Fibroscan与APRI对慢性乙型肝炎合并脂肪肝患者肝纤维化的诊断价值
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摘要
目的:探讨Fibroscan与APRI对CHB合并脂肪肝患者肝纤维化的诊断价值。方法:选取我院2014年5月-2017年7月收治的161例经病理学确诊为CHB合并脂肪肝患者作为研究对象,所有患者均进行常规生化学及Fibroscan、CAP检测。根据肝组织病理学结果,将肝细胞脂肪变分为F1～F3,将纤维化程度分为S0～S4,同时计算APRI模型,应用受试者工作曲线(ROC)评价Fibroscan与APRI诊断CHB合并脂肪肝患者不同程度肝纤维化的效能。结果:161例CHB合并脂肪肝患者中,纤维化病理学分度为S0、S1、S2、S3、S4的分别为35例、39例、48例、28例、11例。LSM值的相关性分析发现LSM值与肝纤维化程度、ALT、AST呈正相关,与BMI、TC、TG、LDL-C、HDL-C、CAP等无相关性。Fibroscan、APRI诊断显著肝纤维化(S≥2)的敏感度分别为83. 9%、73. 6%,特异度分别为74. 3%、67. 6%,Fibroscan诊断S≥2的AUROC为0. 853,明显优于APRI的0. 758(Z=2. 419,P=0. 0156); Fibroscan、APRI诊断进展性肝纤维化(S≥3)的敏感度分别为76. 9%、71. 8%,特异度分别为89. 3%、64. 8%,Fibroscan诊断S≥3的AUROC为0. 881,明显优于APRI的0. 742(Z=2. 892,P=0. 0038);诊断早期肝硬化(S=4)时,Fibroscan、APRI的敏感度分别为100%、72. 7%,特异度分别为69. 3%、66%,AUROC分别为0. 886、0. 717,二者诊断效能差异无统计学意义(P> 0. 05)。结论:Fibroscan诊断CHB合并脂肪肝患者纤维化具有较高准确性,尤以诊断进展性肝纤维化为佳,且优于APRI。
Objective: To investigate the diagnostic value of Fibroscan and APRI for liver fibrosis in patients with chronic hepatitis B and fatty liver. Methods: A total of 161 pathologically confirmed patients with chronic hepatitis B and fatty liver admitted from May 2014 to July2017 in our hospital were enrolled in this study. All patients underwent routine biochemical tests and Fibroscan and CAP tests. According to the results of liver histopathology,the fatty degeneration of hepatocytes was divided into F1-F3,the degree of fibrosis was divided into S0-S4,The APRI model was also calculated and the receiver operating curve(ROC) was used to evaluate the efficacy of Fibroscan and APRI in diagnosing hepatic fibrosis in patients with chronic hepatitis B and fatty liver. Results: Of the 161 patients with chronic hepatitis B and fatty liver disease,the pathological grade of fibrosis was S0,and S1,S2,S3 and S4 were 35,39,48,28 and 11,respectively. LSM value correlation analysis found that LSM value and liver fibrosis,ALT,AST was positively correlated,and no correlation with BMI,TC,TG,LDL-C,HDL-C,CAP. The sensitivity of Fibroscan and APRI in diagnosing significant hepatic fibrosis(S≥2) were 83. 9% and 73. 6% respectively,the specificity was 74. 3% and 67. 6% respectively,and the AUROC of Fibroscan diagnosis S≥2 was 0. 853,significantly higher than that of APRI 0. 758(Z = 2. 419,P = 0. 0156). The sensitivity of Fibroscan and APRI in diagnosis of progressive liver fibrosis(S≥3) were76. 9% and 71. 8% respectively,the specificity was 89. 3% and 64. 8%(P = 0. 0038),the AUROC of Fibroscan diagnosis S≥3 was 0. 881,which was significantly better than that of APRI 0. 742(Z = 2. 892,P = 0. 0038). The sensitivity of Fibroscan and APRI were 100% and 72.7% respectively in the diagnosis of early cirrhosis(S = 4),the specificities were 69. 3%,66%,AUROC respectively 0. 886,0. 717,there was no significant difference between the two diagnostic efficacy(P > 0. 05). Conclusion: Fibroscan diagnosis of chronic hepatitis B patients with fatty liver fibrosis with high accuracy,especially in the diagnosis of advanced liver fibrosis is better,and better than APRI.
Objective: To investigate the diagnostic value of Fibroscan and APRI for liver fibrosis in patients with chronic hepatitis B and fatty liver. Methods: A total of 161 pathologically confirmed patients with chronic hepatitis B and fatty liver admitted from May 2014 to July2017 in our hospital were enrolled in this study. All patients underwent routine biochemical tests and Fibroscan and CAP tests. According to the results of liver histopathology,the fatty degeneration of hepatocytes was divided into F1-F3,the degree of fibrosis was divided into S0-S4,The APRI model was also calculated and the receiver operating curve(ROC) was used to evaluate the efficacy of Fibroscan and APRI in diagnosing hepatic fibrosis in patients with chronic hepatitis B and fatty liver. Results: Of the 161 patients with chronic hepatitis B and fatty liver disease,the pathological grade of fibrosis was S0,and S1,S2,S3 and S4 were 35,39,48,28 and 11,respectively. LSM value correlation analysis found that LSM value and liver fibrosis,ALT,AST was positively correlated,and no correlation with BMI,TC,TG,LDL-C,HDL-C,CAP. The sensitivity of Fibroscan and APRI in diagnosing significant hepatic fibrosis(S≥2) were 83. 9% and 73. 6% respectively,the specificity was 74. 3% and 67. 6% respectively,and the AUROC of Fibroscan diagnosis S≥2 was 0. 853,significantly higher than that of APRI 0. 758(Z = 2. 419,P = 0. 0156). The sensitivity of Fibroscan and APRI in diagnosis of progressive liver fibrosis(S≥3) were76. 9% and 71. 8% respectively,the specificity was 89. 3% and 64. 8%(P = 0. 0038),the AUROC of Fibroscan diagnosis S≥3 was 0. 881,which was significantly better than that of APRI 0. 742(Z = 2. 892,P = 0. 0038). The sensitivity of Fibroscan and APRI were 100% and 72.7% respectively in the diagnosis of early cirrhosis(S = 4),the specificities were 69. 3%,66%,AUROC respectively 0. 886,0. 717,there was no significant difference between the two diagnostic efficacy(P > 0. 05). Conclusion: Fibroscan diagnosis of chronic hepatitis B patients with fatty liver fibrosis with high accuracy,especially in the diagnosis of advanced liver fibrosis is better,and better than APRI.
引文
[1] Liang XF,Bi SL,Yang WZ,et al. Reprint of:Epidemiological serosurvey of Hepatitis B in China-declining HBV prevalence due to Hepatitis B vaccination[J]. Vaccine,2013,31∶121-128.
[2] Fan JG,Chitturi S. Hepatitis B and fatty liver:causal or coincidental?[J]. Gastroenterol Hepatol 2008,23∶679-681.
[3] Pais R,Rusu E,Zilisteanu D,et al. Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease[J]. Eur J Intern Med,2015,26∶30-36.
[4]范建高.重视慢性病毒性肝炎合并脂肪肝的诊断与治疗[J].中华肝脏病杂志,2009,17(11):801-803.
[5] Petta S,Camma C,Di Marco V,et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection[J]. Liver Int,2011,31∶507-515.
[6]丁蕾,郑颖,张海英.弹性成像与肝活检病理对肝纤维化分期相关性研究[J].上海医学影像,2010,19(1)∶46-47.
[7]韩萍,张建,李永刚,等.瞬时弹性扫描诊断肝纤维化准确性研究[J].传染病信息,2010,23(3):139-140.
[8]刘柯慧,吴海清,阮隽,等. Fibroscan在慢性乙型肝炎肝纤维化诊断中的作用及影响因素[J].肝脏,2012,17(9):621-625.
[9]刘丹阳,杨晴,张明香,等. Fibroscan诊断慢性乙型肝炎肝纤维化的价值[J].中国实用医药,2015,10(8):6-8.
[10]张舰琼,徐亮,李萍,等.四种方法诊断慢性乙型肝炎合并轻度肝脂肪变患者肝纤维化比较[J].实用肝脏病杂志,2016,19(6):663-668.
[11]秦金环,张国栋,白留江,等. Fibroscan与谷草转氨酶-血小板指数(APRI)诊断肝纤维化的价值[J].中国肝脏病杂志(电子版),2015,7(3):106-108.
[12]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].传染病信息,2000,13(4):141-150.
[13] Brunt EM,Tiniakos DG. Pathology of steatohepatitis[J]. Best Pract Res Clin Gastroenterology,2002,16(5):691-707.
[14]王炳元.非酒精性脂肪性肝病的诊断[J].中华肝脏病杂志,2008;16(11):808-810.
[15] Friedrich-Rust M,Hadji-Hosseini H,Kriener S,et al. Transient elastography with a new probe for obese patients for non-invasive staging of non-alcoholic steatohpatitis[J]. Eur Radiol,2010,20(6):2390-2396.
[16] V erveer C,Zondervan PE,Ten KF,et al. Evaluation of transientelastography of fibrosis assessment compared with large biopsies in chronic hepatitis B and C[J]. Liver lnt,2012,32(4):622-628.
[17]蓝宇梁. FibroScan在肝细胞脂肪变性慢性乙型肝炎患者肝纤维化诊断中的应用[J].中国医疗器械信息,2016,22(10):63-64.
[18]孝奇,刘志权,等. FibroScan对慢性乙型肝炎肝纤维化患者的应用价值及ALT,AST对其诊断的影响[J].临床肝胆病杂志,2012,28(9):654-656.
[19] Chen H L,W ong G L,C hoi PC,et al. A lanineam inotransferasebased algorithms of liver stiffness measurement by transient elastography(Fibroscan)for Liver fibrosis in chronic hepatitis B. J Viral Hepat,2009,16(1):36-44.
[20]陈学兵,朱霞,陈立宇,等.丙氨酸转氨酶对Fibroscan诊断慢性乙型肝炎肝纤维化分期的影响[J].中华肝脏病杂志,2011,19(4):286-290.
[21]隗功贤,王志鹏.慢性乙型肝炎患者肝纤维化分级中AST/PLT比值指数的临床研究[J].中国肝脏病杂志(电子版),2013,5(2):50-52.
[22]袁迎春,张效敏,蔡咏梅,等.慢性乙型肝炎弹性扫描值与肝纤维化四项指标以及PLT和AFP的相关性[J].江苏医药,2014,40(22):2733-2735.
[23]刘京,刘映霞,董常峰,等. ARFI,Forns指数、FIB-4和APRI无创诊断慢性乙型病毒性肝炎肝纤维化的研究[J/CD].中国肝脏病杂志(电子版),2014,6(1):18-21.
[24]温欣,王学梅,王炳元. Fibro Scan对肝纤维化诊断价值的研究进展[J].世界华人消化杂志,2009. 17(31):3223-3228.
[25]谭有娟,纪冬,牛小霞,等.瞬时弹性成像检测肝硬度失败的因素及分析[J].医学研究杂志,2012,41(11):30-33.
[2] Fan JG,Chitturi S. Hepatitis B and fatty liver:causal or coincidental?[J]. Gastroenterol Hepatol 2008,23∶679-681.
[3] Pais R,Rusu E,Zilisteanu D,et al. Prevalence of steatosis and insulin resistance in patients with chronic hepatitis B compared with chronic hepatitis C and non-alcoholic fatty liver disease[J]. Eur J Intern Med,2015,26∶30-36.
[4]范建高.重视慢性病毒性肝炎合并脂肪肝的诊断与治疗[J].中华肝脏病杂志,2009,17(11):801-803.
[5] Petta S,Camma C,Di Marco V,et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection[J]. Liver Int,2011,31∶507-515.
[6]丁蕾,郑颖,张海英.弹性成像与肝活检病理对肝纤维化分期相关性研究[J].上海医学影像,2010,19(1)∶46-47.
[7]韩萍,张建,李永刚,等.瞬时弹性扫描诊断肝纤维化准确性研究[J].传染病信息,2010,23(3):139-140.
[8]刘柯慧,吴海清,阮隽,等. Fibroscan在慢性乙型肝炎肝纤维化诊断中的作用及影响因素[J].肝脏,2012,17(9):621-625.
[9]刘丹阳,杨晴,张明香,等. Fibroscan诊断慢性乙型肝炎肝纤维化的价值[J].中国实用医药,2015,10(8):6-8.
[10]张舰琼,徐亮,李萍,等.四种方法诊断慢性乙型肝炎合并轻度肝脂肪变患者肝纤维化比较[J].实用肝脏病杂志,2016,19(6):663-668.
[11]秦金环,张国栋,白留江,等. Fibroscan与谷草转氨酶-血小板指数(APRI)诊断肝纤维化的价值[J].中国肝脏病杂志(电子版),2015,7(3):106-108.
[12]中华医学会传染病与寄生虫病学分会,肝病学分会.病毒性肝炎防治方案[J].传染病信息,2000,13(4):141-150.
[13] Brunt EM,Tiniakos DG. Pathology of steatohepatitis[J]. Best Pract Res Clin Gastroenterology,2002,16(5):691-707.
[14]王炳元.非酒精性脂肪性肝病的诊断[J].中华肝脏病杂志,2008;16(11):808-810.
[15] Friedrich-Rust M,Hadji-Hosseini H,Kriener S,et al. Transient elastography with a new probe for obese patients for non-invasive staging of non-alcoholic steatohpatitis[J]. Eur Radiol,2010,20(6):2390-2396.
[16] V erveer C,Zondervan PE,Ten KF,et al. Evaluation of transientelastography of fibrosis assessment compared with large biopsies in chronic hepatitis B and C[J]. Liver lnt,2012,32(4):622-628.
[17]蓝宇梁. FibroScan在肝细胞脂肪变性慢性乙型肝炎患者肝纤维化诊断中的应用[J].中国医疗器械信息,2016,22(10):63-64.
[18]孝奇,刘志权,等. FibroScan对慢性乙型肝炎肝纤维化患者的应用价值及ALT,AST对其诊断的影响[J].临床肝胆病杂志,2012,28(9):654-656.
[19] Chen H L,W ong G L,C hoi PC,et al. A lanineam inotransferasebased algorithms of liver stiffness measurement by transient elastography(Fibroscan)for Liver fibrosis in chronic hepatitis B. J Viral Hepat,2009,16(1):36-44.
[20]陈学兵,朱霞,陈立宇,等.丙氨酸转氨酶对Fibroscan诊断慢性乙型肝炎肝纤维化分期的影响[J].中华肝脏病杂志,2011,19(4):286-290.
[21]隗功贤,王志鹏.慢性乙型肝炎患者肝纤维化分级中AST/PLT比值指数的临床研究[J].中国肝脏病杂志(电子版),2013,5(2):50-52.
[22]袁迎春,张效敏,蔡咏梅,等.慢性乙型肝炎弹性扫描值与肝纤维化四项指标以及PLT和AFP的相关性[J].江苏医药,2014,40(22):2733-2735.
[23]刘京,刘映霞,董常峰,等. ARFI,Forns指数、FIB-4和APRI无创诊断慢性乙型病毒性肝炎肝纤维化的研究[J/CD].中国肝脏病杂志(电子版),2014,6(1):18-21.
[24]温欣,王学梅,王炳元. Fibro Scan对肝纤维化诊断价值的研究进展[J].世界华人消化杂志,2009. 17(31):3223-3228.
[25]谭有娟,纪冬,牛小霞,等.瞬时弹性成像检测肝硬度失败的因素及分析[J].医学研究杂志,2012,41(11):30-33.