Objective To analyze the diagnostic coincidence rate and impact factors of the detection cut-off value for the assessment of liver fibrosis by Transient Elastography ( Fibroscan) and clinical diagnosis in four different chronic liver diseases: chronic hepatitis B , chronic hepatitis C , hepatitis B cirrhosis and hepatitis C cirrhosis. Methods 1 458 patients with chronic liver diseases (446 patients with hepatitis C, 398 patients with hepatitis B, 176 patients with hepatitis C cirrhosis, 438 patients with hepatitis B cirrhosis) admitted to Tangdu Hospital from Apr. 2009to Jun. 2010 were measured to obtain cut-off value by Fibroscan. The diagnostic coincidence rate and impact factors were analyzed in these four groups of liver diseases. Results Liver stiffness measurement using Fibroscan was 12.4 KPa as the cut-off value. By contrast with the clinical diagnosis, the diagnostic coincidence rate of Fibroscan in patients with chronic hepatitis C , hepatitis B, cirrhotic patients with hepatitis C and hepatitis B were 94. 17% , 70. 60% , 85. 80% , 85. 39% , respectively. There was significantly different in the diagnostic rate between chronic hepatitis C and chronic hepatitis B. Liver stiffness measurement of 117 patients with chronic hepatitis B was out of accord with the clinical diagnosis, in which, 34 patients with BMI > 25 kg/m2, accounted for 29. 06% ; 74 patients of liver function ALT > 80 U/L, accounted for 63.25%. Conclusion Fibroscan is helpful to the diagnosis of chronic liver diseases, especially hepatitis C. Obesity and liver inflammation are important impact factors of the cut-off value. The right time and appropriate patients choosing are important to improve the accuracy of Fibroscan for diagnosis.%目的 分析瞬时弹性扫描仪(Fibroscan)在慢性乙型肝炎、慢性丙型肝炎、乙型肝炎肝硬化及丙型肝炎肝硬化四种不同慢性肝病中检测的cut-off值对肝纤维化测量的准确性及影响因素.方法 我院2009年4月- 2010年6月临床诊断的肝病患者共1458例,其中慢性乙型肝炎398例、慢性丙型肝炎446例、乙型肝炎肝硬化438例、丙型肝炎肝硬化176例,分别行Fibroscan测量cut-off值,分析其在不同肝病符合率及可能影响因素.结果 Fibroscan检查的cut-off值以12.4 KPa为分界线,通过与临床诊断对比,Fibroscan检查在慢性丙型肝炎、慢性乙型肝炎、丙型肝炎肝硬化、乙型肝炎肝硬化诊断符合率分别为94.17％、70.60％、85.80％ 、85.39％.其中在丙肝和乙肝诊断符合率方面有显著差异(P ＜0.05); 117例慢乙肝患者的Fibroscan检测的cut-off值与临床诊断不符合,其中34例患者BMI＞25 kg/m2,占29.06％；74例肝功能ALT＞80 U/L,占63.25％.结论 Fibroscan可协助诊断慢性肝病,尤其在慢性丙肝诊断方面意义重大.肥胖和肝脏炎症活动是影响Fibroscan检测结果的重要因素,合适人群的界定、恰当时机的选择对提高Fibroscan检测准确性具有重大意义.
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