瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价

doi:10.3969/j.issn.1006-7795.2017.02.026

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (2): 299-303.doi: 10.3969/j.issn.1006-7795.2017.02.026

瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价

王铁征¹, 武聚山¹, 孟凡坤², 臧运金¹, 林栋栋¹, 李剑³, 李宁¹

1. 首都医科大学附属北京佑安医院普通外科中心, 北京 100069;
2. 首都医科大学附属北京佑安医院超声与功能诊断中心, 北京 100069;
3. 承德医学院附属医院普通外科, 河北承德 067000

收稿日期:2016-07-07 出版日期:2017-03-21 发布日期:2017-04-17
通讯作者: 李宁,E-mail:liningbjyah@vip.sina.com E-mail:liningbjyah@vip.sina.com
基金资助:
国家科技重大专项（2015ZX10004801-001），首都医科大学基础与临床合作基金（14GL.71）

Value of instantaneous elastic measurement on non invasive diagnosis of early hepatitis B -related liver cirrhosis

Wang Tiezheng¹, Wu Jushan¹, Meng Fankun², Zang Yunjin¹, Lin Dongdong¹, Li Jian³, Li Ning¹

1. Department of General Surgery, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China;
2. Department of Ultrasound and Functional Diagnostic Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China;
3. Department of General Surgery, Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China

Received:2016-07-07 Online:2017-03-21 Published:2017-04-17
Supported by:
This study was supported by National Grand Program on Key Infectious Diseases (2015ZX10004801-001), Basic-clinic Cooperation Fund of Capital Medical University(14GL.71)

摘要/Abstract

摘要： 目的研究瞬时弹性测定与肝纤维化病理分期以及门静脉自由压的关系，探讨瞬时弹性测定对早期乙型肝炎相关肝硬化诊断的价值及影响因素。方法 2014年1月至2016年5月于首都医科大学附属佑安医院接受脾切+断流术+肝活检术的60例病人术前进行瞬时弹性测定检测肝脏硬度值（liver stiffness measurement，LSM），术中测量门自由压（free portal pressure，FPP）及取肝组织活检，并结合临床资料及病理进行分析。结果 LSM为（17.6±13.9）kPa，切脾前门静脉压力为（34.99±6.52）cmH₂O（1cmH₂O=0.098 kPa），切脾后门静脉压力为（25.52±4.50）cmH₂O，断流后门静脉压力为（26.28±4.36）cmH₂O，3组差异有统计学意义（P<0.05）。活体组织病理诊断S0 3例，S1 7例，S2 8例，S3 6例，S4 36例。G1 45例，G1~G2 9例，G2 6例。瞬时弹性测定诊断早期肝硬化的曲线下面积（area under the curve，AUC）为0.876，cut-off值7.7 kPa，敏感度和特异度分别为100%、66.67%。LSM与肝脏病理分期呈正相关（r=0.684，P<0.05）。多元线性回归发现AFP为LSM的独立影响因素。结论瞬时弹性测定对肝硬化失代偿期早期、无创诊断有重要的考参价值。

关键词: 瞬时弹性测定, 乙型肝炎, 慢性, 肝硬化, 门静脉高压

Abstract: Objective To study the relationship among the transient elasticity measurement and the fibrosis staging and free portal pressure, explore the diagnostic value and influence factors of transient elastography in early hepatitis B -related liver cirrhosis.Methods Sixty patients who were undertaken splenectomy and devascularization and liver biopsy surgery from January 2014 to May 2016 in Youan Hospital affiliated to Capital Medical University were involved. We detected liver stiffness measurement (LSM)with transient elastographypreoperatively, measured free portal pressure(FPP)and took Wedge biopsy of liver intraoperatively, analyzed in conjunction with clinical and pathologic data. Results LSM was (17.6±13.9) kPa, presplenectomy free portal pressure was (34.99±6.52)cmH₂O (1 cmH₂O=0.098 kPa), postsplenectomy free portal pressure was (25.52±4.50)cmH₂O, postdevascularization free portal pressure was (26.28±4.36)cmH₂O. Data of three groups had a significant difference (P<0.05). According topathological diagnosis,S0 3 cases, S1 7cases, S2 8cases, S3 6cases, S4 36 cases. G1 45 cases, G1-G2 9cases, G2 6 cases. The area under the curve (AUC) for diagnosis of cirrhosis was 0.876, cut-off value 7.7 kPa,the sensitivity and specificity were 100% and 66.67% by transient elasticity measurement. LSM was positively correlated with the stage of liver fibrosis (r=0.684,P<0.05). Multiple linear regression revealed that AFP was an independent factor for LSM.Conclusion Measurement of transient elastography had important reference value with early non-invasive diagnostic in decompensated cirrhosis.

Key words: transient elasticity measurement, hepatitis B, chronic, liver cirrhosis, portal hypertension

中图分类号:

R512.6

王铁征, 武聚山, 孟凡坤, 臧运金, 林栋栋, 李剑, 李宁. 瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价[J]. 首都医科大学学报, 2017, 38(2): 299-303.

Wang Tiezheng, Wu Jushan, Meng Fankun, Zang Yunjin, Lin Dongdong, Li Jian, Li Ning. Value of instantaneous elastic measurement on non invasive diagnosis of early hepatitis B -related liver cirrhosis[J]. Journal of Capital Medical University, 2017, 38(2): 299-303.

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瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价

Value of instantaneous elastic measurement on non invasive diagnosis of early hepatitis B -related liver cirrhosis

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