Liu Jianxue, Zhao Junzhi, Zhang Yaoren, Ji Yonghao, Lin Shumei, Dun Guoliang, Guo Sujuan
Department of Infectious Disease, First Affiliated Hospital of Xi'an Jiaotong University Medical College, Shaanxi, China.
Department of Ultrasonography, Baoji Central Hospital, Baoji, China.
J Ultrasound Med. 2017 Feb;36(2):285-293. doi: 10.7863/ultra.16.01069. Epub 2016 Dec 31.
Liver biopsy remains the reference standard for the assessment of liver fibrosis, but this procedure is invasive and can lead to complications. Thus, studies to determine the optimal noninvasive test are warranted. This study compared several noninvasive tests and their combinations for evaluating liver fibrosis stages in patients with chronic hepatitis B.
The shear wave velocity (SWV) and laboratory indicators were collected from 174 patients with chronic hepatitis B. Formulas were applied to calculate the serum fibrosis model, including the aspartate aminotransaminase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR). The diagnostic performance of all noninvasive tests was assessed in comparison with percutaneous liver biopsy, based on a receiver operating characteristic curve analysis.
The SWV (area under the receiver operating characteristic curve [AUC], 0.82) and APRI (AUC = 0.77) performed better than the FIB-4 (AUC = 0.62), and the AAR (AUC = 0.47) was not suitable for evaluating substantial liver fibrosis (stage ≥F2). The SWV (AUC = 0.96) was the best indicator, being superior to the APRI (AUC = 0.75) and FIB-4 (AUC = 0.74), and the AAR (AUC = 0.45) was not suitable for assessing cirrhosis (F4). Combining the SWV and APRI, the AUC improved to 0.85 for substantial liver fibrosis, and the sensitivity increased to 100% for cirrhosis.
The SWV, APRI, and FIB-4 were valid tests for evaluating substantial liver fibrosis and cirrhosis. The combination of these tests with several noninvasive indicators is expected to enhance the assessment of liver fibrosis stages.
肝活检仍是评估肝纤维化的参考标准，但该操作具有侵入性且可能导致并发症。因此，开展确定最佳非侵入性检测方法的研究很有必要。本研究比较了几种非侵入性检测方法及其组合用于评估慢性乙型肝炎患者肝纤维化分期的情况。
收集了174例慢性乙型肝炎患者的剪切波速度（SWV）和实验室指标。应用公式计算血清纤维化模型，包括天冬氨酸氨基转移酶与血小板比值指数（APRI）、纤维化-4指数（FIB-4）和天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AAR）。基于受试者工作特征曲线分析，将所有非侵入性检测方法的诊断性能与经皮肝活检进行比较评估。
SWV（受试者工作特征曲线下面积[AUC]，0.82）和APRI（AUC = 0.77）的表现优于FIB-4（AUC = 0.62），且AAR（AUC = 0.47）不适合评估显著肝纤维化（≥F2期）。SWV（AUC = 0.96）是最佳指标，优于APRI（AUC = 0.75）和FIB-4（AUC = 0.74），且AAR（AUC = 0.45）不适合评估肝硬化（F4）。将SWV和APRI联合，对于显著肝纤维化，AUC提高至0.85，对于肝硬化，敏感性提高至100%。
SWV、APRI和FIB-4是评估显著肝纤维化和肝硬化的有效检测方法。这些检测方法与几种非侵入性指标的联合有望增强肝纤维化分期的评估。
