肝纤维化分期中的硬度值和血清生物标志物：慢性乙型肝炎患者大手术标本研究。
Stiffness Value and Serum Biomarkers in Liver Fibrosis Staging: Study in Large Surgical Specimens in Patients with Chronic Hepatitis B.
机构信息
From the Departments of Ultrasound (Q.L., J. Li, W.L., X.Q., Y.L.), Pathology (C.L., D.H., J. Liu), and Hepatobiliary Surgery (T.W., H.W.), West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China; and Department of Pathology, Shanghai Medical College, Fudan University, Shanghai, China (H.Z.).
出版信息
Radiology. 2016 Jul;280(1):290-9. doi: 10.1148/radiol.2016151229. Epub 2016 Feb 17.
Purpose To investigate the capabilities of stiffness value and serum biomarkers in the staging of liver fibrosis in patients with chronic hepatitis B (CHB), with pathologic findings in large surgical specimens serving as the reference standard. Materials and Methods This study was approved by the institutional review board, and informed consent was obtained from all patients. Liver stiffness (determined by means of ultrasonography-based elastography point quantification), aspartate aminotransferase-platelet ratio index (APRI), and fibrosis index (based on the four-factor Fibrosis-4 [FIB-4] calculation) were obtained in 386 patients with CHB. With pathologic fibrosis stages in large surgical specimens as the reference standard, capabilities and cutoffs of stiffness and serum biomarkers were first investigated in a cohort of 284 patients and then validated in an independent cohort of 102 patients by means of area under the receiver operating characteristic curve (AUC) analysis. Results Liver stiffness demonstrated significantly stronger correlation with fibrosis stages than did APRI and FIB-4 (r = 0.738 vs r = 0.477 vs r = 0.427, respectively; P < .05 for all). In the development cohort, liver stiffness had significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.97, 0.96, 0.91, and 0.87, respectively) than APRI (0.89, 0.84, 0.73, and 0.74, respectively) and FIB-4 (0.82, 0.79, 0.70, and 0.72, respectively). In the validation cohort, liver stiffness was validated as showing significantly higher AUCs in identifying fibrosis of stage 1 or higher, stage 2 or higher, stage 3 or higher, and stage 4 or higher (0.99, 0.95, 0.89, and 0.88, respectively) than APRI (0.83, 0.76, 0.78, and 0.68, respectively) and FIB-4 (0.76, 0.69, 0.75, and 0.67, respectively). Conclusion Liver stiffness demonstrated considerable capability in identifying each stage of liver fibrosis in patients with CHB, whereas serum biomarkers showed limited capabilities. (©) RSNA, 2016 Online supplemental material is available for this article.
目的 旨在探究在慢性乙型肝炎（CHB）患者中，利用硬度值和血清生物标志物进行肝纤维化分期的能力，以大手术标本的病理发现作为参考标准。
材料与方法 本研究经机构审查委员会批准，并获得所有患者的知情同意。在 386 例 CHB 患者中，通过超声弹性成像点定量法获得肝脏硬度值（LS）、天冬氨酸氨基转移酶-血小板比值指数（APRI）和纤维化指数（基于四因素 Fibrosis-4 [FIB-4] 计算）。以大手术标本的病理纤维化分期作为参考标准，首先在 284 例患者的队列中对硬度和血清生物标志物的能力和截断值进行研究，然后通过受试者工作特征曲线（ROC）分析下的面积（AUC）验证 102 例独立患者队列中的能力。
结果 LS 与纤维化分期的相关性明显强于 APRI 和 FIB-4（r = 0.738 对 r = 0.477 对 r = 0.427，P <.05）。在发展队列中，LS 在识别纤维化 1 期或更高级别、2 期或更高级别、3 期或更高级别和 4 期或更高级别方面的 AUC 显著高于 APRI（0.97、0.96、0.91 和 0.87，分别）和 FIB-4（0.82、0.79、0.70 和 0.72，分别）。在验证队列中，LS 也验证了在识别纤维化 1 期或更高级别、2 期或更高级别、3 期或更高级别和 4 期或更高级别方面的 AUC 显著高于 APRI（0.99、0.95、0.89 和 0.88，分别）和 FIB-4（0.76、0.69、0.75 和 0.67，分别）。
结论 LS 在识别 CHB 患者的各个肝纤维化分期方面具有相当大的能力，而血清生物标志物的能力有限。（©）RSNA，2016 在线补充材料可用于本文。
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