Diagnostic Function And Influnential Factors Of Arfi For Liver Fibrosis In Chronic Liver Disease Patient

Acoustic pulse radiation imaging technology (ARFI technology) is a new method for noninvasive assessment of liver fibrosis, researchers report in many institutions ARFI technology applied in the clinical diagnosis of liver fibrosis have higher value.However research institutions ARFI measurements results accessor methods are different, the domestic use of the average method, with the median method abroad, what kind of accessor methods more appropriate assessment of liver fibrosis, there is no conclusion. Literature reports that many factors can influence ARFI measure value, the influence factors has not been unified. The diagnosis value by ARFI technology of liver disease in patients with liver fibrosis in guangxi region is not known. This study explores accuracy of ARFI value with different accessor methods in evaluating fibrosis degree, on the basis, definite the technique in diagnosis of liver fibrosis in this region and understand the influence factors of liver stiffness values, provide clinical basis for ARFI technology.Objective1. Using acoustic pulse radiation imaging technology (ARFI) quantitative detection of chronic liver disease, record every subjects VTQ values of mean, median, and the maximum value, Comparison of three methods to evaluate the degree of differences fibrosis.2. Using ARFI technology measure of liver fibrosis and cirrhosis of the liver caused by multiple causes lesions, Evaluation of liver stiffness value and the correlation between liver tissue pathological staging, meanwhile, obtain cut off values for diagnosis of close liver fibrosis stage, provide cut off values for for liver fibrosis stage in guangxi region, provide a reliable evaluation method for liver fibrosis of diagnosis and drug curative effect.Materials and MethodClinical date:Our prospective study included 120 consecutive subjects, From November 2011 to March 2015,which were collected from the guangxi zhuang autonomous region people’s hospital.Our subjects were:healthy volunteers-10 (8.3%); patients with chronic hepatitis B (HBV)-54(45%);with clinical and radiographic diagnosis of compensatory cirrhosis-33 (27.5%) and with liver tumor resection specimens after peripheral tissue pathology results for liver fibrosis or cirrhosis patients-23(19.2%). Pathological results according to the 2000 meeting in xian grouping of viral hepatitis prevention plan.All subjects were recorded VTQ measurement values(m/s).S0 of 12 cases(including 10 healthy volunteers, pathology of liver fibrosis SO two people),S1 of the 11,S2 of 19,S3 of 21 cases,S4 of 57 eases(including Clinical diagnosis of liver cirrhosis thirty-two and Pathology of liver Fibrosis S4 twenty-five cases),in total of 120 examples.Inspection and check indicators:1, serological indexes, platelet (PLT), total bilirubin (TBiL), alanine aminotransferase (ALT), aspertate aminotransferase (AST), albumin (propagated), globulin (GLB), gamma 1-glutamine turn phthalein enzyme (GGT), alkaline phosphatase (ALP).The APRI index was calculated according to the following formula, APRI=AST(ULN)/PLT(109/L).This research use Siemens ACUSONS2000 ultrasound imaging, Equipped with ARFI imaging software, Select 4c 1 convex array probe, Check the frequency of 2-4.5 MHz, Interested in fixed zone depth in 3-5 cm from the liver surface, with corresponding The pathological tissue area as much as possible, record every subjects VTQ values of mean, median, and the maximum value, hirty-one patients were underwent Fibroscan. from French Echosens company, used the medium probe model.Statistical processing:statistical analysis using software spss19.0 and MedCalc 9.2.1.0 software.Result1.Intraclass correlation coefficient among the three groups of data is 0.952, intraclass correlation coefficient between each two methods are above 0.9. Compared with the pathology of liver fibrosis,Integrated area under the ROC curve for the average method, the median method and the maximum value method are:0.8481753,0.8694962 and 0.8238794, the pairwise comparison found that the average method and the median method no significant difference in the diagnostic accuracy, the diagnostic accuracy for the Average method and the median method were greater than the maximum method. There is a certain degree of overlap between the consecutive stages for average method (SO and S1, S1 and S2 and S1 and S3, S2 and S3).degree of overlap between the consecutive stages for median method were SO1and S2, S12and S3. among them, the median method have higher correlation with fibrosis pathological grading (r = 0.760) than the average method (r= 0.723) and the maximum method (r= 0.679).2. According to the ROC curve,the area under the ROC curve prediction of liver fibrosis for ARFI and FibroScan were above 0.8, and above 0.795 for APRI index, the area under the ROC curve for ARFI prediction of liver fibrosis SO～ S4 period were greater than APRI index, for liver fibrosis of S1, S2 and S4 period, ARFI have greater areas under roc curve than FibroScan. Three noninvasive diagnostic methods have good correlation with liver fibrosis grading, The correlation coefficient were ARFI (r= 0.841), FibroScan (r= 0.795), APRI index (r= 0.645), respectively.3. This study used multiple stepwise regression analysis showed that the liver VTQ values had correlation with PLT、GGT、BMI、age、GLB, The negative correlation were found between the VTQ values and the parameters such as PLT and ALB,The significant positive correlations were found between the VTQ values and the parameters such as age、GGT、BMI、GLB, respectively (p<0.05), and the maximum correlation coefficient was found between the VTQ values and PLT in our study(β=-0.434). Liver VTQ values had no correlation with gender, nationality, whether patients with liver cancer, TBil, ALT, AST and ALP (P> 0.05).4.This results showed that, for the median VTQ value, using the cutoff values of1.24m/s、1.4 m/s、1.68 m/s and1.74 m/s for diagnosis of S≥1,S> 2, S≥3and S= 4, the corresponding AUROCs were0.983 (Se93.5%, Sp100%),0.936 (Se 87.6%, Sp 87%),0.913(Se 80.8%, Sp 92.9%)and 0.885(Se 89.5%, Sp 79.4%), respectively.Conclusion1. Three methods had different diagnosis accuracy for evaluate liver fibrosis and cut off values, comprehensive comparison, the median method can better evaluate fibrosis.2. ARFI technology for quantitative detection liver stiffness is affected by PLT、 GGT、BM、age、GLB.3. ARFI technology for quantitative detection liver stiffness is not affected by transaminase, bilirubin, patients with jaundice, or hight levels transaminase, can consider using ARFI technology to evaluate liver fibrosis.