2019 年第 5 期 第 14 卷

瞬时弹性成像及血清肝纤维化检测对肝硬化患者食管静脉曲张的临床诊断价值分析

Clinical diagnostic values of Fibroscan and Fibrotest for esophageal varices in patients with liver cirrhosis

作者：王慧莲王俊平

英文作者：

单位：030012太原，山西省人民医院消化科

英文单位：

关键词：肝硬化；食管静脉曲张；瞬时弹性成像；血清纤维化检测

英文关键词：

• 摘要：

• 【摘要】目的    探讨瞬时弹性成像系统（Fibroscan）和血清肝纤维化检测对肝硬化患者食管静脉曲张(EV)的临床诊断价值。方法    回顾性分析2014年2月至2017年2月于山西省人民医院门诊就诊或住院的肝硬化患者194例，均接受胃镜、Fibroscan及血清肝纤维化检查。根据是否发生EV分为无EV组（84例）和EV组（110例）。比较2组患者血清肝纤维化指标［透明质酸酶、层粘连蛋白（LN）、Ⅲ型前胶原(PⅢNP）、Ⅳ型胶原］和肝硬度值，分析血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原和肝硬度值对肝硬化患者EV的诊断价值。结果    无EV组血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原和肝硬度值均明显低于EV组，差异均有统计学意义（均P＜0.05）。Fibroscan检测肝硬度值及血清透明质酸酶、PⅢNP、Ⅳ型胶原对肝硬化患者EV有一定预测价值（曲线下面积=0.758、0.742、0.679、0.640，95%置信区间：0.690～0.825、0.673～0.812、0.604～0.754、0.562～0.718，均P＜0.05），敏感度均达到0.8及以上，而血清LN对肝硬化患者EV无明显预测价值（P=0.311）。肝硬度值与血清透明质酸酶、LN、PⅢNP、Ⅳ型胶原均有相关性（r=0.537、0.282、0.524、0.408，均P＜0.001），其中肝硬度值与血清透明质酸酶、PⅢNP关系较密切,与Ⅳ型胶原低度相关，与LN关系不密切。结论    Fibroscan检测肝硬度值具有无创、可重复、便捷等特点，结合血清肝纤维化指标（透明质酸酶、PⅢNP、Ⅳ型胶原）综合评估，可作为筛选肝硬化患者EV的检查方法，具有很好的临床应用价值。

• 【Abstract】Objective    To evaluate Fibroscan(transient elastography) and Fibrotest in the diagnosis of esophageal varices(EV) in patients with liver cirrhosis. Methods    From February 2014 to February 2017, 194 patients with liver cirrhosis were examined by gastroscopy, Fibroscan and Fibrotest in Shanxi Provincial People′s Hospital. According to the comorbidity of EV, the patients were divided into non-EV group(84 cases) and EV group(110 cases). Liver fibrosis serum indicators including hyaluronidase(HA), laminin(LN), type Ⅲ procollagen(PⅢNP), type Ⅳ collagen(Ⅳ-Col) and liver stiffness were detected. Diagnostic values of above factors were analyzed. Results    Serum levels of HA, LN, PⅢNP, Ⅳ-Col and liver stiffness in non-EV group were significantly lower than those in EV group(P＜0.05). Liver stiffness measured by Fibroscan, serum HA, PⅢNP and Ⅳ-Col levels showed high predictive values for EV(area under curve: 0.758, 0.742, 0.679, 0.640; 95% confidence interval: 0.690-0.825, 0.673-0.812, 0.604-0.754, 0.562-0.718, all P＜0.05); the sensitivities were greater than 0.8; serum LN showed no significant relation with EV(P=0.311). Liver stiffness was positively correlated with the levels of HA, LN, PⅢNP and Ⅳ-Col(r=0.537, 0.282, 0.524, 0.408; all P＜0.001). Conclusion    Fibroscan is minimally invasive, repeatable and convenient for liver stiffness measurement; combined with Fibrotest, it shows great value in the diagnosis of EV in patients with liver cirrhosis.