[1]陈玲玲 吴梅梅 林伟国 郑伟兵 朱 琪.瞬时弹性成像技术在肝纤维化及脂肪肝诊断中的作用[J].福建医药杂志,2020,42(02):29-32.
　CHEN Lingling,WU Meimei,LIN Weiguo,et al.Role of Fibroscan in the diagnosis of liver fibrosis and hepatic steatosis[J].FUJIAN MEDICAL JOURNAL,2020,42(02):29-32.
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瞬时弹性成像技术在肝纤维化及脂肪肝诊断中的作用()
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《福建医药杂志》[ISSN:1002-2600/CN:35-1071/R]

卷:
42
期数:
2020年02期
页码:
29-32
栏目:
临床研究
出版日期:
2020-04-15

文章信息/Info

Title:
Role of Fibroscan in the diagnosis of liver fibrosis and hepatic steatosis
文章编号:
1002-2600(2020)02-0029-04
作者:
陈玲玲 吴梅梅 林伟国 郑伟兵 朱 琪1
厦门大学附属福州第二医院肝胆内科(福州 350007)
Author(s):
CHEN Lingling; WU Meimei; LIN Weiguo; ZHENG Weibing; ZHU Qi.
Department of Hepatobiliary Internal Medicine, Fuzhou Second Hospital Affiliated to Xiamen University,Fuzhou,Fujian 350007,China
关键词:
瞬时弹性成像技术;  肝硬化;  非酒精性脂肪肝;  肝纤维化;  肝脂肪变
Keywords:
fibroscan;  liver cirrhosis;  nonalcoholic fatty liver;  liver fibrosis;  hepatic steatosis
分类号:
R575
文献标志码:
A
摘要:
目的 分析瞬时弹性成像技术(Fibroscan)在肝纤维化及脂肪肝诊断中的作用。 方法 纳入2014年9月至2017年9月初次就诊厦门大学附属福州第二医院临床诊断为乙肝表面抗原携带者、肝硬化代偿期、非酒精性脂肪肝的患者为研究对象。每个研究对象均进行1次Fibroscan检测。以肝硬化患者为研究1组,乙肝表面抗原携带者为对照组,通过比较两组间瞬时弹性测定值(E值)情况来判断Fibroscan检测肝纤维化程度的准确率。以非酒精性脂肪肝患者为研究2组,乙肝表面抗原携带者为对照组,通过比较两组间的肝脂肪受控衰减参数(CAP)值来判断Fibroscan检测肝脂肪变程度的准确率。结果 研究1组共纳入肝硬化患者83例,对照组纳入乙肝表面抗原携带者1 026例。E值(kPa)以7.3为临界值时,研究1组与对照组间阳性率差异有统计学意义(98.80% vs 29.73%,χ2=161.237,P=0.000); E以9.7为临界值时,两组间阳性率差异有统计学意义(98.80% vs 11.01%,χ2=408.303,P=0.000); E以12.4为临界值,两组间阳性率差异有统计学意义(96.39% vs 4.87%,χ2=621.426,P=0.000); E以17.5为临界值,两组间阳性率差异有统计学意义(93.98% vs 1.85%,χ2=816.490,P=0.000)。研究1组E值中位数为26.30 kPa,对照组E值中位数为6.10 kPa,两组间平均值差异有统计学意义(P=0.000)。研究2组共纳入非酒精性脂肪肝患者632例,对照组纳入乙肝表面抗原携带者1 026例。以CAP值≥237.7 dB/m为阳性,研究2组阳性586例,阴性46例; 对照组阳性325例,阴性701例。研究2组与对照组间阳性率差异有统计学意义(92.72% vs 31.68%,χ2= 588.724,P=0.000)。研究2组CAP值的中位数为293 dB/m,对照组CAP值的中位数为212 dB/m,两组间平均值差异有统计学意义(P=0.000)。 结论 Fibroscan在肝纤维化及脂肪肝诊断中具有重要价值。
Abstract:
Objective To analyze the role of Fibroscan in the diagnosis of liver fibrosis and hepatic steatosis.Methods The patients who were firstly diagnosed as hepatitis B surface antigen carriers, compensatory stage of liver cirrhosis and non-alcoholic fatty liver in Fuzhou Second Hospital Affiliated to Xiamen University from September 2014 to September 2017 were included in the study.The Fibroscan test was performed in each of the subjects.Patients with liver cirrhosis were taken as the study group one and carriers of hepatitis B surface antigen were taken as the control group.By comparing the instantaneous elasticity measurement(E value)between the two groups, the accuracy of Fibroscans detection of liver fibrosis was judged. Non-alcoholic fatty liver patients were taken as the study group two and hepatitis B surface antigen carriers were taken as the control group.The accuracy of Fibroscan for detecting the degree of liver steatosis was compared by comparing the liver fat controlled attenuation parameter(CAP)value between the two groups.Results There were 1 026 cases of HBsAg carriers, 83 cases of liver cirrhosis and 632 cases of non-alcoholic fatty liver.When the critical value of E was 7.3 kPa, there was a significant difference in the positive rate between the two groups(study group one 98.80% vs control group two 9.73%,P=0.000); When the critical value of E was 9.7, there was a significant difference in the positive rate between the two groups(study group one 98.80% vs control group 11.01%,P=0.000); When the critical value of E was 12.4, there was a significant difference in the positive rate between the two groups(study group one 96.39% vs control group 4.87%,P=0.000); When the critical value of E was 17.5, there was a significant difference in the positive rate between the two groups(study group one 93.98% vs control group 1.85%,P=0.000).The median of E value in study group one was 26.30 kPa.The median of E value in control group was 6.10 kPa.The value between the two groups had statistically significant differences(P=0.000).When the critical value of CAP was 237.7 dB/m,the positive rate of study group two was 92.72%, and the positive rate of control group was 31.68%.The median value of CAP in study group two was 293 dB/m.The median of CAP value of control group was 212 dB/m.The average value between the two groups had statistically significant differences(P=0.000).Conclusion Fibroscan is of great value in detecting the degree of liver fibrosis and the degree of hepatic steatosis.

参考文献/References:

[1] Jung K S, Kim S U.Clinical applications of transient elastography[J].Clinical and molecular hepatology,2012,18(2): 163-173.
[2] Brener S.Transient elastography for assessment of liver fibrosis and steatosis: an evidence-based analysis[J].Ont Health Technol Assess Ser, 2015,15(18):1-45.
[3] Lai-Hung W G.Update of liver fibrosis and steatosis with transient elastography(Fibroscan)[J].Gastroenterology Report,2013,1(1):19-26.
[4] Vuppalanchi R, Sanyal A J.Myths and mysteries about staging hepatic fibrosis by fibroscan[J].Clin Gastroenterol Hepatol,2015,13(4):780-782.
[5] Shen F, Zheng R D, Mi Y Q, et al.Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients[J].World Journal of Gastroenterology,2014,20(16):4702-4711.
[6] Vuppalanchi R, Siddiqui M S, Van Natta M L, et al.Performance characteristics of vibration-controlled transient elasto-graphy for evaluation of nonalcoholic fatty liver disease[J].Hepatology,2018,67(1):134-144.
[7] 宋乐,江晓静.瞬时弹性检测技术在肝脏疾病诊断中的应用[J].实用肝脏病杂志,2016,19(1):105-108.
[8] Guo L, Zheng L, Hu L, et al.Transient elastography(FibroScan)performs better than non-invasive markers in assessing liver fibrosis and cirrhosis in autoimmune hepatitis patients[J].Med Sci Monit,2017,23:5106-5112.
[9] 中华医学会肝病学分会,中华医学会感染病分会.慢性乙型肝炎防治指南(2010年版)[J].中华肝脏病杂志,2010,19(1):13-24.
[10] 陈灏珠,钟南山.内科学 [M].第8版.北京:人民卫生出版社,2013:419-428.
[11] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163-166.
[12] Lai-Hung W G.Prediction of fibrosis progression in chronic viral hepatitis[J].Clinical and Molecular Hepatology, 2014,20(3):228-236.
[13] Lu F M, Zhuang H.Management of hepatitis B in China[J].Chin Med J,2009,122(001): 3-4.
[14] Jia J, Hou J, Ding H,et al.Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B[J].Journal of Gastroenterology and Hepatology,2015,30(4):756-762.
[15] 武永萍,魏占芳,石栓柱,等.瞬时弹性超声成像在评价乙型肝炎肝纤维化严重程度中的价值[J].肝脏,2019,24(8):905-907.
[16] G?bel T, Schadewaldt-Tümmers J, Greiner L, et al.Transient elastography improves detection of liver cirrhosis compared to routine screening tests[J].World Journal of Gastroenterology, 2015,21(3):953-960.
[17] 秦敏.慢性乙型肝炎肝硬化FibroScan测量结果与肝穿刺病理的关系[J].肝脏,2019,24(6):674-676.
[18] Fan J G, Farrell G C.Epidemiology of non-alcoholic fatty liver disease in China[J].J Hepatol,2009,50(1): 204-210.
[19] 吴惠敏,华静.受控衰减参数在评估肝脏脂肪变性中的应用[J].国际消化病杂志,2018,38(6):353-356.
[20] Baumeler S,Jochum W, Neuweiler J, et al.Controlled attenuation parameter for the assessment of liver steatosis in comparison with liver histology: a single-centre real life experience[J].Swiss Med Wkly, 2019,149:w20077.
[21] 陈建能,陈爱萍,潘勤,等.FibroScan实施受控衰减参数检测肝脂肪变的影响因素及应用价值分析[J].肝脏,2016,21(10):805-809.

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备注/Memo

备注/Memo:
基金项目:2018年福州市卫计系统创新团队培育项目(2018-S-wt5)1 通信作者,Email:Zhuqi8979@163.com
更新日期/Last Update: 2020-04-15