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投稿时间：2022-04-18 网络发布日期：2023-01-20
投稿时间：2022-04-18 网络发布日期：2023-01-20
中文摘要: 目的探讨声触诊弹性成像（STE）、声触诊弹性测量（STQ）及天门冬氨酸氨基转移酶与血小板比率指数（APRI）、基于4因子的纤维化指数（fibrosisindexbasedonthefourfactors,FIB-4指数）对慢性肝病纤维化的诊断效能及与病理的相关性。
方法选取2018年8月至2022年2月昆明市第一人民医院收治的符合研究条件的患者80例，行肝脏穿刺活检，穿刺前行STE、STQ检查得出肝硬度值（LSMSTE、LSMSTQ）中位数，收集肝穿刺活检前7d内的血清学指标，计算APRI和FIB-4，与肝脏穿刺活检病理结果对照，以病理结果为“金标准”，绘制F2期、F3期、F4期的LSMSTE、LSMSTQ和APRI、FIB-4诊断肝纤维化的受试者工作特征曲线（ROC），并计算曲线下面积（AUC）及各期敏感度、特异度，AUC采用Delong法进行比较。应用Spearman相关系数评估LSMSTE、LSMSTQ、APRI、FIB-4与病理分期之间的相关性。
结果LSMSTE、LSMSTQ、APRI和FIB-4诊断慢性肝病肝纤维化的AUC分别为0.863、0.840、0.693、0.805;AUC比较发现，F2期、F3期、F4期LSMSTE、LSMSTQ诊断效能相当（P＞0.05）;F2期、F4期LSMSTE、LSMSTQ均优于APRI(P＜0.05)，与FIB-4诊断效能相当(P＞0.05);F3期LSMSTE、LSMSTQ、FIB-4优于APRI（P＜0.05）。LSMSTE诊断肝纤维化F2期、F3期、F4期的敏感度分别为80.0%、63.2%、81.3%，特异度分别为80.0%、83.3%、82.8%;LSMSTQ诊断肝纤维化F2期、F3期、F4期的敏感度分别为71.7%、76.3%、75.0%，特异度分别为90.0%、69.0%、93.7%。相关性分析结果显示，LSMSTE、LSMSTQ、FIB-4及APRI与肝纤维化程度分别呈正相关（r=0.630、0.646、0.470、0.293，P<0.05）。
结论LSMSTE、LSMSTQ、APRI及FIB-4均可用于临床评估慢性肝病肝纤维化程度，但剪切波弹性成像LSMSTE、LSMSTQ诊断效能明显优于血清学诊断模型APRI、FIB-4。
Abstract:ObjectiveToexplorethediagnosticefficacyofsoundtouchelastography（STE）,soundtouchquantify（STQ）,aspartateaminotransferase-to-plateletratioindex（APRI）andfibrosisindexbasedonthefourfactors（FIB-4index）inevaluatingthedegreeofliverfibrosisinpatientswithchronicliverdiseaseandthecorrelationbetweenthemandpathology.
MethodsFromAugust2018toFebruary2022,80eligiblepatientswereselectedandunderwentliverbiopsyintheFirstHospitalofKunming.LSMSTEandLSMSTQwereobtainedbySTEandSTQexaminationbeforeliverbiopsy.Serologicalindexeswerecollectedwithin7daysbeforeliverbiopsyforAPRIandFIB-4.Takingthepathologicaldiagnosisofliverpuncturebiopsyasthegoldenstandard,theROCcurvesofLSMSTE,LSMSTQ,APRIandFIB-4forjudgingliverfibrosisinF2,F3andF4stagesweredrawed,andtheAUC,sensitivityandspecificityateachstagewerecalculated,withAUCbeingcomparedusingtheDelongmethod.TheassociationsofLSMSTE,LSMSTQ,APRIandFIB-4withpathologicalstageswereevaluatedbySpearmanscorrelationcoefficient.
ResultsAUCsofLSMSTE,LSMSTQ,APRIandFIB-4indiagnosingliverfibrosiswere0.863,0.840,0.693and0.805,respectively.ThediagnosticperformancesofLSMSTEandLSMSTQweresimilarforjudgingliverfibrosisinF2,F3andF4stages(P＞0.05).ThediagnosticperformancesofLSMSTEandLSMSTQweresuperiortoAPRIandwerecomparabletoFIB-4inF2andF4stages(P＜0.05).InthediagnosticperformancesforF3stage,LSMSTE,LSMSTQandFIB-4weresignificantlybetterthanAPRI(P＜0.05).IndiagnosingF2,F3andF4stagesofliverfibrosis,thesensitivityofLSMSTEwere80.0%,63.2%and81.3%,anditsspecificitywere80.0%,83.3%and82.8%,respectively;thesensitivityofLSMSTQwere71.7%,76.3%and75.0%,anditsspecificitywere90.0%,69.0%and93.7%,respectively.ThecorrelationanalysisshowedthatLSMSTE,LSMSTQ,FIB-4andAPRIwerepositivelycorrelatedwiththedegreeofliverfibrosis(r=0.630,0.646,0.470，0.293,P<0.05）.
ConclusionLSMSTE,LSMSTQ,APRIandFIB-4canbeusedtoevaluateliverfibrosisdegreeinchronicliverdiseaseinclinic,butthediagnosticefficacyofLSMSTEandLSMSTQisobviouslysuperiortothatofAPRIandFIB-4.
keywords: Soundtouchelastography Soundtouchquantify Aspartateaminotransferase-to-plateletratioindex Fibrosisindexbasedonthefourfactors Liverfibrosis
文章编号： 中图分类号：R575.2 R445.1 文献标志码：B
基金项目:云南省教育厅科学研究基金（2019J1296）
附件
| Author Name | Affiliation |
| DINGShi-lan,ZHUCheng-cheng,XIAOChun-hua,LIHong,LIYong-feng,DINGJie,YANGWan-dong | DepartmentofUltrasound,TheFirstHospitalofKunming,Kunming,Yunnan650000,China |
引用文本：
丁世兰，朱成诚，肖春华，李鸿，李永峰，丁捷，杨皖东.剪切波弹性成像及血清学模型评估慢性肝病纤维化[J].中国临床研究,2023,36(1):70-75.
丁世兰，朱成诚，肖春华，李鸿，李永峰，丁捷，杨皖东.剪切波弹性成像及血清学模型评估慢性肝病纤维化[J].中国临床研究,2023,36(1):70-75.