發(fā)布時間：2018-02-26 22:31

  本文關鍵詞： 慢性乙型病毒肝炎 纖維化 算法 瞬時彈性成像 肝活檢　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景近年來肝臟穿刺活檢術一直被認為是診斷肝纖維化的金標準,但是它也有一定的局限性,比如費用高、有創(chuàng)性、出血等。這些局限性促使一些非侵入性檢測方法的產生,比如FS、APRI、FIB 4等,這些非侵入性檢測方法的聯(lián)合應用首先被用于慢性丙型病毒性肝炎患者,但是很少有用這些聯(lián)合算法檢測慢性乙型病毒性肝炎患者肝纖維化的相關研究報道。抗病毒治療可以減少慢性乙型病毒性肝炎患者肝硬化、肝癌的發(fā)生率,顯著性肝纖維化是慢性乙型病毒性肝炎患者抗病毒治療的一個指征,所以對慢性乙型病毒性肝炎的患者來說,顯著性肝纖維化的診斷很重要。該研究的目的在于應用聯(lián)合算法檢測顯著性肝纖維化、肝硬化,減少不必要的肝臟活檢率。方法對于307位進行肝臟穿刺的慢乙肝患者,在進行肝臟穿刺術的同一天獲得他們的APRI值、FIB 4值以及FS值。APRI、FIB 4以及FS的診斷臨界值都來自于已發(fā)表的文獻,APRI、FIB 4以及FS診斷顯著性肝纖維化的臨界值分別為0.25、1.45和9.4,APRI、FIB 4以及FS排除肝硬化的臨界值分別為0.25、2.9和9.4,FS診斷肝硬化的臨界值為13.1。本研究提出了分步聯(lián)合算法,先用APRI或FIB 4進行初步篩選,再用FS對余下病人進行進一步篩選。對于APRI0.25(或FIB 41.45)的患者,可診斷為顯著性肝纖維化,對于APRI≤0.25(或FIB 4≤1.45)的患者,若其FS9.4,則可診斷為顯著性肝纖維化,而對于FS≤9.4的那一部分未明確診斷的患者則是需要進行肝臟穿刺術的。結果與單獨應用APRI或FS檢測顯著性肝纖維化相比較,聯(lián)合算法APRI+FS可顯著降低肝活檢率(65.1%比75.9%或78.5%,P=0.003或P0.001)。FIB 4+FS聯(lián)合算法檢測顯著性肝纖維化與單獨應用FIB 4或FS相比可顯著降低肝活檢率(58.3%比67.4%或78.5%,P=0.019或P0.001)。在大于50歲的患者中,聯(lián)合算法FIB 4+FS檢測顯著性肝纖維化較APRI+FS可顯著降低肝活檢率,但準確率也有所下降,它們的肝活檢率分別為22.6%和56.5%,P0.001,診斷的準確性分別為83.9%和98.4%,P=0.004.當聯(lián)合算法用于檢測肝硬化時,APRI+FS和FIB 4+FS的肝活檢分別為3.6%和1.3%。結論聯(lián)合算法APRI+FS和FIB 4+FS用于檢測顯著性肝纖維化和肝硬化可顯著降低肝活檢率,還具有高準確率、敏感性和陽性預測值。
[Abstract]:Background liver biopsy has been regarded as the gold standard for the diagnosis of liver fibrosis in recent years, but it also has some limitations, such as high cost and invasive. These limitations have led to the emergence of non-invasive testing methods, such as FSAPRII-FIB 4, which are first used in patients with chronic hepatitis C. However, there are few related studies using these combined algorithms to detect liver fibrosis in patients with chronic viral hepatitis B. Anti-viral therapy can reduce the incidence of liver cirrhosis and liver cancer in patients with chronic viral hepatitis B. Significant liver fibrosis is an indication of antiviral therapy in patients with chronic viral hepatitis B, so for patients with chronic viral hepatitis B, Diagnosis of significant liver fibrosis is important. The aim of the study was to detect significant liver fibrosis, cirrhosis and reduce unnecessary liver biopsy rates by using a combined algorithm. Methods 307 patients with chronic hepatitis B underwent liver puncture. On the same day the liver puncture was performed, their APRI value, FS value, FS value, FIB4 value and FS diagnostic critical value were obtained from the published literature, APRII FIB4 and FS, which were 0.251.45 and 0.251.45, respectively. The critical values of FIB 4 and FS for the diagnosis of liver cirrhosis were 0.252.9 and 9.4F, respectively. A step by step algorithm was proposed in this study. The patients with APRI 0.25 (or FIB 41.45) were diagnosed as significant hepatic fibrosis and those with APRI 鈮，

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