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1、18·论著·《中国肝脏病杂志(电子版)》2014年第6卷第1期ARFI、Forns指数、FIB-4和APRI无创诊断慢性乙型病毒性肝炎肝纤维化的研究1,2111112212刘京,刘映霞,董常峰,姚思敏,李莎茜,袁静,陈川铁,赵美芬,林益敏,彭忠田(1.深圳巿第三人民医院感染科,感染性疾病国家重点学科,广东深圳518112;2.南华大学第一临床学院感染科,1湖南衡阳421001)摘要:目的声辐射力脉冲成像技术(ARFI)及血清学诊断模型(Forns指数、FIB-4、APRI)对慢性乙型病毒性肝炎肝纤维化评估的价值。方法111例确诊为慢性乙型病毒性
2、肝炎患者,根据肝组织活检病理分期结果分组:无明显肝纤维化组(S0、S1)40例,明显肝纤维化组(≥S2)48例、早期肝硬化组(S4)23例。每例患者同期进行ARFI、Forns指数、FIB-4、APRI的评估。比较无创诊断模型与肝脏病理的相关性,并根据受试者工作特征曲线(ROC)分析无创诊断模型对肝纤维化的诊断价值。结果ARFI、Forns指数、FIB-4、APRI4种无创诊断方法与肝组织活检具有良好的一致性,其皮尔逊相关系数(Pearsoncorrelationcoefficient)分别为0.882、0.639、0.589、0.418。明显
3、肝纤维化组(≥S2)及早期肝硬化组,ARFI的诊断价值均优于FIB-4(Z=2.882,P=0.004;Z=3.215,P=0.001)、APRI(Z=4.850,P<0.001;Z=3.198,P=0.001)、Forns指数(Z=2.182,P=0.029;Z=2.798,P=0.005)。结论ARFI对明显肝纤维化及早期肝硬化的诊断具有较高的价值,值得推广。关键词:无创诊断;慢性乙型病毒性肝炎;肝纤维化ARFI,Fornsindex,FIB-4andAPRIdiagnosisliverfibrosisinpatientswithchron
4、icliverdiseases1,2111112LIUJing,LIUYing-xia,DONGChang-feng,YAOSi-min,LISha-xi,YUANJing,CHENChuan-tie,212ZHAOMei-fen,LINYi-min,PENGZhong-tian(1.DepartmentofInfectiousDiseases,ThirdPeople’sHospitalofShenzhen,Shenzhen518112,China;2.DepartmentofInfectiousDiseases,theFirstAffilia
5、tedHospitalofNanhuaUniversity,Hengyang421001,China)Abstract:ObjectiveToassessmentthevalueofacousticradiationforceimpulse(ARFI)andserologicaldiagnosismodel(Fornsindex,FIB-4,APRI)toliverfibrosisofchronichepaticB.MethodsTotalof111patientconfirmedasCHB,dividedintogroupsaccording
6、totheresultoftheliverbiopsy:nosignificantliverfibrosisgroup(S0,S1)40cases,significantlyfibrosisgroup(≥S2)48cases,earlycirrhosisgroup(S4)23cases.Duringthesameperiod,eachpatientwiththeassessmentofARFI,Fornsindex,Fib-4andAPRI.Comparedthecorrelationofnoninvasivediagnosismodeland
7、liverbiopsy.Moreover,analysisthediagnosticvalueofnoninvasiveliverfibrosismodeltotheliverfibrosisaccordingtothereceiver-operatingcharacteristiccurve.ResultsARFI,Fornsindex,FIB-4,APRI,thefourkindsofnoninvasivediagnosticmethodhasagoodconsistencywithliverbiopsy,andtheirPearsonco
8、rrelationcoefficientwere0.882,0.639,0.589,0.418.TheassessmentvalueofARFItos