血清学指标联合瞬时弹性成像对乙肝肝纤维化及食管静脉曲张程度的诊断价值
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摘要
目的评估血清学指标联合瞬时弹性成像(TE)对慢性乙型肝炎(乙肝)肝纤维化及食管静脉曲张(EV)程度的诊断价值。方法对135例慢性乙肝患者使用FibroSan检测肝脏纤维化,同时测定患者的肝功能、肝纤维化4项以及凝血功能指标。采用多元logisitic回归,建立回归方程,筛选预测肝纤维化及EV程度的影响因素。结果 FS值、球蛋白(GLB)、层粘连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PⅢNP)、Ⅳ型胶原(CⅣ)、AST与小血小板比值指数(APRI)、FIB-4在肝纤维化组与非肝纤维化组患者之间的差异均有统计学意义(均P<0.05)。HA、FS、GLB、APRI、FIB-4与肝纤维化程度均呈正相关(均P<0.05)。多元logisitic回归分析显示FS、HA是肝纤维化的影响因素(P<0.05),其预测率与肝纤维化分期呈正相关。FS与APRI、FIB-4、HA联合诊断EV轻、中、重度的AUC分别是0.917、0.910、0.921。结论 TE联合HA检测能明显提高乙肝肝纤维化诊断效能,FS联合HA、APRI、FIB-4能更好地预测肝硬化EV程度。
Objective To evaluate the application of transient elastography(TE) combined with serological tests in diagnosis of liver fibrosis and the severity of esophageal varices in patients with chronic hepatitis B(CHB). Methods One hundred and thirty five patients with CHB were enrolled in the study. Liver fibrosis was detected by transient elastography(FibroSan, FS) and the liver function, blood coagulation index were also measured. The risk factors of liver fibrosis were analyzed by univariate and multivariate Logistic regression analysis. Results There were significant difference in FS, GLB, LN, HA, PⅢNP, CIV, APRI and FIB-4 levels between patients with liver fibrosis and those without fibrosis(P<0.05). The HA, FS, GLB, APRI and FIB-4 were positively correlated with the severity of liver fibrosis(P<0.05). Multiple Logistic regression analysis showed that FS and HA were the independent risk factors of liver fibrosis(P<0.05). There was positive correlation between the prediction rate and the severity of liver fibrosis. The area under the curve(AUC) of FS combined with APRI, FIB-4 and HA in predicting mild,moderate and severe esophageal varices were 0.917, 0.910 and 0.921, respectively. Conclusion FS combined with HA can significantly improve the clinical diagnosis of liver fibrosis in patients with chronic hepatitis B. FS combined with APRI, FIB-4, HA may perform better in predicting the severity of esophageal varices in cirrhosis patients.
Objective To evaluate the application of transient elastography(TE) combined with serological tests in diagnosis of liver fibrosis and the severity of esophageal varices in patients with chronic hepatitis B(CHB). Methods One hundred and thirty five patients with CHB were enrolled in the study. Liver fibrosis was detected by transient elastography(FibroSan, FS) and the liver function, blood coagulation index were also measured. The risk factors of liver fibrosis were analyzed by univariate and multivariate Logistic regression analysis. Results There were significant difference in FS, GLB, LN, HA, PⅢNP, CIV, APRI and FIB-4 levels between patients with liver fibrosis and those without fibrosis(P<0.05). The HA, FS, GLB, APRI and FIB-4 were positively correlated with the severity of liver fibrosis(P<0.05). Multiple Logistic regression analysis showed that FS and HA were the independent risk factors of liver fibrosis(P<0.05). There was positive correlation between the prediction rate and the severity of liver fibrosis. The area under the curve(AUC) of FS combined with APRI, FIB-4 and HA in predicting mild,moderate and severe esophageal varices were 0.917, 0.910 and 0.921, respectively. Conclusion FS combined with HA can significantly improve the clinical diagnosis of liver fibrosis in patients with chronic hepatitis B. FS combined with APRI, FIB-4, HA may perform better in predicting the severity of esophageal varices in cirrhosis patients.
引文
[1]齐祥飞.声脉冲辐射力成像检测脾脏硬度无创评估乙肝肝硬化食管静脉曲张程度及出血风险[D].南昌:南昌大学,2016.
[2]Povero D,Busletta C,Novo E,et al.Liver fibrosis:a dynamic and potentially reversible process[J].Histol histopathol,2010,25(8):1075-1091.
[3]张颖慧,杨雪,张笛,等.主观综合性评估乙型肝炎性肝硬化病人的营养状况[J].肠外与肠内营养,2016,23(6):329-331.
[4]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版)[J].中华肝脏病杂志,2015,23(12):888-905.
[5]柳金金,鲁沛,贾继东.肝硬化患者食管静脉曲张再出血的预测因素[J].中华肝脏病杂志,2014,22(8):636-638.
[6]苏正昌.拉米夫定联合心得安治疗乙肝肝硬化合并食管静脉曲张的研究[J].临床医学工程,2016,23(7):921-922.
[7]戴晏平,高青.规范化内镜治疗肝硬化食管静脉曲张出血的预后分析[J].中华肝脏病杂志,2017,25(3):195-199.
[8]Guidelines for the Prevention,care and treatment of persons with chronic hepatitis B infection[J].Internal Medicine,CM,2015,24(7):454.
[9]中华医学会消化内镜学分会食管冒静脉曲张学组.消化道静脉曲张及出血内镜诊断和治疗规范试行方案(2009年)[J].中华消化内镜杂志,2010,27(1):1-4.
[10]Bedossa P,Poynard T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology,1996,24(2):289-293.
[11]邱冰峰,徐骐,徐汤舟,等.拉米夫定对乙型肝炎肝硬化患者肝纤维化状态与血小板参数的影响研究[J].中华医院感染学杂志,2016,26(8):1054-1057.
[12]戴雯,代倩,李晶晶,等.FibroTouch无创诊断慢性HBV感染者肝纤维化程度的临床价值[J].安徽医科大学学报,2016,51(9):982-987.
[13]明芳,秦刚,李民,等.Fibro Touch在慢性肝病中临床的应用及与多参数模型的比较[J].重庆医学,2017,46(36):758-762.
[14]唐艳芳,甘龙禹,李旭东,等.FibroTouch与FIB-4对慢性乙型肝炎肝纤维化的诊断价值[J].广东医学,2017,38(18):573-577.
[15]周林妍,李岩.FibroTouch检测肝脏硬度与血清肝纤维化指标的相关性分析[J].中国医科大学学报,2017,46(1):26-30.
[16]李文静,尚妍妍,王冰雪,等.非侵入性检查评估肝硬化食管静脉曲张及出血的价值[J].实用医学杂志,2016,32(17):687-690.
[17]刘丹,朱清静,万十千.瞬时弹性成像技术检测肝脾硬度值对乙肝肝硬化患者食管静脉曲张破裂出血的预测价值[J].中国医学装备,2017,14(4):884-888.
[18]陈志敏,黄德扬,刘惠媛,等.瞬时弹性成像联合天冬氨酸转氨酶/血小板比值指数和FIB-4指数预测肝硬化食管静脉曲张程度的临床价值[J].广州医科大学学报,2016,44(2):22-25.
[2]Povero D,Busletta C,Novo E,et al.Liver fibrosis:a dynamic and potentially reversible process[J].Histol histopathol,2010,25(8):1075-1091.
[3]张颖慧,杨雪,张笛,等.主观综合性评估乙型肝炎性肝硬化病人的营养状况[J].肠外与肠内营养,2016,23(6):329-331.
[4]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版)[J].中华肝脏病杂志,2015,23(12):888-905.
[5]柳金金,鲁沛,贾继东.肝硬化患者食管静脉曲张再出血的预测因素[J].中华肝脏病杂志,2014,22(8):636-638.
[6]苏正昌.拉米夫定联合心得安治疗乙肝肝硬化合并食管静脉曲张的研究[J].临床医学工程,2016,23(7):921-922.
[7]戴晏平,高青.规范化内镜治疗肝硬化食管静脉曲张出血的预后分析[J].中华肝脏病杂志,2017,25(3):195-199.
[8]Guidelines for the Prevention,care and treatment of persons with chronic hepatitis B infection[J].Internal Medicine,CM,2015,24(7):454.
[9]中华医学会消化内镜学分会食管冒静脉曲张学组.消化道静脉曲张及出血内镜诊断和治疗规范试行方案(2009年)[J].中华消化内镜杂志,2010,27(1):1-4.
[10]Bedossa P,Poynard T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology,1996,24(2):289-293.
[11]邱冰峰,徐骐,徐汤舟,等.拉米夫定对乙型肝炎肝硬化患者肝纤维化状态与血小板参数的影响研究[J].中华医院感染学杂志,2016,26(8):1054-1057.
[12]戴雯,代倩,李晶晶,等.FibroTouch无创诊断慢性HBV感染者肝纤维化程度的临床价值[J].安徽医科大学学报,2016,51(9):982-987.
[13]明芳,秦刚,李民,等.Fibro Touch在慢性肝病中临床的应用及与多参数模型的比较[J].重庆医学,2017,46(36):758-762.
[14]唐艳芳,甘龙禹,李旭东,等.FibroTouch与FIB-4对慢性乙型肝炎肝纤维化的诊断价值[J].广东医学,2017,38(18):573-577.
[15]周林妍,李岩.FibroTouch检测肝脏硬度与血清肝纤维化指标的相关性分析[J].中国医科大学学报,2017,46(1):26-30.
[16]李文静,尚妍妍,王冰雪,等.非侵入性检查评估肝硬化食管静脉曲张及出血的价值[J].实用医学杂志,2016,32(17):687-690.
[17]刘丹,朱清静,万十千.瞬时弹性成像技术检测肝脾硬度值对乙肝肝硬化患者食管静脉曲张破裂出血的预测价值[J].中国医学装备,2017,14(4):884-888.
[18]陈志敏,黄德扬,刘惠媛,等.瞬时弹性成像联合天冬氨酸转氨酶/血小板比值指数和FIB-4指数预测肝硬化食管静脉曲张程度的临床价值[J].广州医科大学学报,2016,44(2):22-25.