FibroTouch诊断慢性乙型肝炎肝纤维化的影响因素及临床价值

目的:分析Fibro Touch诊断慢性乙型肝炎(CHB)肝纤维化的影响因素及临床评估效能。方法:收集2015年11月至2017年2月行Fibro Touch检查的CHB患者306例,同时检测血清学、影像学等指标。结果:年龄、病程、血小板(PLT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBil)、血清白蛋白(Alb)、球蛋白(Glo)、白蛋白/球蛋白比值(A/G)、脾脏长度、脾脏厚度对肝脏硬度值(LSM)有影响(P<0.05);其中年龄、病程、ALT、AST、Glo、GGT、TBil、脾脏长度、脾脏厚度与LSM值呈正相关(r>0);Alb、PLT与LSM值呈负相关(r<0)。LSM值与肝脏病理分期具有显著高度相关(r=0.84,P<0.01)。LSM在轻微肝纤维化期与肝纤维化期的曲线下面积为0.856(95%CI 0.733~0.978),敏感性为71.43%,特异性为92.54%。LSM在肝硬化期与非肝硬化期的曲线下面积为0.942(95%CI 0.897~0.987),敏感性为82.35%,特异性为94.67%。结论:Fibro Touch诊断CHB患者时,LSM值可能受年龄、病程、PLT、ALT、AST、Alb、Glo、GGT、TBil、脾脏长度、脾脏厚度因素的影响,但是Fibro Touch对诊断轻微肝纤维化与肝硬化具有较高的价值。

The factors and clinical value of FibroTouch on diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective:To observe the influencing factors and clinical evaluation of liver fibrosis in patients with chronic hepatitis B(CHB)by FibroTouch liver stiffness measurement(LSM).Methods:A total of 306 CHB patients who underwent FibroTouch in the outpatient/hospital clinic of the Department of Hepatology,Ruikang Hospital,Guangxi University of Traditional Chinese Medicine from November 2015 to February 2017,and collected serological and imaging indicators were collected.Results:Age,PLT,duration of disease,ALT,AST,Alb,GLO,GGT,TBil,spleen length,spleen thickness and LSM were statistically significant(P<0.05);age,duration,ALT,AST,GLO,GGT,TBil,spleen length,spleen thickness and LSM were positively correlated(r>0);Alb,PLT and LSM were negatively correlated(r<0).LSM values were significantly correlated with liver pathological stage(r=0.84,P<0.01).The LSM value under the curve between the mild liver fibrosis group and the liver fibrosis group was 0.856(95%CI,0.733~0.978),the sensitivity was 71.43%,and the specificity was 92.54%.The area under the curve of LSM in the cirrhosis group and the non-cirrhosis group was 0.942(95%CI,0.897~0.987),the sensitivity was 82.35%,and the specificity was 94.67%.Conclusion:Although FibroTouch may be affected by age,duration,PLT,ALT,AST,Alb,GLO,GGT,TBil,spleen length,and spleen thickness in patients with chronic hepatitis B,FibroTouch is used to diagnose mild liver fibrosis.The cirrhosis phase has a high value.