中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2014年
2期
113-117
,共5页
林利静%陈高峰%顾宏图%周扬%袁继丽%邢枫%赵长青%徐列明
林利靜%陳高峰%顧宏圖%週颺%袁繼麗%邢楓%趙長青%徐列明
림리정%진고봉%고굉도%주양%원계려%형풍%조장청%서렬명
肝硬化%弹性成像技术%疗效评判
肝硬化%彈性成像技術%療效評判
간경화%탄성성상기술%료효평판
Liver cirrhosis%Elasticity imaging techniques%Curative effect evaluation
目的 评价FibroScan评判中医药抗肝纤维化疗效的价值,并探讨多种因素对肝脏弹性值(LSM)变化的影响.方法 收集102例接受2次检查的慢性肝病患者的LSM、发病原因、用药情况及2次FibroScan检查时间点前后1个月内的肝功能和凝血各项指标.组内前后比较用配对t检验,两组组间比较用独立样本t检验,多组间比较用方差分析、Q检验、非参数检验用秩和检验或x2检验、Fisher精确检验.结果 无明显肝纤维化组、肝纤维化组LSM下降或上升的幅度≥2 kPa时,肝硬化组LSM下降或上升的幅度≥4 kPa时,前后LSM均数比较,差异有统计学意义.以上述标准统计,治疗后纤维化程度不变及减轻者,联合用药组为78.8%(26/33)、扶正化瘀方组为90.7%(49/54),其他用药组为60.0%(9/15),3组间疗效差异有统计学意义(P=0.018),两两比较结果显示,扶正化瘀方组与其他用药组组间差异有统计学意义(P=0.010).在总体患者和LSM升高的患者中,肝功能各项指标和凝血指标差异均无统计学意义(P值均> 0.05).而在LSM下降的患者中,ALT、AST和谷氨酰转肽酶活性下降,且和第1次检查相比,差异有统计学意义.结论 FibroScan可作为一种无创方法,参与慢性肝病综合疗效评判.其评判肝纤维化疗效的标准:无明显肝纤维化、肝纤维化及肝硬化患者的LSM变化值宜分别设为2kPa、2 kPa及4kPa.且FibroScan评判抗肝纤维化疗效未受到ALT、AST、γ-谷氨酰转移酶和凝血酶原时间、国际标准化比值的明显影响.
目的 評價FibroScan評判中醫藥抗肝纖維化療效的價值,併探討多種因素對肝髒彈性值(LSM)變化的影響.方法 收集102例接受2次檢查的慢性肝病患者的LSM、髮病原因、用藥情況及2次FibroScan檢查時間點前後1箇月內的肝功能和凝血各項指標.組內前後比較用配對t檢驗,兩組組間比較用獨立樣本t檢驗,多組間比較用方差分析、Q檢驗、非參數檢驗用秩和檢驗或x2檢驗、Fisher精確檢驗.結果 無明顯肝纖維化組、肝纖維化組LSM下降或上升的幅度≥2 kPa時,肝硬化組LSM下降或上升的幅度≥4 kPa時,前後LSM均數比較,差異有統計學意義.以上述標準統計,治療後纖維化程度不變及減輕者,聯閤用藥組為78.8%(26/33)、扶正化瘀方組為90.7%(49/54),其他用藥組為60.0%(9/15),3組間療效差異有統計學意義(P=0.018),兩兩比較結果顯示,扶正化瘀方組與其他用藥組組間差異有統計學意義(P=0.010).在總體患者和LSM升高的患者中,肝功能各項指標和凝血指標差異均無統計學意義(P值均> 0.05).而在LSM下降的患者中,ALT、AST和穀氨酰轉肽酶活性下降,且和第1次檢查相比,差異有統計學意義.結論 FibroScan可作為一種無創方法,參與慢性肝病綜閤療效評判.其評判肝纖維化療效的標準:無明顯肝纖維化、肝纖維化及肝硬化患者的LSM變化值宜分彆設為2kPa、2 kPa及4kPa.且FibroScan評判抗肝纖維化療效未受到ALT、AST、γ-穀氨酰轉移酶和凝血酶原時間、國際標準化比值的明顯影響.
목적 평개FibroScan평판중의약항간섬유화료효적개치,병탐토다충인소대간장탄성치(LSM)변화적영향.방법 수집102례접수2차검사적만성간병환자적LSM、발병원인、용약정황급2차FibroScan검사시간점전후1개월내적간공능화응혈각항지표.조내전후비교용배대t검험,량조조간비교용독립양본t검험,다조간비교용방차분석、Q검험、비삼수검험용질화검험혹x2검험、Fisher정학검험.결과 무명현간섬유화조、간섬유화조LSM하강혹상승적폭도≥2 kPa시,간경화조LSM하강혹상승적폭도≥4 kPa시,전후LSM균수비교,차이유통계학의의.이상술표준통계,치료후섬유화정도불변급감경자,연합용약조위78.8%(26/33)、부정화어방조위90.7%(49/54),기타용약조위60.0%(9/15),3조간료효차이유통계학의의(P=0.018),량량비교결과현시,부정화어방조여기타용약조조간차이유통계학의의(P=0.010).재총체환자화LSM승고적환자중,간공능각항지표화응혈지표차이균무통계학의의(P치균> 0.05).이재LSM하강적환자중,ALT、AST화곡안선전태매활성하강,차화제1차검사상비,차이유통계학의의.결론 FibroScan가작위일충무창방법,삼여만성간병종합료효평판.기평판간섬유화료효적표준:무명현간섬유화、간섬유화급간경화환자적LSM변화치의분별설위2kPa、2 kPa급4kPa.차FibroScan평판항간섬유화료효미수도ALT、AST、γ-곡안선전이매화응혈매원시간、국제표준화비치적명현영향.
Objective To assess the performance of FibroScan in evaluating the curative effects of traditional Chinese medicine (TCM) on liver fibrosis,and to analyze factors influencing the diagnostic accuracy.Methods Data of FibroScan values,types of disease,use of drug,liver function indexes,prothrombin time (PT) and international normalized ratio (INR) were collected at both pre-(1 month prior) and post-FibroScan for 102 patients who underwent at least two FibroScan procedures.Patients were subgrouped according to presence of fibrosis,presence of cirrhosis,and TCM formulation and statistically analyzed.Results The pre-and post-FibroScan mean liver stiffness measurements (LSMs) were significantly different when the variation of LSM was ≥ 2 kPa for the non-fibrotic group (vs.the fibrotic group),or when the variation was ≥ 4 kPa for the cirrhotic group (vs.the non-cirrhotic group).In addition,the three TCM formulation groups showed significant differences,with the most robust difference exhibited between the FuZheng HuaYu formulation group and the other treatment groups (P =0.010).No significant differences were observed for the liver function indexes,PT,or INR.However,the post-FibroScan levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and gamma-glutamyltransferase (GGT) was significantly reduced in patients with reduced LSM.Conclusion FibroSean may be a useful non-invasive clinical tool for evaluating the comprehensive curative effect of treatments for chronic liver diseases,and its performance is not obviously impacted by ALT,AST,GGT,PT,and INR.The criteria for efficacy established by FibroScan are 2 kPa for the patients without liver fibrosis and 4 kPa for patients with liver cirrhosis.