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目的:探讨瞬时弹性成像(FibroScan)诊断慢性乙型肝炎肝纤维化的准确性。方法:选取慢性乙型肝炎患者289例,其中未做病理组198例,病理组91例,正常对照50例,病理组患者行病理肝纤维化检测,未做病理组患者检查B超,全部患者及正常对照应用FibroScan进行肝脏硬度检测(liver stiffness measurement,LSM)值测量。分析未做病理组慢乙肝组与正常对照组间及未做病理组慢乙肝组B超肝纤维化各级间LSM值的差异;病理慢乙肝组采用受试者工作特征(Receiver Operating haracteristic,ROC)曲线分析FibroScan诊断肝纤维化的准确性,并得出各期诊断界值;根据该诊断界值对未做病理慢乙肝组进行FibroScan肝纤维化分期,分析其与B超肝纤维化分级的一致性。结果:LSM值在未做病理慢乙肝组和正常对照组间及B超肝纤维化各级间差别显著(P<0.05);其中病理组统计结果显示F1、F2、F3、F4期肝纤维化的ROC曲线下面积(Area under Receiver Operating Characteristic,AUROC)分别为0.726、0.847、0.806、0.864,诊断界值分别为6.5、7.4、10.1、17.0 kPa,敏感性分别为69.62%、68.33%、66.67%、72.22%,特异性分别为66.67%、87.10%、85.71%、91.78%;肝纤维化的FibroScan分期和B超分级具有一致性(Kappa值=0.366,P<0.05)。结论:FibroScan对慢性乙型肝炎肝纤维化尤其是严重肝纤维化及肝硬化诊断准确性高,具有良好的临床应用价值。
Objective: To investigate the accuracy of FibroScan in diagnosis of chronic hepatitis B liver fibrosis. Methods: A total of 289 patients with chronic hepatitis B were enrolled. Among them, 198 cases were pathological group, 91 cases were pathological group and 50 cases were normal control group. Pathological liver fibrosis was detected in pathological group, And normal control using FibroScan liver stiffness measurement (liver stiffness measurement, LSM) measurements. The difference of LSM between B-type liver cirrhosis and B-type liver cirrhosis without pathology group was analyzed. The receiver operating characteristic (ROC) ) Curve analysis of FibroScan diagnostic accuracy of liver fibrosis, and to draw the diagnostic cutoff value; according to the diagnostic cutoff value of non-pathological chronic hepatitis B group FibroScan liver fibrosis staging, analysis and B-type liver fibrosis consistency. Results: There was a significant difference (P <0.05) between LSM value and pathologic grade of chronic hepatitis B and between normal control group and different stages of B-type liver fibrosis (P <0.05). The pathological results showed that F1, F2, F3 and F4 stages of liver fibrosis Area under receiver operating characteristic (AUROC) were 0.726,0.847,0.806,0.864 respectively, the diagnostic cutoff values were 6.5, 7.4, 10.1 and 17.0 kPa respectively, the sensitivity were 69.62%, 68.33% and 66.67% , 72.22% and specificity of 66.67%, 87.10%, 85.71% and 91.78% respectively. The FibroScan staging and B grade of liver fibrosis were consistent (Kappa = 0.366, P <0.05). Conclusion: FibroScan has high diagnostic value in the diagnosis of liver fibrosis in chronic hepatitis B, especially severe liver fibrosis and cirrhosis, and has good clinical value.