王昀??杜超??樊金宇??黄文韬

[摘要] 目的 探討血清丙氨酸转氨酶（alanine aminotransferase，ALT）水平对肝纤维化扫描仪（FibroScan）诊断慢性乙肝肝纤维化的影响。 方法 选取2012年9月～2014年12月我院收治的乙肝肝纤维化患者195例，依据病理活检后1周的血清ALT水平分为ALT<1×ULN组（108例）、1≤ALT≤2×ULN（49例）、ALT>2×ULN（38例），比较不同临床分级患者的LSM、ALT和不同ALT水平下患者的LSM水平，并通过ROC曲线下面积评估血清ALT对FibroScan诊断慢性乙肝肝纤维化的影响。 结果 肝纤维化1级、2级、3级、4级（肝硬化）患者的LSM和ALT水平差异有统计学意义（P<0.05）。ALT<1×ULN、1≤ALT≤2×ULN、ALT>2×ULN三组中，肝纤维化患者的LSM水平差异有统计学意义（P<0.05）。ALT<1×ULN、1≤ALT≤2×ULN、ALT>2×ULN三组中，肝纤维化的诊断AUC分别为0.931、0.952、0.667，准确度分别为92.34%、85.69%、63.12%，敏感度分别为91.45%、89.61%、44.27%；肝硬化的诊断AUC分别为0.956、0.963、0.952，准确度分别为89.23%、93.17%、94.05%，敏感度分别为95.21%、96.74%、98.15%。 结论 血清ALT水平超过正常上限2倍可降低FibroScan诊断慢性乙肝肝纤维化的准确性，但对肝硬化的诊断无明显影响。

[关键词] 丙氨酸转氨酶；肝纤维化扫描仪；乙肝；肝纤维化

[中图分类号] R285 [文献标识码] A [文章编号] 2095-0616（2017）11-143-04

Effect of serum ALT level on fibroScan in diagnosis of liver fibrosis of chronic hepatitis B

WANG Yun1 DU Chao2 FAN Jinyu2 HUANG Wentao1

Department of Clinical Laboratory，the First Outpatient Department，Hongqi Hospital Affiliated to Mudanjiang Medical University，Mudanjiang 157000，China；2.Department of Clinical Laboratory，Hongqi Hospital Affiliated to Mudanjiang Medical University，Mudanjiang 157000，China

[Abstract] Objective To investigate the effect of alanine aminotransferase （ALT） on liver fibrosis scanner （FibroScan） in diagnosis of patients with liver fibrosis of chronic hepatitis B. Methods 195 patients with liver fibrosis of chronic hepatitis B who were admitted to our hospital from September 2012 to December 2014 were selected. According to ALT level of 1 week after biopsy，they were divided into ALT<1×ULN group，1≤ALT≤2×ULN group （n=49） and ALT>2×ULN group （n=38）.LSM and ALT of patients in different clinical grades were compared and LSM levels of patients with different ALT levels were also compared.Effect of ALT on FibroScan in diagnosis of patients with chronic hepatitis B was evaluated by area under ROC curve. Results LSM and ALT levels of patients with first grade，second grade， third grade and fourth liver fibrosis （liver cirrhosis） were different and the difference was statistically significant （P<0.05）.LSM levels of patients with liver fibrosis in ALT<1×ULN group，1≤ALT≤2×ULN group （n=49） and ALT>2×ULN group were different and difference was statistically significant （P<0.05）.Areas under the curve （AUC） of diagnosis of liver fibrosis were respectively 0.956，0.963 and 0.9252.Accuracy was 92.34%，85.69% and 63.12% respectively and sensitivity was 91.45%，89.61% and 44.27% respectively.AUC of diagnosis of liver cirrhosis was 0.956，0.963 and 0.9252 respectively.Accuracy was 89.23%，93.17% and 94.05% respectively and sensitivity was respectively 95.21%，96.74% and 98.15%. Conclusion The level of ALT more than 2 times of the upper limit of normal can reduce the accuracy of FibroScan in diagnosis of liver fibrosis of chronic hepatitis B，but it has no significant effect on the diagnosis of liver cirrhosis.

[Key words] Alanine aminotransferase；Liver fibrosis scanner；Hepatitis B；Liver fibrosis

慢性乙肝是指乙肝病毒检查呈阳性，且病程超过6个月的肝炎表现者，患者肝功能存在不同程度的损害或障碍，并有肝纤维化改变，其主要原因为慢性乙肝具有病程长、易反复的特点，患者肝内纤维结缔组织异常增生，大量细胞外基质沉积，从而形成肝纤维化。随着疾病的不断发展，患者肝小叶结构逐渐遭到破坏，从而发展为肝硬化。肝纤维化进程对乙肝患者的临床预后具有重要影响，因此对肝纤维化的诊断和评估成了疾病治疗的重中之重[1-2]。FibroScan是一种无创性肝纤维化诊断手段，已被广泛应用于肝硬化的诊断和鉴别中。……