)計算APRI數(shù)值，同時進行肝臟組織活檢評估，以肝組織穿刺活檢病理結(jié)果為金標準，病理診斷分級按Metavir分期方法進行分期（無纖維化、輕、中、重度纖維化及肝硬化）。將所得數(shù)據(jù)運用SPSS19.0軟件系統(tǒng)進行分析，非正態(tài)連續(xù)性數(shù)據(jù)以中位數(shù)（四分位數(shù)間距）表示，計量資料以（均數(shù)±標準差）表示，以≥F2為診斷標準繪制受試者，分析曲線下面積(Area underthe receiver operating characteristic curve AUROC)，得出最佳截斷值，計算RTE及APRI的敏感度及特異度。P0.05為差異，表示有統(tǒng)計學意義。比較實時組織彈性成像(real-time tissue elastograph, RTE)單獨診斷，APRI單獨診斷，RTE聯(lián)合APRI診斷不同程度肝纖維化的敏感度、特異度。 結(jié)果: 單獨實時組織彈性成像(real-time tissue elastograph, RTE)，單獨APRI診斷明顯肝纖維化的敏感度較高分別為0.824、0.971；特異度分別為0.923、0.923。隨著肝纖維化程度的加重，RTE評分和APRI參數(shù)皆隨之增加，RTE評分和APRI參數(shù)皆與肝纖維化程度具有較強的正相關性（R分別為0.622，0.673）。肝纖維化各期APRI差異有統(tǒng)計學意義（P0.05）。以病理結(jié)果≥F2期作為診斷明顯肝纖維化的標準，RTE及APRI的曲線下面積分別為0.948、0.947，，其診斷價值較高。RTE評分聯(lián)合APRI診斷明顯纖維化的敏感度和特異度分別為0.781、0.963，準確度為0.735。 結(jié)論： RTE聯(lián)合APRI可明顯提高對輕中重度肝纖維化及肝硬化的診斷，及對肝纖維化嚴重程度的判定，尤其是對早發(fā)現(xiàn)明顯肝纖維化并準確診斷肝纖維化程度有重要作用。但是，對于纖維化的早期階段之間的診斷區(qū)分還不夠明確，還不能取代肝活檢。
[Abstract]:Objective: at present, rapid non-invasive examination of liver fibrosis in patients with chronic liver disease has attracted wide attention. The purpose of this study was to perform real-time liver tissue elastography (real-timetissue elastograph, RTE) score and APRI (AST to Platelet Ratio Index) in patients with chronic liver disease, combined with histopathological examination. To evaluate the clinical value of imaging combined with serology in the diagnosis of chronic hepatic fibrosis. Methods: this study was approved by the Ethics Committee of the second affiliated College of Zheng University. All the patients signed the informed consent form. 60 patients with chronic hepatitis B were examined by color ultrasound, liver function and blood routine before biopsy and histopathological examination, and RTE score was given. The serum aspartate aminotransferase (AST),) platelet (PLT), was used to calculate the APRI value by using the APRI= [{AST (IU/1) / ULN (IU/1)} 脳 l00] / platelet count (109 / L), and the liver tissue biopsy was performed. According to the pathological results of liver biopsy as gold standard, the pathological diagnosis grading was performed according to Metavir staging (no fibrosis, mild, moderate, severe fibrosis and cirrhosis). The data were analyzed by SPSS19.0 software system. The non-normal continuity data were expressed as median (quartile spacing), the measurement data were expressed as mean 鹵standard deviation, and the subjects were plotted using 鈮

本文編號：2223523