核素首次通过法测定肝动脉血流指数预测日本血吸虫病肝纤维化程度?
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摘要
目的通过核素首次通过法测定肝动脉血流指数(hepatic artery blood flow index,HBI)预测日本血吸虫病肝纤维化程度。方法选取67例日本血吸虫病患者为研究对象,采用METAVIR评分系统评估纤维化程度。静脉注射二磷酸锝~(99)(~(99m)Tc-MDP)后,即刻采用首次通过法测定肝血流指数。采用受试者操作特征曲线下面积(area under receivers operating characteristic curve,AUROC)衡量肝血流指数预测肝纤维化的价值。结果肝血流指数与肝纤维化程度呈正相关(r=0.717,P<0.001)。肝血流指数预测显著肝纤维化的AUROC为0.916(95%CI:0.844~0.987,P<0.001),截止点为32.77时,敏感性为87.5%,特异性为62.5%,阳性预测值(positive predictive value,PPV)为70.0%,阴性预测值(negative predictive value,NPV)为83.3%。血流指数预测严重肝硬化的AUROC为0.832(95%CI:0.729~0.935,P<0.001),截止点为40.70时,敏感性为96.3%,特异性为58.8%,PPV为70.0%,NPV为96.5%。结论核素首次通过法测定肝动脉血流指数是一种新型评估日本血吸虫病肝纤维化程度的方法,有助于判断预后。
Objective To predict the degree of liver fibrosis induced by Schistosoma japonicum according to hepatic artery blood flow index(HBI) measured by nuclide first pass method. Methods Total of 67 patients with Schistosomiasis japonicum were selected. The degree of liver fibrosis was assessed by METAVIR scoring system. HBI was measured by injection of nuclear isotope technetium-99-methylene diphosphate(99 mTc-MDP). The area under the receiver's operating characteristic curve(AUROC) was used to measure the diagnostic value. Results There was a positive correlation between hepatic blood flow index and the degree of liver fibrosis(r = 0.717,P < 0.001). The AUROC of hepatic blood flow index in predicting significant liver fibrosis was 0.916(95%CI: 0.844~0.987, P < 0.001), the cut-off value was 32.77, the sensitivity was 87.5%, the specificity was 62.5%, the positive predictive value(PPV) was 70.0% and the negative predictive value(NPV) was 83.3%. The AUROC of hepatic blood flow index in predicting severe liver cirrhosis was 0.832(95%CI: 0.729~0.935, P < 0.001), the cut-off value was 40.70, the sensitivity was 96.3%, the specificity was 58.8%, the PPV was 70.0% and the NPV was 96.5%. Conclusion HBI is a novel diagnostic tool for the assessment of liver fibrosis and is helpful for predicting prognosis.
Objective To predict the degree of liver fibrosis induced by Schistosoma japonicum according to hepatic artery blood flow index(HBI) measured by nuclide first pass method. Methods Total of 67 patients with Schistosomiasis japonicum were selected. The degree of liver fibrosis was assessed by METAVIR scoring system. HBI was measured by injection of nuclear isotope technetium-99-methylene diphosphate(99 mTc-MDP). The area under the receiver's operating characteristic curve(AUROC) was used to measure the diagnostic value. Results There was a positive correlation between hepatic blood flow index and the degree of liver fibrosis(r = 0.717,P < 0.001). The AUROC of hepatic blood flow index in predicting significant liver fibrosis was 0.916(95%CI: 0.844~0.987, P < 0.001), the cut-off value was 32.77, the sensitivity was 87.5%, the specificity was 62.5%, the positive predictive value(PPV) was 70.0% and the negative predictive value(NPV) was 83.3%. The AUROC of hepatic blood flow index in predicting severe liver cirrhosis was 0.832(95%CI: 0.729~0.935, P < 0.001), the cut-off value was 40.70, the sensitivity was 96.3%, the specificity was 58.8%, the PPV was 70.0% and the NPV was 96.5%. Conclusion HBI is a novel diagnostic tool for the assessment of liver fibrosis and is helpful for predicting prognosis.
引文
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[17]王社芹.彩色多普勒超声诊断肝硬化门脉血流改变的价值[J].中外女性健康研究,2016,(12):182-183.
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[21]王荣琦,任伟光,赵素贤,等.瞬时弹性成像技术与多参数模型评估慢性肝病肝纤维化程度的临床研究[J].中华肝脏病杂志,2015,23(4):265-269.
[22]刘芳,李庭红,韩涛,等.瞬时弹性成像在肝硬化门静脉高压中的临床评价[J].中华肝脏病杂志,2013,21(11):840-844.
[23]Ganne-CarriéN,Ziol M,de Ledinghen V,et al.Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases[J].Hepatology,2006,44(6):1511-1517.
[24]Chan HL,Wong GL,Choi PC,et al.Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography(Fibroscan)for liver fibrosis in chronic hepatitis B[J].Viral Hepat,2008,16(1):36-44.
[25]李芳林,戴琳,张琪,等.瞬时弹性记录仪检测肝纤维化影响因素及稳定性分析[J].南方医科大学学报,2008,28(4):595-597.
[26]Kettaneh A,Marcellin P,Douvin C,et al.Features associated with success rate and performance of FibroScan measurements for the diagnosis of cirrhosis in HCV patients:a prospective study of 935patients[J].J Hepatol,2007,46(4):628-634.
[27]张旭,王煜,马娟.5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较[J].临床肝胆病杂志,2016,32(10):1888-1893.
[28]Rocha HL,Diniz AL,Borges VF,et al.Assessment of portal venous index as a non-invasive method for diagnosing liver fibrosis in patients with chronic hepatitis C[J].Arq Gastroenterol,2012,49(1):14-18.
[29]Iranpour P,Lall C,Houshyar R,et al.Altered Doppler flow patterns in cirrhosis patients:an overview[J].Ultrasonography,2016,35(1):3-12.
[30]莫耀溥,马文伟,邹德环,等.门脉分流指数对代偿期肝硬化的诊断应用[J].影像诊断与介入放射学,1998,7(3):147-149.
[31]张影.内镜下套扎治疗食管静脉曲张出血的疗效观察及对门脉血流动力学的影响[J].现代消化及介入诊疗,2015,20(6):680-682.
[32]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.
[2]Shiha G,Sarin SK,Ibrahim AE,et al.Liver fibrosis:consensus recommendations of the Asian Pacific Association for the Study of the Liver(APASL)[J].Hepatol Int,2009,3(2):323-333.
[3]Oliveri F,Coco B,Ciccorossi P,et al.Liver stiffness in the hepatitis B virus carrier:a non-invasive marker of liver disease influenced by the pattern of transaminases[J].World J Gastroenterol,2008,14(40):6154-6162.
[4]Li Y,Chen D,Ross AG,et al.Severe hepatosplenic schistosomiasis:c linicopathologic study of 102 cases undergoing splenectomy[J].Hum Pathol,2011,42(1):111-119.
[5]中华人民共和国卫生部疾病控制司.血吸虫病防治手册[M].3版.上海:上海科学技术出版社,2000:107-113.
[6]The French METAVIR Cooperative Study Group.Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C[J].Hepatology,1994,20(1):15-20.
[7]Ghany MG,Strader DB,Thomas DL,et al.Diagnosis,management,and treatment of hepatitis C:an update[J].Hepatology,2009,49(4):1335-1374.
[8]Miles KA,Hayball MP,Dixon AK.Functional images of hepatic perfusion obtained with dynamic CT[J].Radiology,1993,188(2):405-411.
[9]Bataller R,Brenner DA.Hepatic stellate cells as a target for the treatment of liver fibrosis[J].Semin Liver Dis,2001,21(3):437-451.
[10]陆伦根,蔡晓波.2009 APASL肝纤维化共识解读[J].胃肠病学,2010,15(6):324-325.
[11]李亚芳.肝纤维化药物治疗的研究进展[J].国际消化病杂志,2016,36(4):197-201.
[12]徐瑞,常江,黄华,等.慢性乙型肝炎肝纤维化无创诊断的进展[J].胃肠病学,2016,21(6):372-375.
[13]张仕华.肝纤维化无创诊断的研究进展[J].国际检验医学杂志,2017,38(5):667-668.
[14]贾继东.肝纤维化无创诊断技术的机会与挑战[J].中华肝脏病杂志,2014,22(9):641-642.
[15]李萍,王丽,胡蓉,等.血清纤维化标志物和肝功能指标在慢性乙型肝炎患者肝纤维化诊断中的价值[J].疑难病杂志,2017,16(6):575-583.
[16]徐琳琳,李洁,韩绍磊,等.彩色多普勒超声诊断肝硬化门脉血流改变的临床价值[J].中国实用医药,2015,10(34):39-40.
[17]王社芹.彩色多普勒超声诊断肝硬化门脉血流改变的价值[J].中外女性健康研究,2016,(12):182-183.
[18]陈中将.超声门静脉血流动力学检测在老年肝硬化门静脉高压诊断中的意义[J].中国老年学杂志,2016,36(3),655-657.
[19]杨明磊,姚定康.磁共振弹性成像在肝纤维化无创诊断中的应用[J].临床肝胆病杂志,2016,32(3),588-592.
[20]徐晓鸾,孟繁坤,孙丽娟.肝脏瞬时弹性成像和门静脉血流动力学指标检测对慢性乙型肝炎患者肝纤维化的诊断意义[J].实用肝脏病杂志,2016,19(4):433-435.
[21]王荣琦,任伟光,赵素贤,等.瞬时弹性成像技术与多参数模型评估慢性肝病肝纤维化程度的临床研究[J].中华肝脏病杂志,2015,23(4):265-269.
[22]刘芳,李庭红,韩涛,等.瞬时弹性成像在肝硬化门静脉高压中的临床评价[J].中华肝脏病杂志,2013,21(11):840-844.
[23]Ganne-CarriéN,Ziol M,de Ledinghen V,et al.Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases[J].Hepatology,2006,44(6):1511-1517.
[24]Chan HL,Wong GL,Choi PC,et al.Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography(Fibroscan)for liver fibrosis in chronic hepatitis B[J].Viral Hepat,2008,16(1):36-44.
[25]李芳林,戴琳,张琪,等.瞬时弹性记录仪检测肝纤维化影响因素及稳定性分析[J].南方医科大学学报,2008,28(4):595-597.
[26]Kettaneh A,Marcellin P,Douvin C,et al.Features associated with success rate and performance of FibroScan measurements for the diagnosis of cirrhosis in HCV patients:a prospective study of 935patients[J].J Hepatol,2007,46(4):628-634.
[27]张旭,王煜,马娟.5种无创诊断技术单独及联合应用对慢性乙型肝炎肝纤维化的诊断价值比较[J].临床肝胆病杂志,2016,32(10):1888-1893.
[28]Rocha HL,Diniz AL,Borges VF,et al.Assessment of portal venous index as a non-invasive method for diagnosing liver fibrosis in patients with chronic hepatitis C[J].Arq Gastroenterol,2012,49(1):14-18.
[29]Iranpour P,Lall C,Houshyar R,et al.Altered Doppler flow patterns in cirrhosis patients:an overview[J].Ultrasonography,2016,35(1):3-12.
[30]莫耀溥,马文伟,邹德环,等.门脉分流指数对代偿期肝硬化的诊断应用[J].影像诊断与介入放射学,1998,7(3):147-149.
[31]张影.内镜下套扎治疗食管静脉曲张出血的疗效观察及对门脉血流动力学的影响[J].现代消化及介入诊疗,2015,20(6):680-682.
[32]龚江波,吴利达,金学林,等.再改良Sugiura术对肝硬化门静脉高压症患者门静脉血流动力学及肝功能的影响[J].中华肝胆外科杂志,2017,23(2):90-94.