肝纤维化患者无创诊断模型建立与诊断价值评估

摘要

Objective To evaluate liver instantaneous elastic imaging FibroScan and multiparameter model applica-tion value in the liver fibrosis caused by different causes,and expect higher specificity and sensitivity of model parame-ters, analyze the different noninvasive diagnostic values in the assessment of liver fibrosis model.Methods Two hun-dred and ninety-four patients diagnosed as liver fibrosis were selected from Oct. 2013 to Oct. 2015 in the Shanxi Hospi-tal of Traditional Chinese Medicine,included 171 cases of chronic hepatitis B liver fibrosis and 46 cases of liver fibrosis in chronic hepatitis C,35 cases of alcoholic hepatitis liver fibrosis,42 cases of autoimmune hepatitis. Hardness value was detected by FibroScan liver (LSM); and serological related indicators were measured. SPSS 21.0 statistical soft-ware was used to statistical analysis,the receiver-operating characteristic curve(ROC) was used to analyze the accuracy of the four kinds of chronic liver disease of liver fibrosis.Results LSM value,Frons index,RPR,APRI score and Fib-4 had statistical significance among four indexes (P<0.05). AUROC of hepatitis B cirrhosis was ≥0.75, AUROC of hepatitis C cirrhosis group was≥0.80,the difference was not significant. In alcoholic hepatitis cirrhosis group,all over AUROC except for APRI model was ≥0.95. AUROC of autoimmune hepatitis cirrhosis group of LSM was 0.85,higher than that of other diagnosis model,the sensitivity(Se) and specificity(Sp) reached 0.74 and 0.74,respectively.Con-clusion LSM value,Frons index,RPR,APRI score,Fib-4 index are simple and effective noninvasive assessments of liver fibrosis index,the degree of hepatic fibrosis diagnosis efficiency is not influenced by etiology, they can be widely used in all kinds of diagnosis of liver fibrosis,especially in diagnosis of alcoholic liver fibrosis.%目的 评估肝脏瞬时弹性成像技术FibroScan与多参数模型在不同病因所致肝纤维化中应用价值,并期望得出特异性与敏感性较高的模型参数,分析不同无创诊断模型在肝纤维化中的评估价值.方法 选取2013年10月-2015年10月就诊于山西省中医院确诊为肝纤维化患者294例,其中慢性乙型肝炎肝纤维化171例,慢性丙型肝炎肝纤维化46例,酒精性肝炎肝纤维化35例,自身免疫性肝炎肝纤维化42例.用FibroScan检测肝脏硬度值(LSM);并测定血清学相关指标.采用SPSS 21.0统计学软件进行分析,采用受试者工作特征曲线(ROC)分析诊断四种慢性肝病肝纤维化的准确性.结果 LSM值、Frons指数、RPR、APRI评分、Fib-4指数两两比较,差异均有统计学意义(P<0.05).乙型肝炎肝硬化AUROC均≥0.75,丙型肝炎肝硬化组AUROC均≥0.80,差异无统计学意义(P>0.05);酒精性肝炎肝硬化组除APRI模型外,余AUROC均≥0.95;自身免疫性肝炎肝硬化组LSM的AUROC=0.85,高于其他诊断模型,敏感性(Se)和特异性(Sp)也分别达到了0.74和0.91.结论 LSM值、Frons指数、RPR、APRI评分、Fib-4指数是简单、有效的无创肝纤维化评价指标,在肝纤维化程度的诊断效能上不受病因学的影响,可广泛应用于各种肝纤维化诊断,在酒精性肝纤维化的诊断上尤为突出.