摘要
目的比较基于瞬时弹性成像技术（transient elastography, TE）的FibroScan、脉冲辐射力成像技术（acoustic radiation force impulse，ARFI）联合血清学模型即天冬氨酸转氨酶与血小板比值（aspartate aminotransferase-to-platelet ratio，APRI）、纤维化指数-4 （fibrosis-4，FIB-4）评估乙型肝炎相关肝纤维化的诊断效能。方法选取2014年10月至2017年5月在上海市普陀区中心医院的慢性HBV感染患者67例，同时行2种肝脏成像技术FibroScan、ARFI及血清学检查，以病理学结果为金标准，分析比较FibroScan、ARFI分别联合血清学模型APRI、FIB-4无创评估肝纤维化的价值。符合正态分布的计量资料采用t检验，非正态分布的计量资料采用Mann-Whitney U检验。结果以肝组织病理纤维化分期结果为依据，血清学模型APRI、FIB-4及FibroScan、ARFI诊断肝纤维化≥S2的受试者工作特征（receiver operating characteristic, ROC）曲线下面积（area under curve, AUC）分别为0.752、0.612、0.885和0.850；诊断肝纤维化≥S3的AUC分别为0.746、0.733、0.851和0.863；诊断肝纤维化≥S4的AUC分别为0.782、0.705、0.962和0.981。两两联合，即APRI联合FibroScan、APRI联合ARFI、FIB-4联合FibroScan、FIB-4联合ARFI诊断肝纤维化≥S2的AUC分别为0.887、0.861、0.893、0.853；诊断肝纤维化≥S3的AUC分别为0.873、0.871、0.900和0.875；诊断肝纤维化≥S4的AUC分别为0.952、0.981、0.969和0.981。FibroScan、ARFI与肝脏炎症分级（r＝0.467，P＝0.000，r＝0.371，P＝0.002）、黄疸呈正相关（r＝0.424，P＝0.000，r＝0.0.312，P＝0.01），与血小板负相关（r＝－0.331，P＝0.006，r＝－0.312，P＝0.01）。FibroScan、ARFI及联合后的ROC曲线下面积相较单一血清学模型显著升高（均P〈0.05）。结论血清学模型APRI、FIB-4及FibroScan、ARFI对肝纤维化均有一定评估价值，FibroScan、ARFI的价值更大，而ARFI因其可融合于普通超声检查系统�
ObjectiveTo compare the diagnostic efficacy of transient elastography （TE） FibroScan and acoustic radiation force impulse imaging （ARFI） combined with serological models including aspartate aminotransferase-to-platelet ratio （APRI） and fibrosis-4 （FIB-4） in hepatitis B virus-related fibrosis.MethodsSixty-seven patients with chronic HBV infection from October 2014 to May 2017 in Department of Infectious Diseases, Putuo Hospital were enrolled. Both FibroScan and ARFI were conducted in all patients together with serological tests. According to the golden standard of pathology results, the diagnosis values of FibroScan, ARFI combined with APRI or FIB-4 were compared as noninvasive assessment for liver fibrosis. Data with homogeneity of variance were tested by t test, and data with heterogeneity of variance were tested by Mann-Whitney U test.ResultsBased on the pathology results, the receiver operating characteristic （ROC） areas under the curve （AUC） of APRI, FIB-4, FibroScan and ARFI in diagnosis of hepatic fibrosis ≥S2 were 0.752, 0.612, 0.885, and 0.850, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S3 were 0.746, 0.733, 0.851, and 0.863, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S4 were 0.782, 0.705, 0.962 and 0.981, respectively. Combined liver imaging technique and serological tests, such as APRI with FibroScan, APRI with ARFI, FIB-4 with FibroScan or FIB-4 with ARFI, the AUC of ROC curve in the 4 groups in diagnosis of hepatic fibrosis ≥S2 were 0.887, 0.861, 0.893, and 0.853, respectively; in the diagnosis of hepatic fibrosis ≥S3 were 0.873, 0.871, 0.900, and 0.875, respectively; and in diagnosis of hepatic fibrosis ≥S4 were 0.952, 0.981, 0.969, and 0.981, respectively. FibroScan and ARFI were positively correlated with liver inflammation （r=0.467, P=0.000; r=0.371, P=0.002） and jaundice （r=0.424, P=0.000; r=0.0.312, P=0.01）, while negatively correlated with platelet （r=-0.331, P=0.006; r=-0.312, P=0.01）. The AUC o
作者
吴柳
薛冬英
张洁
李维正
孙琳
李季
张文宏
邵凌云
Wu Liu;Xue Dongying;Zhang Jie;Li Weizheng;Sun Lin;Li Ji;Zhang Wenhong;Shao Lingyun(Department of Infectious Diseases,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200062,Chin)
出处
《中华传染病杂志》
CAS
CSCD
2018年第5期270-276,共7页
Chinese Journal of Infectious Diseases
基金
上海市卫计委青年项目（20144Y0185）
上海市卫计委面上项目（201440370）
