Objective: To investigate the correlation of liver stiffness measured by FibroTouch (FT) and FibroScan (FS) with Ishak fibrosis score in patients with chronic hepatitis B. Methods: A total of 313 patients with chronic hepatitis B who visited Department of Liver Cirrhosis in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 2014 to May 2016 were enrolled. All the patients underwent liver biopsy, and FT and FS were used to determine liver stiffness measurement (LSM). Serum biochemical parameters were measured, and the aspartate aminotransferase-to-platelet ratio index (APRI) in a multi-parameter model of liver fibrosis and fibrosis-4 (FIB-4) index were calculated. The consistency between the results of four noninvasive examinations and Ishak fibrosis score was compared. The t-test was used for comparison of LSM determined by FT and FS. Pearson correlation analysis was used investigate the correlation between LSM determined by FT and FS; Spearman correlation analysis was used to investigate the correlation of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and Knodell score with LSM determined by FT and FS; the correlation between LSM determined by FT and FS and fibrosis stage was analyzed by partial correlation analysis adjusted by Knodell score for liver inflammatory activity; Spearman correlation analysis was used for APRI, FIB-4, and fibrosis stage. Based on the Ishak fibrosis score, the receiver operating characteristic (ROC) curve was used to analyze the values of four noninvasive methods in the diagnosis of liver fibrosis. Results: There was no significant difference in LSM measured by FT and FS in all patients (15.75±9.42 kPa vs 15.42±10.52 kPa, P > 0.05) and Pearson correlation analysis indicated a significant positive correlation between them (r = 0.858, P < 0.01); serum ALT and AST levels and liver inflammatory activity were correlated with LSM determined by FT and FS. There was a significant positive correlation between LSM determined by FT and FS and fibrosis stage (r = 0.501 and 0.526, both P < 0.001), and APRI and FIB-4 were also positively correlated with fibrosis stage (r = 0.236 and 0.218, both P < 0.001). Based on the Ishak fibrosis score, in the diagnosis of fibrosis stages F3, F4, F5, and F6, the areas under the ROC curve were 0.915/0.856/0.839/0.816 for FT, 0.933/0.883/0.849/0.856 for FS, 0.618/0.630/0.608/0.638 for APRI, and 0.614/0.624/0.595/0.649 for FIB-4, and FT and FS had a significantly larger areas under the ROC curve than APRI and FIB-4. Conclusion: LSM determined by FT or FS has a good correlation with the Ishak fibrosis score, so FT and FS have a significantly better diagnostic performance for liver fibrosis than APRI and FIB-4.
目的： 评价慢性乙型肝炎患者FibroTouch (FT)、FibroScan (FS)检测肝脏硬度与肝组织学Ishak纤维化评分的相关性。 方法： 收集2014年11月至2016年5月就诊于上海中医药大学附属曙光医院肝硬化科的慢性乙型肝炎患者313例，所有患者均行肝组织病理活检，FT与FS分别测定肝脏硬度值（LSM），检测血清生物化学指标并计算多参数肝纤维化模型天冬氨酸氨基转移酶（AST）/血小板比值指数（APRI）和基于4因子的纤维化指数（FIB-4），并比较4种非创检查结果与纤维化病理Ishak评分的一致性。由FT与FS测定的LSM比较采用t检验，两组LSM值间的相关性分析采用Pearson相关分析，血清丙氨酸氨基转移酶（ALT）、AST水平和肝组织Knodell评分与FT及FS测定的LSM相关性分析采用Spearman相关分析，2种仪器LSM与肝纤维化病理分期的相关性采用经过肝组织炎症活动度Knodell评分校正的偏相关分析，APRI、FIB-4与肝纤维化病理分期采用Spearman相关分析；以肝纤维化病理作为标准，受试者工作特征曲线（ROC）分析4种非创方法诊断肝纤维化的价值。 结果： 313例患者FT与FS检测LSM分别为（15.75±9.42）kPa和（15.42±10.52）kPa，P>0.05，差异无统计学意义；Pearson相关分析，相关系数为0.858（P<0.01），提示两种检测结果呈显著正相关；血清ALT、AST、肝组织炎症活动度与两种仪器LSM值呈低水平相关。两种仪器FT和FS的LSM测定值与肝纤维化病理分期的r值分别为0.501、0.526，P值均< 0.001，均呈显著正相关；APRI和FIB-4与肝纤维化病理分期的r值分别为0.236、0.218，P值均< 0.001，与肝纤维化病理分期均呈低度正相关。以肝组织病理Ishak评分为依据，四种方法诊断纤维化分期F3、F4、F5及F6的ROC曲线下面积，FT为：0.915、0.856、0.839、0.816；FS为：0.933、0.883、0.849、0.856；APRI为：0.618、0.630、0.608、0.638；FIB-4为：0.614、0.624、0.595、0.649，FT和FS的曲线下面积均明显大于APRI和FIB-4。 结论： FT与FS测定LSM与肝组织纤维化病理具有良好的相关性，明显优于APRI和FIB-4，可较好用于肝纤维化临床判断。.
Keywords: Hepatitis B, chronic; Liver Cirrhosis; Liver histopathology; Serological index models; Transient elastography.