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目的探讨瞬时弹性波检测(Fibroscan,FS)对慢性乙型肝炎患者疾病进展的评价作用及影响因素。方法收集660例FS检测的慢性乙型肝炎患者临床资料和其中96进行肝组织活检的病理结果,分析各临床指标对FS值(硬度值)的影响。根据肝脏病理纤维化分期进行分类,绘制不同纤维化分期FS值的受试者工作特征曲线(ROC),计算曲线下面积(AUC)。结果不同性别、年龄、PLT、PTA、ALT、TBIL、ALB、门脉内径和脾脏厚度水平的FS值有差异(P<0.05)。多元线性逐步回归分析显示,ALT、PTA、ALB、脾脏厚度、门静脉内径、PLT、TBIL与FS值相关,其对FS值的影响依次减弱。肝纤维化轻度(S1)18例、中度(S2)39例、重度(S3)12例和肝硬化(S4)27例的AUC分别为0.724、0.832、0.836和0.798,诊断的界值分别为9.8、10.5、12.3和14.8 kPa。结论 FS与肝脏病理纤维化分期符合率高,是评估慢性乙型肝炎疾病进展有价值的无创检查方法。
Objective To evaluate the effect of Fibroscan (FS) on the disease progression in patients with chronic hepatitis B and its influencing factors. Methods The clinical data of 660 patients with chronic hepatitis B detected by FS and the histopathological results of 96 biopsies were collected. The effects of various clinical indexes on the FS value (hardness value) were analyzed. According to the classification of hepatic fibrosis stage, the receiver operating characteristic curve (ROC) of different fibrosis staging FS values were plotted to calculate the area under the curve (AUC). Results There were significant differences in FS value between different gender, age, PLT, PTA, ALT, TBIL, ALB, portal vein diameter and spleen thickness (P <0.05). Multivariate linear stepwise regression analysis showed that the effects of ALT, PTA, ALB, spleen thickness, portal vein diameter, PLT, TBIL and FS value were weakened in turn. AUC of 18 with mild fibrosis (S1), 39 with moderate (S2), 12 with severe (S3) and 27 with cirrhosis (S4) were 0.724, 0.832, 0.836 and 0.798, respectively 9.8, 10.5, 12.3 and 14.8 kPa. Conclusions The high coincidence rate of FS and liver fibrosis staging is a valuable noninvasive method for assessing the progress of chronic hepatitis B.