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LSM值与APRI评估慢性肝病肝纤维化程度的临床研究
作者:高蕾 王银玲 王茂荣  
单位:东南大学
关键词:慢性肝病 肝纤维化 LSM值 ARPI 
分类号:
出版年·卷·期(页码):2011·30·第四期(541-544)
摘要:

[摘要] 目的 以肝活检结果为参考标准,探讨肝脏硬度测定(LSM)值、天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值指数(APRI)用于评估慢性肝病肝纤维化程度的临床应用价值。方法 94例慢性肝病患者肝活检当日或前一天作血常规和肝功能检测与瞬时弹性扫描(FibroScan®, FS)检查。以肝活检结果为标准,比较LSM值与ARPI评估肝纤维化程度的接受者操作特征(ROC)曲线下面积(AUC),并比较相应的截断点(cut-off值)及其灵敏度和特异度。结果 应用LSM值与ARPI区分显著肝纤维化(S≥2)的截断点分别为8.10kPa、0.45,对应的AUC分别为0.85、0.67;两者区分早期肝硬化(S≥3)和肝硬化(S=4)的截断点分别为9.80 kPa、0.98与13.10 kPa、0.98,对应的AUC分别为0.96、0.66与0.97、0.72。在测定结果与肝纤维化程度相关性上,LSM值(r=0.64, P <0.05)比APRI(r=0.42, P <0.05)更明显。结论 应用LSM值和APRI评估慢性肝病肝纤维化程度时,以LSM值反映更为准确。

Abstract: Object To use liver stiffness measurement (LSM) value and aspartate aminotransferase-to-platelet ratio index (APRI) to evaluate the fibrosis in patients with chronic liver diseases and to compare the results with those of clinical assessment of fibrosis by using liver biopsies as the reference standard. Methods Ninety four hospitalized patients with 42 chronic hepatitis B, 8 chronic hepatitis C, 6 non-alcoholic fatty liver disease, 11 autoimmune hepatitis, 7 Hereditary hyperbilirubinemia underwent FibroScan, blood count, liver function tests, as well as liver biopsies at the same or following next day between April 2009 and March 2010. Compared with histologic fibrosis stage at liver biopsy, all the LSM value and the calculated APRI were assessed by using receiver operating characteristic (ROC) analysis. The corresponding cut-off values, sensitivity and specificity were also calculated and compared. Results LSM and ARPI cut-off points were 8.1kPa, 0.45 for S of 2 or greater, 9.80, 0.98 for S of 3 or greater, and 13.1kPa, 0.98 for S of 4, respectively. Accordingly, the areas under the ROC curves (AUC) for LSM and ARPI were 0.85 and 0.67 for S of 2 or greater, 0.96 and 0.66 for S of 3 or greater, 0.97 and 0.72 for S of 4, respectively. LSM (r=0.64, P <0.05) performed better than ARPI (r=0.42, P <0.05). Conclusion LSM and APRI are not invasive and LSM is more accurate when applied to evaluate liver fibrosis in patients with chronic liver diseases.

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