临床上迫切需要用非创伤的手段诊断肝纤维化。Castera[ 11 ]研究表明。Fibroscan数值对F≥2、F≥3和F = 4的分界值分别为7.1 kPa、9.5 kPa和12.5 kPa。结论是Fibroscan和Fibrotest好于APR I,而最好的诊断价值是联合Fibroscan和Fibrotest,其AUROC值对F≥2、F≥3和F = 4分别为0.88、0.95、0.95。当两者结果一致时(占70% ～80% ) ,与活检的符合率对F ≥2、F ≥3 和F = 4 分别为84%、95%和94%。所以联合应用Fibroscan和Fibrotest评价纤维化可以使多数的慢性丙型肝炎患者避免肝活检。Fibrotest和Fibroscan的显著差异见于四分之一的患者,较多见于F2 (47% )和F3 (28% )的诊断,其中多于70%的病例可找到原因,归因于Fibrotest者两倍于Fibroscan。
在一项对183例丙型肝炎的研究中,联合使用这两项试验的AUROC曲线下面积提示其对纤维化分级的诊断正确性F > 2为0.88, F > 3为0.95, F > 4为0.95,当Fibrotestt和Fibroscan结果相一致时,得到肝活检检查证实F > 2为0.84, F > 4为0.95, F = 4为0.94。这样联合应用血清学标志物将使其互相补充,增加检测的正确率和准确率。
综上所述,国内对Fibrotest与Fibroscan的研究才刚刚起步,应当投入更多的人力、物力研究Fibrotest与Fibroscan联合应用对肝纤维化的诊断价值。
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来源：中国实用内科杂志 作者：袁利超
