中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2011年
4期
286-290
,共5页
陈学兵%朱霞%陈立宇%陈恩强%唐红
陳學兵%硃霞%陳立宇%陳恩彊%唐紅
진학병%주하%진립우%진은강%당홍
肝炎,乙型,慢性%肝硬化%活组织检查,肝%FibroScan%肝脏硬度
肝炎,乙型,慢性%肝硬化%活組織檢查,肝%FibroScan%肝髒硬度
간염,을형,만성%간경화%활조직검사,간%FibroScan%간장경도
Hepatitis B,chronic%Liver cirrhosis%Biopsy,liver%FibroScan%Liver stiffness measurement
目的 探讨慢性乙型肝炎(CHB)患者中,不同水平的ALT对FibroScan诊断不同肝纤维化分期准确性的影响.方法 回顾性分析213例慢性乙型肝炎患者,根据血清ALT水平分为ALT＜1×正常值上限(ULN)、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3组,分析3组采用FibroScan诊断不同肝纤维化分期的ROC曲线下面积,判断其诊断准确性.根据不同资料采用t检验、x2检验、受试者工作曲线或其曲线下面积(AUROC)进行统计学分析.结果在213例CHB患者中,FibroScan值与不同肝纤维化分期在3组患者中均有明显的相关性(rs值分别为0.773、0.889和0.412,P值均＜0.05).FibroScan诊断2级以上肝纤维化(F≥2,F0～1对比F2～4)和肝硬化(F=4,F0～3对比F4)的AUROC分别为0.916和0.971;其截断值分别为7.0kPa和13.0kPa;准确度分别为84.0%和93.4%.其诊断F≥2的AUROC和准确度均低于肝硬化.ALT＜1×ULN、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3组在诊断明显肝纤维化的AUROC分别为0.939、0.967和0.687,其敏感度分别为90.0%、89.7%和47.8%;准确度为90.5%、93.9%和68.4%.ALT≥2×ULN组的AUROC、敏感度和准确度明显低于另两组;而ALT＜2×ULN两组的AUROC和准确度相近.ALT＜1×ULN、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3组在诊断肝硬化的AUROC分别为0.970、0.985和0.952,其敏感度分别为93.8%、100%和100%;准确度分别为:88.9%、95.9%和92.1%.3组的AUROC、敏感度和准确度均较高,未随ALT升高而出现明显变化.结论 FibroScan是诊断2级以上肝纤维化,尤其是肝硬化可靠的检测方法; FibroScan诊断慢性乙型肝炎所致肝硬化的准确性可能受ALT升高的影响不明显;诊断2级以上肝纤维化的准确性对于ALT＜2×ULN的慢性乙型肝炎患者无明显影响,但是对ALT≥2×ULN的患者,其诊断的准确性降低.
目的 探討慢性乙型肝炎(CHB)患者中,不同水平的ALT對FibroScan診斷不同肝纖維化分期準確性的影響.方法 迴顧性分析213例慢性乙型肝炎患者,根據血清ALT水平分為ALT＜1×正常值上限(ULN)、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3組,分析3組採用FibroScan診斷不同肝纖維化分期的ROC麯線下麵積,判斷其診斷準確性.根據不同資料採用t檢驗、x2檢驗、受試者工作麯線或其麯線下麵積(AUROC)進行統計學分析.結果在213例CHB患者中,FibroScan值與不同肝纖維化分期在3組患者中均有明顯的相關性(rs值分彆為0.773、0.889和0.412,P值均＜0.05).FibroScan診斷2級以上肝纖維化(F≥2,F0～1對比F2～4)和肝硬化(F=4,F0～3對比F4)的AUROC分彆為0.916和0.971;其截斷值分彆為7.0kPa和13.0kPa;準確度分彆為84.0%和93.4%.其診斷F≥2的AUROC和準確度均低于肝硬化.ALT＜1×ULN、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3組在診斷明顯肝纖維化的AUROC分彆為0.939、0.967和0.687,其敏感度分彆為90.0%、89.7%和47.8%;準確度為90.5%、93.9%和68.4%.ALT≥2×ULN組的AUROC、敏感度和準確度明顯低于另兩組;而ALT＜2×ULN兩組的AUROC和準確度相近.ALT＜1×ULN、1×ULN≤ALT＜2×ULN和ALT≥2×ULN 3組在診斷肝硬化的AUROC分彆為0.970、0.985和0.952,其敏感度分彆為93.8%、100%和100%;準確度分彆為:88.9%、95.9%和92.1%.3組的AUROC、敏感度和準確度均較高,未隨ALT升高而齣現明顯變化.結論 FibroScan是診斷2級以上肝纖維化,尤其是肝硬化可靠的檢測方法; FibroScan診斷慢性乙型肝炎所緻肝硬化的準確性可能受ALT升高的影響不明顯;診斷2級以上肝纖維化的準確性對于ALT＜2×ULN的慢性乙型肝炎患者無明顯影響,但是對ALT≥2×ULN的患者,其診斷的準確性降低.
목적 탐토만성을형간염(CHB)환자중,불동수평적ALT대FibroScan진단불동간섬유화분기준학성적영향.방법 회고성분석213례만성을형간염환자,근거혈청ALT수평분위ALT＜1×정상치상한(ULN)、1×ULN≤ALT＜2×ULN화ALT≥2×ULN 3조,분석3조채용FibroScan진단불동간섬유화분기적ROC곡선하면적,판단기진단준학성.근거불동자료채용t검험、x2검험、수시자공작곡선혹기곡선하면적(AUROC)진행통계학분석.결과재213례CHB환자중,FibroScan치여불동간섬유화분기재3조환자중균유명현적상관성(rs치분별위0.773、0.889화0.412,P치균＜0.05).FibroScan진단2급이상간섬유화(F≥2,F0～1대비F2～4)화간경화(F=4,F0～3대비F4)적AUROC분별위0.916화0.971;기절단치분별위7.0kPa화13.0kPa;준학도분별위84.0%화93.4%.기진단F≥2적AUROC화준학도균저우간경화.ALT＜1×ULN、1×ULN≤ALT＜2×ULN화ALT≥2×ULN 3조재진단명현간섬유화적AUROC분별위0.939、0.967화0.687,기민감도분별위90.0%、89.7%화47.8%;준학도위90.5%、93.9%화68.4%.ALT≥2×ULN조적AUROC、민감도화준학도명현저우령량조;이ALT＜2×ULN량조적AUROC화준학도상근.ALT＜1×ULN、1×ULN≤ALT＜2×ULN화ALT≥2×ULN 3조재진단간경화적AUROC분별위0.970、0.985화0.952,기민감도분별위93.8%、100%화100%;준학도분별위:88.9%、95.9%화92.1%.3조적AUROC、민감도화준학도균교고,미수ALT승고이출현명현변화.결론 FibroScan시진단2급이상간섬유화,우기시간경화가고적검측방법; FibroScan진단만성을형간염소치간경화적준학성가능수ALT승고적영향불명현;진단2급이상간섬유화적준학성대우ALT＜2×ULN적만성을형간염환자무명현영향,단시대ALT≥2×ULN적환자,기진단적준학성강저.
Objective To analyze whether or not the accuracy of liver stiffness measurement (LSM)with transient elastography (FibroScan) for the diagnosis of liver fibrosis influenced by serum alanine aminotransferase (ALT) levels in patients with chronic hepatitis B. Methods 213 consecutive CHB patients who underwent liver biopsy and LSM were enrolled and divided into three groups by the criteria of ALT＜1×ULN, 1×ULN≤ALT＜2×ULN and ALT≥2×ULN. The areas under the receiver operating curve (AUC) were analyzed and the accuracy of FibroScan for the diagnosis of liver fibrosis were detected in the three groups. Results Significant correlation existed between the stages of liver fibrosis and LSM (rs=0.773,0.889 and 0.412, P＜0.05). AUCs of LSM in all patients for significant fibrosis (F≥2, F0-1 vs F2-4)and cirrhosis (F=4, F0-3 vs F4) were 0.916 and 0.971 respectively.The accuracy of diagnosis for significant fibrosis and cirrhosis were 84.0% and 93.4% respectively.AUCs of LSM in ALT＜1×ULN,1×ULN≤ALT＜2×ULN and ALT≥2×ULN groups for significant fibrosis were 0.939, 0.967 and 0.687 respectively.The sensitivity of the three groups was 90.0%, 89.7% and 47.8% respectively. The accuracies of the three groups was 90.5%, 93.9% and 68.4% respectively. The AUC, sensitivity and accuracy of ALT≥2×ULN group for significant fibrosis were significantly lower than the other two groups. AUCs of LSM in three groups for cirrhosis were 0.970, 0.985 and 0.952 respectively. The sensitivities of the three groups were 93.8%,100% and 100% respectively. The accuracies of the three groups were 88.9%, 95.9% and 92.1% respectively.The AUCs, sensitivity and accuracy for cirrhosis of the three groups didn't change with elevated ALT. Conclusion Transient elastography (FibroScan) is a reasonable noninvasive tool to diagnose significant fibrosis,especially liver cirrhosis in CHB patients. The accuracy of FibroScan for diagnosis of liver cirrhosis may not be influenced by elevated ALT. While in ALT≥2 ×ULN group, the accuracy of FibroScan for diagnosis of significant fibrosis was significantly lower as compared to the ALT≤2×ULN groups.
