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中文摘要：
背景肝纤维化是慢性肝病发展为肝硬化的可逆中间环节,早期诊断和及时干预对延缓疾病进展及改善预后极为重要。目的通过分析超声弹性成像组织弥散定量分析和天冬氨酸氨基转移酶（AST）与血小板计数（PLT）比值指数（APRI）、综合评分对慢性病毒性肝炎肝纤维化的诊断价值,为无创诊断肝纤维化提供临床依据。方法选取2012年2月—2013年12月在广东省人民医院感染科住院治疗的慢性乙型肝炎患者158例,其中F1期38例（F1期组）、F2期53例（F2期组）、F3期38例（F3期组）、F4期29例（F4期组）,另选取同期本院体检的健康志愿者38例为对照组,检测AST、丙氨酸氨基转移酶（ALT）、γ-谷氨酰转肽酶（GGT）、总胆红素、PLT等血清学指标,记录超声弹性成像组织弥散定量评分（ES）,根据公式计算APRI及综合评分。分析APRI及综合评分诊断肝纤维化分期的ROC曲线下面积,综合评分截断值及灵敏度、特异度。结果对照组与不同肝纤维化分期组患者AST、ALT、GGT、总胆红素及PLT水平比较,差异均有统计学意义（P〈0.05）。F1期组、F2期组、F3期组、F4期组患者超声弹性成像组织弥散定量分析检测感兴趣区（ROI）的应变均值、标准偏差、蓝色区域（AREA）、复杂度比较,差异均有统计学意义（P〈0.05）;组间两两比较,差异均有统计学意义（P〈0.05）。Spearman等级相关分析结果显示,APRI、ES、综合评分与肝纤维化分期均呈正相关（rs=0.646,P〈0.001;rs=0.739,P〈0.001;rs=0.830,P〈0.001）。APRI诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.86、0.88、0.89;综合评分诊断≥F2期、≥F3期和≥F4期肝纤维化的ROC曲线下面积分别为0.93、0.95、0.92。综合评分截断值为100分时,诊断≥F2期肝纤维化的灵敏度为84.6%、特异度为88.2%;综合评分截断值为100分时,诊断≥F3期肝纤维化的灵敏度为91.5%、特异度
英文摘要：
Background Hepatic fibrosis is a reversible intermediate link between chronic liver disease and cirrhosis. The early diagnosis and intervention in time are very important to delay the progression and improve the prognosis.Objective To analyze the value of ultrasonic elastography tissue diffusion quantitative analysis,APRI,and composite score in diagnosis of chronic hepatitis- related liver fibrosis,and to provide clinical evidence for the non- invasive diagnosis of liver fibrosis. Methods 158 patients with chronic hepatitis B 〔38 cases in stage F1（ stage F1 patient group）,53 cases in stage F2（ stage F2 patient group）,38 cases in stage F3（ stage F3 patient group）,29 cases in stage F4（ stage F4 patient group） 〕who were admitted to the Department of Infections of Gangdong Provincial People＇ s Hospital from February 2012 to December 2013,were selected as study subjects. In the meantime,38 healthy volunteers who received medical examination in the hospital were included in control group. Levels of AST, ALT, GGT, total bilirubin and PLT were detected, ultrasonic elastography tissue diffusion quantitative scores（ ES） were recorded,APRI and the composite scores were calculated according to the formula. The area under the ROC curve of APRI and composite score in diagnosis of liver fibrosis stage,the cut- off value,sensitivity and specificity of composite score were analyzed. Results There were significant differences in levels of AST, ALT, GGT, total bilirubin and PLT between control group and liver fibrosis patient groups with different stage,respectively（ P〈 0. 05）. There were significant differences in average relative strain value,standard deviation,AREA and complexity among stage F1 patient group,stage F2 patient group,stage F3 patient group and stage F4 patient group（ P〈 0. 05）,there were significant differences in the above indicators between any two of the groups（ P〈 0. 05）. According to Spearman rank correlation test results,APRI,ES,and composite score was positively co
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