CAJ | 학술논문

目的：探讨FibroTest联合FibroScan对慢性乙型肝炎肝纤维化的诊断价值。方法留取2011年8月至2013年7月天津市第二人民医院的99例行肝活组织检查的慢性乙型肝炎患者的血清，检测α2-巨球蛋白（α2-MG）、结合珠蛋白（HP）和载脂蛋白A1（apoAⅠ），记录TBil和GGT的数值，并根据其结果结合患者的年龄和性别计算出FibroTest的数值。并对99例慢性乙型肝炎患者用FibroScan测定肝脏硬度值。根据Scheuer肝纤维化分期标准设定2个判定点，分别为显著肝纤维化（S2～S4期），严重肝纤维化（S3～S4期）[1]。以肝活组织检查病理结果为金标准绘制出FibroTest及FibroScan的受试者工作特征曲线下面积（AUROC）。评价两者对慢性乙型肝炎肝纤维化的诊断价值，并应用 Logistic 逐步回归分析方法探讨联合诊断价值。结果 FibroTest 与 Fi-broScan对S2～S4期的AUROC分别0．805（95％CI：0．713～0．897，P＜0．001），0．896（95％CI：0.833～0．959，P＜0．001），对S3～S4期的AUROC值分别为0．834（95％CI：0．741～0．928，P＜0．001），0．945（95％CI：0．891～0．999，P＜0．001）。两者联合后对显著纤维化（S2～S4期）的AUROC值为0．911（95％CI：0．854～0．967，P＜0．001）。结论 FibroTest联合FibroScan可以更准确地估计慢性乙型肝炎患者肝脏有无显著纤维化，提高诊断特异度，并保证较高的诊断准确率，对于慢性乙型肝炎预后评估及治疗决策有指导意义。
목적：탐토FibroTest연합FibroScan대만성을형간염간섬유화적진단개치。방법류취2011년8월지2013년7월천진시제이인민의원적99례행간활조직검사적만성을형간염환자적혈청，검측α2-거구단백（α2-MG）、결합주단백（HP）화재지단백A1（apoAⅠ），기록TBil화GGT적수치，병근거기결과결합환자적년령화성별계산출FibroTest적수치。병대99례만성을형간염환자용FibroScan측정간장경도치。근거Scheuer간섬유화분기표준설정2개판정점，분별위현저간섬유화（S2～S4기），엄중간섬유화（S3～S4기）[1]。이간활조직검사병리결과위금표준회제출FibroTest급FibroScan적수시자공작특정곡선하면적（AUROC）。평개량자대만성을형간염간섬유화적진단개치，병응용 Logistic 축보회귀분석방법탐토연합진단개치。결과 FibroTest 여 Fi-broScan대S2～S4기적AUROC분별0．805（95％CI：0．713～0．897，P＜0．001），0．896（95％CI：0.833～0．959，P＜0．001），대S3～S4기적AUROC치분별위0．834（95％CI：0．741～0．928，P＜0．001），0．945（95％CI：0．891～0．999，P＜0．001）。량자연합후대현저섬유화（S2～S4기）적AUROC치위0．911（95％CI：0．854～0．967，P＜0．001）。결론 FibroTest연합FibroScan가이경준학지고계만성을형간염환자간장유무현저섬유화，제고진단특이도，병보증교고적진단준학솔，대우만성을형간염예후평고급치료결책유지도의의。
Objective To investigate the diagnostic value of FibroTest combined with FibroScan for liver fibrosis in patients with chronic hepatitis B (CHB).Methods Serum samples were collected from 99 CHB patients who underwent liver biopsy in Tianjin Second People′s Hospital from August 2011 to July 2013.Serum levels ofα2-macroglobulin,haptoglobin,apolipoprotein AI,total bilirubin,and gamma-glutamyl transpeptidase were measured,and FibroTest scores were calculated according to the measurement results,as well as the age and sex of patients.In addition,all patients underwent liver stiffness measurement by FibroScan.According to the Scheuer system,liver fibrosis was staged as significant fibrosis (S2-S4)and severe fibrosis (S3-S4).With liver biopsy as the gold standard,the areas under the re-ceiver operating characteristic curves (AUCs)of FibroTest and FibroScan were determined.The diagnostic values of FibroTest and FibroScan for liver fibrosis in CHB patients were evaluated accordingly,and their combined diagnostic value was determined by logistic stepwise regres-sion analysis.Results The AUCs of FibroTest and FibroScan for the prediction of significant fibrosis (S2 -S4)were 0.805 (95% CI:0.713-0.897,P<0.001)and 0.896 (95% CI:0.833-0.959,P<0.001),respectively,and their AUCs for the prediction of severe fibrosis (S3-S4)were 0.834 (95% CI:0.741 -0.928,P<0.001)and 0.945 (95% CI:0.891 -0.999,P<0.001),respectively. Their combined AUC for the prediction of significant fibrosis (S2-S4)was 0.911 (95% CI:0.854-0.967,P<0.001).Conclusion The combination of FibroTest and FibroScan can evaluate the liver fibrosis in CHB patients more accurately,and it not only improves diag-nostic specificity,but also ensures high diagnostic accuracy,providing guidance for the prognostic evaluation and treatment of CHB.