中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2008年
12期
897-901
,共5页
桂红莲%谢青%王晖%周惠娟%蔡伟%安宝燕%姜山%许蓓%林之莓%徐玉敏
桂紅蓮%謝青%王暉%週惠娟%蔡偉%安寶燕%薑山%許蓓%林之莓%徐玉敏
계홍련%사청%왕휘%주혜연%채위%안보연%강산%허배%림지매%서옥민
肝炎,乙型,慢性%肝纤维化%诊断,无创伤%受试者工作特征曲线%FibroTest-ActiTest
肝炎,乙型,慢性%肝纖維化%診斷,無創傷%受試者工作特徵麯線%FibroTest-ActiTest
간염,을형,만성%간섬유화%진단,무창상%수시자공작특정곡선%FibroTest-ActiTest
Hepatitis B,chronic%Liver fibrosis%Diagnosis,noninvasive%ROC curve%FibroTest-ActiTest
目的 验证FibroTest-ActiTest(FT-AT)对慢性HBV感染者肝脏纤维化和炎症程度的诊断价值,并分析导致FT和肝活组织检查两者不一致性的原因.方法 选择经皮肝穿刺活组织检查的慢性HBV感染患者100例,并当天留取血清做相关生物化学指标检测.以受试者工作特征(ROC)曲线判定诊断价值.结果 100份肝组织标本长度为8～30 mm(中位数15 mm);可供评价汇管区5～26个(中位数为9个).所有患者中存在显著纤维化(F3～F6)者39例,显著炎症(A2～A4)者65例.诊断显著炎症(A2～A4)、显著纤维化(F3～F6)和肝硬化(F5～F6)的ROC曲线下面积分别是0.833、0.840和0.862,95%可信区间分别为0.753～0.913、0.750～0.929和0.721～1.003.FT≤0.31以86%阴性预测值排除显著肝纤维化,而FT≥0.72则以92%阳性预测值确诊显著肝纤维化.FT和肝活组织检查结果比较,纤维化存在2级以上差异者有26例;其不一致性:3例归咎于肝活组织检查,7例归咎于FT,16例原因未定.结论 FT-AT可较准确评估慢性乙型肝炎患者的肝纤维化和炎症状态.当选择合适分界值判定有无显著肝纤维化时,FT可使68%的患者避免肝穿刺,并保证87%的诊断准确率.
目的 驗證FibroTest-ActiTest(FT-AT)對慢性HBV感染者肝髒纖維化和炎癥程度的診斷價值,併分析導緻FT和肝活組織檢查兩者不一緻性的原因.方法 選擇經皮肝穿刺活組織檢查的慢性HBV感染患者100例,併噹天留取血清做相關生物化學指標檢測.以受試者工作特徵(ROC)麯線判定診斷價值.結果 100份肝組織標本長度為8～30 mm(中位數15 mm);可供評價彙管區5～26箇(中位數為9箇).所有患者中存在顯著纖維化(F3～F6)者39例,顯著炎癥(A2～A4)者65例.診斷顯著炎癥(A2～A4)、顯著纖維化(F3～F6)和肝硬化(F5～F6)的ROC麯線下麵積分彆是0.833、0.840和0.862,95%可信區間分彆為0.753～0.913、0.750～0.929和0.721～1.003.FT≤0.31以86%陰性預測值排除顯著肝纖維化,而FT≥0.72則以92%暘性預測值確診顯著肝纖維化.FT和肝活組織檢查結果比較,纖維化存在2級以上差異者有26例;其不一緻性:3例歸咎于肝活組織檢查,7例歸咎于FT,16例原因未定.結論 FT-AT可較準確評估慢性乙型肝炎患者的肝纖維化和炎癥狀態.噹選擇閤適分界值判定有無顯著肝纖維化時,FT可使68%的患者避免肝穿刺,併保證87%的診斷準確率.
목적 험증FibroTest-ActiTest(FT-AT)대만성HBV감염자간장섬유화화염증정도적진단개치,병분석도치FT화간활조직검사량자불일치성적원인.방법 선택경피간천자활조직검사적만성HBV감염환자100례,병당천류취혈청주상관생물화학지표검측.이수시자공작특정(ROC)곡선판정진단개치.결과 100빈간조직표본장도위8～30 mm(중위수15 mm);가공평개회관구5～26개(중위수위9개).소유환자중존재현저섬유화(F3～F6)자39례,현저염증(A2～A4)자65례.진단현저염증(A2～A4)、현저섬유화(F3～F6)화간경화(F5～F6)적ROC곡선하면적분별시0.833、0.840화0.862,95%가신구간분별위0.753～0.913、0.750～0.929화0.721～1.003.FT≤0.31이86%음성예측치배제현저간섬유화,이FT≥0.72칙이92%양성예측치학진현저간섬유화.FT화간활조직검사결과비교,섬유화존재2급이상차이자유26례;기불일치성:3례귀구우간활조직검사,7례귀구우FT,16례원인미정.결론 FT-AT가교준학평고만성을형간염환자적간섬유화화염증상태.당선택합괄분계치판정유무현저간섬유화시,FT가사68%적환자피면간천자,병보증87%적진단준학솔.
Objectives To confirm the diagnostic value ofFibroTest-ActiTest (FT-AT) in predicting fiver fibrosis and inflammatory activity in patients with chronic hepatitis B (CHB), and to study the discor-dances between FT and their liver biopsies. Methods A study was performed on 100 patients with CHB who underwent liver biopsies in our hospital. Serum samples for biochemical markers were taken on the day of their biopsies. Diagnostic accuracies were assessed by ROC curve analysis. Results The median biopsy specimen size was 15mm (range: 8-30), with 9 (median) portal tracts (range 5-26). Thirty-nine patients were classified as Ishak F3-F6 in fibrosis and 65 patients as A2-A4 in inflammation. Areas under ROC curve for diagnosis of significant inflammation (A2-A4), significant fibrosis (F3-F6), and cirrhosis (F5-F6) were 0.833 (95% CI: 0.753-0.913), 0.840 (0.750-0.929), and 0.862 (0.721-1.003), respectively. FT < 0.31 had a NPV of 86% for excluding significant fibrosis, whereas FT ≥ 0.72 had a PPV of 92% for predicting significant fibrosis. Among the 26 patients with 2 fibrosis stages of discordances between FT and biopsy, the discordance was attributable to biopsy in 3 cases, to FT in 7, and undetermined in 16. Conclusion This study confirms the diagnostic value of FT-AT and suggests that 68% of our patients with CHB can be reliably identified by FT without a liver biopsy and with a dignosis accuracy of 87%.
