CAJ | 학술논문

目的探讨瞬时弹性成像(Fibroscan)用于评估胆道闭锁肝纤维化程度的可靠性以及相关界值,为胆道闭锁无创性评估提供依据.方法回顾性分析2012年3月至2013年2月我院普外科手术治疗的31例胆道闭锁患儿术中肝脏病理、术前Fibroscan检查以及血液学指标.其中Fibroscan检查结果以肝脏硬度测量值(LSM)表示.获取样本病例Kasai手术中取得并保存的肝脏病理标本,应用Masson染色评定肝纤维化程度.统计分析LSM、各项血液学指标与肝纤维化程度之间的相关性,并用ROC曲线评价各项指标在诊断胆道闭锁肝硬化方面的应用价值.结果对31例胆道闭锁术中肝脏病理进行Metavir分级,其中无F0和F1,F2组4例,F3组20例,F4组7例;无肝硬化组(F0-F3)24例,肝硬化组(F4)7例.以肝脏病理分级不同分组(F2、F3、F4),LSM分别为(9.10±3.30) kPa、(11.02±3.31)kPa、(22.86±12.43)kPa;APRI指数分别为1.76±1.12、2.34±1.93、2.72±2.36.LSM的组间差异均有显著统计学意义(P=0.001),行组内均值比较,LSM在F2与F4、F3与F4差异均有显著意义,而在F2与F3之间差异无统计学意义;APRI指数组间差异无统计学意义(P=0.741).LSM和APRI用于判断胆道闭锁肝硬化(F4)的受试者工作曲线下面积(AUROC)分别为0.886和0.536.LSM以15.15 kPa为界值,APRI以1.855为界值,判断F4的敏感性、特异性、阳性预测值、阴性预测值分别为0.857、0.917、0.750、0.957和0.714、0.583、0.357、0.882.结论 Fibroscan检查可用于胆道闭锁患儿肝纤维化程度的评估.LSM判别胆道闭锁患儿是否已达肝硬化的界值为15.15 kPa,其准确性明显高于APRI指数.
목적 탐토순시탄성성상(Fibroscan)용우평고담도폐쇄간섬유화정도적가고성이급상관계치,위담도폐쇄무창성평고제공의거.방법 회고성분석2012년3월지2013년2월아원보외과수술치료적31례담도폐쇄환인술중간장병리、술전Fibroscan검사이급혈액학지표.기중Fibroscan검사결과이간장경도측량치(LSM)표시.획취양본병례Kasai수술중취득병보존적간장병리표본,응용Masson염색평정간섬유화정도.통계분석LSM、각항혈액학지표여간섬유화정도지간적상관성,병용ROC곡선평개각항지표재진단담도폐쇄간경화방면적응용개치.결과 대31례담도폐쇄술중간장병리진행Metavir분급,기중무F0화F1,F2조4례,F3조20례,F4조7례;무간경화조(F0-F3)24례,간경화조(F4)7례.이간장병리분급불동분조(F2、F3、F4),LSM분별위(9.10±3.30) kPa、(11.02±3.31)kPa、(22.86±12.43)kPa;APRI지수분별위1.76±1.12、2.34±1.93、2.72±2.36.LSM적조간차이균유현저통계학의의(P=0.001),행조내균치비교,LSM재F2여F4、F3여F4차이균유현저의의,이재F2여F3지간차이무통계학의의;APRI지수조간차이무통계학의의(P=0.741).LSM화APRI용우판단담도폐쇄간경화(F4)적수시자공작곡선하면적(AUROC)분별위0.886화0.536.LSM이15.15 kPa위계치,APRI이1.855위계치,판단F4적민감성、특이성、양성예측치、음성예측치분별위0.857、0.917、0.750、0.957화0.714、0.583、0.357、0.882.결론 Fibroscan검사가용우담도폐쇄환인간섬유화정도적평고.LSM판별담도폐쇄환인시부이체간경화적계치위15.15 kPa,기준학성명현고우APRI지수.
Objective To evaluate the reliability of using transient elastography (Fibroscan) for liver fibrosis in biliary atresia (BA),establish its critical values and provide rationales for non-invasive assessment.Methods A total of 31 BA patients at our hospital from March 2012 to February 2013 were recruited.Their liver biopsy samples were collected during Kasai operation,preoperative fibroscans performed and hematological parameters measured.The fibroscan values were presented as liver stiffness measurement (LSM).The extent of liver fibrosis was evaluated microscopically with Masson trichrome staining.The correlations between LSM,hematological parameters and liver fibrosis were analyzed.The operating characteristic curve (ROC) was used to define the critical values for diagnosis of liver cirrhosis in BA.Results According to Metavir score system,their levels of liver fibrosis were determined as group F2 (n =4),F3(n =20),F4 (n =7),F0 (n =0) and F1 (n =0).There were 24 non-cirrhotic (F0-F3) and 7 cirrhotic cases (F4).In groups F2,F3 and F4,the mean LSMs were (9.10 ± 3.30),(11.02 ± 3.31) and (22.86 ± 12.43) kPa and the values of aspartate aminotransferase to platelet ratio index (APRI) were 1.76 ± 1.12,2.34 ± 1.93 and 2.72 ± 2.36 respectively.Statistical differences existed in LSM between F2 and F4,as well as F3 and F4.However,there was no statistical difference between F2 and F3.No statistical inter-group difference existed in APRI (P=0.741＞0.05).The areas under the receive operating characteristic curve (AUROC) of LSM and APRI for diagnosing liver cirrhosis were 0.886 and 0.536 respectively.The cutoff values of LSM and APRI were 15.15 kPa and 1.855.And their levels of sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) were 0.857,0.917,0.750,0.957 and 0.714,0.583,0.357,0.882 respectively.Conclusions Fibroscan may be effectively used to assess liver fibrosis in BA.A LSM cutoff value of 15.15 kPa is able to distinguish cirrhotic BA patients from noncirrhotic ones.And its accuracy is obviously better than that of APRI.