肝纤维化无创伤诊断方法的临床应用

1、会计学1肝纤维化无创伤诊断方法的临床应用肝纤维化无创伤诊断方法的临床应用第1页/共60页第2页/共60页第3页/共60页第4页/共60页第5页/共60页临临床床检查检查生化模型生化模型肝穿肝穿影像影像(US, MRI, endoscopy)硬度硬度血液血液标记标记第6页/共60页第7页/共60页第8页/共60页第9页/共60页Rockey,06第10页/共60页第11页/共60页第12页/共60页Bedossa et al, Hepatology 2003第13页/共60页第14页/共60页第15页/共60页第16页/共60页第17页/共60页第18页/共60页NameComponentsSe

2、nsitivity/Specificity for Advanced FibrosisPPV/NPV for Advanced fibrosisAST/ALTAST, ALT53% / 100%100% / 81%Forns testAge, PLT, GGT, Cholesterol, PT94% / 51%40% / 96%PGA indexPLT, GGT, Apolipoprotein A91% / 81%85% / 89%FPIAST, Cholesterol, HOMA-IR, Age, History of alcohol intake85% / 48%70% / 69%Fibr

3、otestGGT, Haptoglobin, Apolipoprotein A, 2-macroglobulin, bilirubin87% / 59%63% / 85%APRIAST, PLT41% / 95%88% / 64%第19页/共60页NameComponentsSensitivity/Specificity for Advanced FibrosisPPV/NPV for Advanced fibrosisFibrospectHyaluronic acid, TIMP-1, 2-macroglobulin83% / 66%72% / 78%ELFGNumerous ECM pro

4、teins and proteinases：collagen IV, collagen VI, PIIINP, MMP-2, MMP-9, TIMP-1, tenascin, laminin, and HA90% / 41%35% / 92%SLFG2-macroglobulin, age, GGT, hyaluronic acid(8.7) N / 95.8%70.1% / 86.1%91.1% / 51.6%第20页/共60页第21页/共60页第22页/共60页第23页/共60页第24页/共60页TestComponentsSenSpecPPVNPVAST/ALT ratioAST/ALT

5、53%100%100%81%Forns testPlatelets, GGT, TC94%51%40%96%APRIAST, platelets41%95%88%64%PGA indexPlatelets, GGT, apolipoprotein A87%59%63%85%FibrotestGGT, haptoglobin, bilirubin, apolipoprotein A, 2-macroglobulin87%59%63%85%FibrospectHyaluronic acid, TIMP-1, 2-macroglobulin83%66%72%78%FPIAST, cholestero

6、l, HOMA-IR85%48%70%69%ELFECM proteins and proteinases90%41%35%92%Rocket DC and Bissell DM. Hepatology 2006.第25页/共60页TestComponentsSenSpecPPVNPVZeng et alage, 2-macroglobulin, GGT, hyaluronic acid98%27%65%91%40%90%85%52%Hui et alBMI, bilurubin, albumin, platelet88%50%38%92%37%88%53%81%FibrotestGGT, h

7、aptoglobin, bilirubin, apolipoprotein A, 2-macroglobulin89%52%43%92%18%99%92%75%Myers et al., J Hepatol 2003.Hui et al., Am J Gastroenterol 2005.Zeng et al., Hepatology 2005. 第26页/共60页第27页/共60页第28页/共60页第29页/共60页0.000.200.400.600.801.0001234Fibrosis stageFibroTestPoynard, Clin Chem 2004; 50:1344-55.F

8、3-F40.73-0.74F30.59-0.72F20.49-0.58F00.00-0.21F0-F10.22-0.27F10.28-0.31F1-F20.32-0.48F40.75-1.00Expected FibrosisFibroTestAUC: 0.73-0.87第30页/共60页第31页/共60页http:/www.iqur.co.uk/site/iqur/home第32页/共60页第33页/共60页第34页/共60页第35页/共60页第36页/共60页第37页/共60页VS = 1.0 m/s%-50 5 Depth (mm)Time (ms)0204060102030405060

9、%-50 5 Depth (mm)Time (ms)0204060102030405060%-50 5 Depth (mm)Time (ms)0204060102030405060E = 3.0 kPaE = 27.0 kPaE = 7.7 kPaF0F2F4VS = 1.6 m/sVS = 3.0 m/s第38页/共60页Etiology Pat. #AUROCfor F2AUROCfor F4ReferenceHBV1610.870.93Chan HL et al.J Viral Hepat. 2008HBV2020.810.93Marcellin P et al.Liver Int. 2

10、008 多项研究证实对乙肝肝纤维化诊断准确性高多项研究证实对乙肝肝纤维化诊断准确性高第39页/共60页分组肝硬度(KPa)Control5.4 1.6Inactive carrier7.04 2.7Chronic hepatitis8.26 5.3LC compensated15.9 8.3LC decompensated31.8 20.3HCC45.1 34.5LC decompensatedLC compensatedChrinic hepaitiscarrierStiffness806040200(p 2 ?第49页/共60页Castera et al, Gastroenterology

11、 2008 第50页/共60页所以研究者提出如下的所以研究者提出如下的HCV患者诊疗流程：患者诊疗流程：第51页/共60页病因明确的所有肝病患者都应首先执行无创检查病因明确的所有肝病患者都应首先执行无创检查生化标志生化标志/ FibroScan无需肝穿无需肝穿随访或者治疗随访或者治疗无需肝穿无需肝穿HCC + 血管曲张血管曲张筛选筛选肝穿肝穿只有治疗方案无法确定时只有治疗方案无法确定时低值排除显著纤维化低值排除显著纤维化高值指示纤维化高值指示纤维化 F3/4空白区域空白区域Manning DS, Afdhal N H. GASTROENTEROLOGY 2008;134:16701681第52页/共60页第53页/共60页第54页/共60页第55页/共60页NameComponentsSensitivity/Specificity for Advanced FibrosisPPV/NPV for Advanced fibrosisFibrospectHyaluronic acid, TIMP-1, 2-macroglobulin83% / 66%72% / 78%ELFGNumerous ECM proteins and proteinases：collagen IV, collagen VI, PIIINP, MMP-2, MM