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摘要：
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摘要：目的 比较瞬时弹性成像技术（Fibroscan）与声脉冲辐射力（acoustic radiation force impulse
imaging，ARFI）技术诊断慢性乙型肝炎（chronic hepatitis B，CHB）肝纤维化的临床价值。方法 选
取2017年4月至2018年4月于西安交通大学第一附属医院接受诊治的87例CHB患者为研究对象，分
别进行Fibroscan和ARFI检查，同时以肝组织活检病理结果为金标准，采用ROC曲线评价两种方法
的诊断价值。结果 肝组织活检显示F0～F4期患者分别为11例（12.64%）、9例（10.34%）、26例
（29.88%）、20例（22.99%）和21例（24.14%）。Spearman相关性分析表明Fibroscan法、ARFI法
测定值与肝组织活检病理分期间存在相关性（r = 0.735、0.512，P均＜ 0.001），且肝脏硬度（liver
stiffness meaurment，LSM）值和剪切波速（virtual touch tissue quantification，VTQ）值也呈正相关关
系（r = 0.622，P ＜ 0.001）。F1期与F0期患者的LSM值和VTQ值差异均无统计学意义（P ＞ 0.05），
F2、F3和F4期患者的LSM值和VTQ值均显著高于F0期（P ＜ 0.05）。F1、F2和F3期患者LSM值差异
有统计学意义（F = 8.635，P = 0.012），而VTQ值差异无统计学意义（F = 2.256，P = 0.126）。ROC
曲线分析表明，Fibroscan诊断显著肝纤维化（F2～F4期）的AUC为0.835（95%CI：0.765～0.912），
敏感度和特异性分别为78.5%和87.8%，ARFI的AUC为0.702（95%CI：0.617～0.796），敏感度和特
异性分别为70.6%和72.5%，差异有统计学意义（P ＜ 0.05）。Fibroscan诊断肝硬化（F4期）的AUC
为0.887，ARFI的AUC为0.874，差异无统计学意义（z = 1.673，P = 0.143）。结论 Fibroscan和ARFI
均无法较好地区分F0期与F1期患者，但对显著肝纤维化（F2～F4期）患者的鉴别诊断能力较好，且
Fibroscan法的诊断价值优于ARFI法。
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Abstract: Objective To compare the diagnostic value of Fibroscan and acoustic pulse radiation force
(ARFI) on liver fibrosis in patients with chronic hepatitis B (CHB). Methods Total of 87 patients with CHB
in Affiliated Hospital of Xi’an Jiaotong University from April 2017 to April 2018 were selected. Fibroscan
and ARFI were performed, and the pathological results of liver biopsy were used as the gold standard. ROC
curve was used to evaluate the diagnostic value of the two methods. Results Liver biopsy showed that there
were 11 cases (12.64%), 9 cases (10.34%), 26 cases (29.88%), 20 cases (22.99%) and 21 cases (24.14%)
in F0～F4 stage, respectively. Spearman correlation analysis showed that there was a correlation between
Fibroscan and ARFI methods and the pathological stages of liver biopsy (r = 0.735, 0.512; P ＜ 0.001).
There was also a positive correlation between the value of liver stiffness meaurment (LSM) and virtual touch
tissue quantification (VTQ) (r = 0.622，P ＜ 0.001). There were no significant differences in LSM and VTQ
between patients in F1 and F0 stage (P ＞ 0.05). LSM and VTQ of patients in F2, F3 and F4 stage were
significantly higher than those in F0 stage (P ＜ 0.05). There was significant difference in LSM value among
patients in F1, F2 and F3 stage (F = 8.635, P = 0.012), but there was no significant difference in VTQ value
(F = 2.256, P = 0.126). ROC curve analysis showed that the AUC, sensitivity and specificity of Fibroscan in
diagnosis of significant liver Fibrosis (F2～F4 stage) were 0.835 (95%CI: 0.765～0.912), 78.5% and 87.8%,
respectively; the AUC, sensitivity and specificity of ARFI were 0.702 (95%CI: 0.617～0.796), 70.6% and
72.5%, respectively. The differences were statistically significant (P ＜ 0.05). The AUC of Fibroscan and
ARFI in diagnosis of liver cirrhosis (F4 stage) were 0.887 and 0.874, respectively, and there was no significant
difference (z = 1.673, P = 0.143). Conclusions Neither Fibroscan nor ARFI can distinguish patients in F0 and
F1 stage well, but both of them have good diagnostic ability for patients with significant liver fibrosis (F2～F4
stage), and the diagnostic value of Fibroscan is better than that of ARFI.
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