摘要
目的探索Fibroscan联合血清学肝纤维化标志物检测诊断早期肝硬化的可行性。方法 34例临床诊断为慢性乙型病毒性肝炎(CHB)患者,同时进行Fibroscan、血清肝纤维化标志物、腹部B超检查和肝穿刺活检,并抽样进行胃镜检查,将非创伤性检查的结果与组织病理诊断比较。应用SPSS V17.0统计学软件,将组织病理学诊断为S2、S3、S4期患者的Fibroscan与血清学肝纤维化标志物的检测值分别进行LSD-t检验;计算肝脏弹性值(FS值)、腹部B超检查结果及Fibroscan联合血清学肝纤维化标志物检测值分别与病理诊断的吻合率。结果病理诊断为S2、S3、S4期的患者,其各期的Fibroscan FS值(9.45±4.36、15.27±4.15、23.50±7.69)、血清学肝纤维化标志物HA值(96.49±49.93、180.76±67.40、396.08±97.30)两两相比,差异有统计学意义(P<0.05);但其余的血清学肝纤维化指标检测值显示,S2、S3期之间差异无统计学意义(P>0.05),S3、S4和S2、S4之间相比,差异有统计学意义(P<0.01);Fibroscan与病理诊断S0-1、S2、S3、S4期的吻合率分别为:33.33%、81.82%、37.50%、67.67%;腹部B超诊断基本正常、慢性肝炎和肝硬化的吻合率分别为:16.67%、67.7%和16.67%;Fibroscan联合肝纤维化标志物诊断与病理诊断的吻合率分别为:57.14%、91.67%、57.14%、87.50%。胃镜检查有食管静脉曲张患者的病理诊断均显示S4期,胃镜检查诊断慢性浅表性胃炎者,其病理诊断均为S2期。结论 Fibroscan与血清学肝纤维化标志物(尤其是HA)联合检测有利于提高肝纤维化的早期诊断率。若结合腹部B超和胃镜检查更有利于临床诊疗和预后判断。
Objective To explore the feasibility of early diagnosis of cirrhosis by Fibroscan and serum liver fibrosis markers.Methods Thirty-four cases of chronic hepatitis B （CHB） patients were recruited.Each of them was exami-nated by Fibroscan , serum hepatic fibrosis markers , abdominal ultrasonography , and hepatic biopsy .Then 4 samples taken randomly from them were performed gastroscopy .The non-invasive methods were compared with their pathological diagnosis .SPSS V17 .0 LSD-t test was applied to analyze the values of Fibroscan and serum liver fibrosis markers , in the patients’ pathology diagnosises S2, S3, S4 period, respectively.The match rate was calculated that Fibroscan , abdomi-nal B ultrasound and Fibroscan combined with serum liver fibrosis markers matched the pathological diagnosis .Results The values of Fibroscan and HA in the pathological stage S 2, S3, S4 respectively were 9.45 ±4.36, 15.27 ±4.15, 23.50 ±7.69 and 96.49 ±49.93, 180.76 ±67.40, 396.08 ±97.30 （P〈0.05）.There were no significant differ-ences in the values of the other serum liver fibrosis markers （ CG, LN, PⅢP, CⅣ） between the pathological stage of S 2 and S3 （P〉0.05）, however, there were significant differences between the values of the stages S 2, S4 or S3, S4, re-spectively （P 〈0.01）.The match rates of Fibroscan values and histology of S0-1, S2, S3, S4 were 33.33%, 81 .82%, 37 .50%, 67 .67%, respectively .The match rates of almost normal , chronic hepatitis , cirrhosis tested by ab-dominal ultrasonography and pathological stages S 0-1, S2-3, S4 were 16.67%, 67.7%, 16.67%.The match rates of Fibroscan values combining with serum liver fibrosis markers and 4 pathological stages were 57 .14%, 91 .67%, 57.14%, 87.50%;the patients with esophageal and （or） gastric varices were found by gastroscopy , which their hepat-ic pathological examination showed stage S 4; but the gastroscopy hinted the patients with chronic superficial gastritis whose hepatic pathology exhibited S2.Conclusion Fibroscan combining serum liver fibrosis markers （especially HA） can improve the detection of early liver fibrosis or cirrhosis in clinic , and uniting abdominal ultrasonography will be more advantageous to the clinical diagnosis and prognosis .
出处
《胃肠病学和肝病学杂志》
CAS
2015年第4期447-451,共5页
Chinese Journal of Gastroenterology and Hepatology
