有创性与无创性检测肝纤维化分期对比研究

熊慧 毛龙细 熊小蔚

【摘要】 目的：探究有創性与无创性检测在肝纤维化分期中的应用效果。方法：选取2018年1-3月于本院进行治疗的86例确诊为肝纤维化患者为研究对象，按照其病理检查结果将其分为S1组（n=19）、S2组（n=22）、S3组（n=20）、S4组（n=25）。分别检测四组血清学指标（HA、Ⅳ-C、LN）、超声检测指标（肝硬度值、超声评分）、肿瘤标志物（AFP、CA125、CA19-9）水平，比较3种无创检测与有创性检测在肝纤维化分期中诊断一致性。结果：S4组HA、Ⅳ-C及LN水平均高于其他三组，S3组均高于S2、S1组，且S2组均高于S1组，组间比较差异均有统计学意义（P<0.05）；S4组肝硬度及超声评分均高于其他三组，S3组均高于S2、S1组，且S2组均高于S1组，组间比较差异均有统计学意义（P<0.05）；S4组AFP、CA125、CA19-9水平均高于其他三组，S3组均高于S2、S1组，且S2组均高于S1组，组间比较差异均有统计学意义（P<0.05）；经一致性检验，发现血清学指标、超声检测、肿瘤标志物与肝穿活检病理检测结果均有较高的一致性（Kappa=0.635、0.623、0.329，P<0.05）。结论：无创性检测如血清学指标、超声检测及肿瘤标志物对肝纤维化分期均有较高的诊断价值，与有创性检测病理结果有较高的一致性，值得进行临床推广使用。

【关键词】 有创检测； 无创检测； 肝纤维化； 分期

【Abstract】 Objective：To explore the application effect of invasive and non-invasive detection in staging of liver fibrosis.Method：A total of 86 patients with liver fibrosis who were treated in our hospital from January to March 2018 were selected as the subjects.According to the results of pathological examination，they were divided into S1 group（n=19），S2 group（n=22），S3 group（n=20），S4 group（n=25）.The serological indicator（HA，Ⅳ-C，LN），ultrasonic indexes（liver stiffness，ultrasonic score） and tumor markers（AFP，CA125，CA19-9） were measured in four groups，the consistency of three non-invasive detection and invasive detection in staging of liver fibrosis were compared.Result：The levels of HA，Ⅳ-C and LN in S4 group were higher than those of the other three groups，S3 group were higher than those of S2 and S1 groups，and S2 group were higher than those of S1 group，the differences were statistically significant（P<0.05）.The liver stiffness，ultrasonic score in S4 group were higher than those of the other three groups，S3 group were higher than those of S2 and S1 groups，and S2 group were higher than those of S1 group，the differences were statistically significant（P<0.05）.The levels of AFP，CA125，CA19-9 in S4 group were higher than those of the other three groups，S3 group were higher than those of S2 and S1 groups，and S2 group were higher than those of S1 group，the differences were statistically significant（P<0.05）.The consistency test showed that the serological indicator，ultrasonic testing，tumor marker were in good agreement with the results of liver biopsy（Kappa=0.635，0.623，0.329，P<0.05）.

Conclusion：Non-invasive detection such as serological indicator，ultrasound detection and tumor markers have high diagnostic value for liver fibrosis staging，and have high consistency with pathological results of invasive detection，which is worthy of clinical application.

【Key words】 Invasive detection； Non-invasive detection； Liver fibrosis； Staging

First-authors address：The Third Affiliated Hospital of Nanchang University，Nanchang 330008，China

doi：10.3969/j.issn.1674-4985.2018.31.002

乙型肝炎是指血清学检查乙型表面抗原（HBsAg）和乙型肝炎E抗原（HBeAg）为阳性，伴随脾大、恶心、肝区疼痛等临床症状的疾病，该病是由慢性乙型肝炎病毒（HBV）感染所致，患者多出现纳差、乏力、畏寒等临床症状。流行病学调查显示，全球约有超过20亿人感染了HBV，其中

2.4亿人为慢性乙型肝炎患者，每年约有65万人死于乙型肝炎，我国的调研显示，目前国内约有8亿人感染过HBV，该数字占全国人口的58.2%，因该病引起的死亡人数每年达30万人，位列传染病致死首位[1-2]。乙肝初期临床症状并不明显，但如患者得不到及时有效的治疗，多会发展为肝纤维化，肝纤维化是指在各类致病因子的影响下，个体的肝内结缔组织出现异常增生的现象，也是肝硬化、肝癌的初期阶段[3]。临床研究发现，肝纤维化引发的肝硬化会使患者的病死率成倍增长，德国一项调研指出，50岁以下非肝硬化患者的标准死亡率为3.1%，而相同年龄的肝硬化患者其标准死亡率高达26.2%[4-5]，提示未来肝纤维化会成为威胁我国居民健康的重要因素。……