关键词: 肝纤维化, 弹性成像技术, 无创血清学模型

Abstract: Objective  To explore the value of the combination of FibroTouch， fibrosis index based on the 4 factors (FIB4)， ASTtoPLT ratio index (APRI) and GGTtoPLT vatio index (GPRI) in diagnosis of liver fibrosis in patients with chronic liver disease. Methods  A total of 337 patients with chronic liver disease were selected and performed liver biopsy in Department of Traditional and Western Medical Hepatology， the  Third Hospital of Hebei Medical University from January 2014 to April 2017. The GPRI， APRI， FIB4 were calculated and liver stiffness was measured by FibroTouch. The diagnostic values of FibroTouch， GPRI， APRI and FIB4 for liver fibrosis degree were compared by receiver operating characteristic (ROC) curves， and area under ROC curves (AUROCs) were used to analyze the results of the models. Spearman analysis was used to evaluate the correlation between LSM， APRI， GPRI， FIB4 and clinical characteristics. Posterior probability was calculated to explore the accuracy of combining four methods in diagnosis of liver fibrosis. Results  The patients were divided into significant liver fibrosis group (a liver fibrosis stage of ≥S2， n=169)， advanced liver fibrosis group (a liver fibrosis stage of ≥S3， n=86)， liver cirrhosis group (a liver fibrosis stage of =S4， n=42). The AUROCs of the LSM for predicting significant liver fibrosis， advanced liver fibrosis and liver cirrhosis were 0.826， 0.882，0.920， which were significantly higher than FIB4 (0.734， 0.711， 0.739)， APRI (0.662， 0.669， 0.719) and GPRI (0.621， 0.674， 0.720); LSM was correlated with histopathological fibrosis (r=0.564， P=0.000) and inflammation grade (r=0.651， P=0.000). The probability of LSM in diagnosing liver fibrosis of S≥2， S≥3 and S=4 was 72.44%， 80.52%， 84.21%. When FIB4， APRI and GPRI were combined with LSM in diagnosing liver fibrosis of S≥2， S≥3 and S=4， the posterior probability was 95.71%， 98.6%， 99.08%. Conclusion  A combination of FibroTouch and FIB4 can improve the accuracy of diagnosing liver fibrosis， and the demand of liver biopsy will dicrease significantly when combined with APRI and GPRI further， which is beneficial to confirming timely， monitoring dynamically and treating effectively.

Key words: liver cirrhosis, transient elastography, noninvasive serological model