丙氨酸氨基转移酶<2倍正常值上限的慢性乙型肝炎患者肝脏硬度值的影响因素分析

Analysis of influencing factors on liver stiffness measurement in chronic hepatitis B patients with alanine aminotransferase<2 times the upper limit of normal value

目的分析丙氨酸氨基转移酶(ALT)<2倍正常值上限(ULN)慢性乙型肝炎患者肝脏硬度值(LSM)的影响因素。方法选取2019年6月至2021年12月宜春市人民医院收治的250例ALT<2倍ULN慢性乙型肝炎患者为研究对象。患者均进行肝脏瞬时弹性超声(Fibroscan)检查及病理检查,通过病理检查了解患者肝纤维化程度及炎症活动度,并收集患者临床资料[性别、病程、年龄、体重指数(BMI)、ALT、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBil)、凝血酶原时间(PT)、乙型肝炎病毒DNA(HBV-DNA)],比较不同肝纤维化、不同炎症活动度患者的LSM,分析影响LSM的相关因素。结果250例患者肝纤维化分期为S0期4例(1.60%),S1期144例(57.60%),S2期75例(30.00%),S3期27例(10.80%),不同肝纤维化分期患者的LSM整体比较,差异有统计学意义(P<0.05),其中S1期、S2期、S3期组间比较,差异有统计学意义(P<0.05),但S0期与S1期比较差异无统计学意义(P>0.05),LSM从低到高为S1期<S2期<S3期。250例患者中炎症活动度分别为G1度80例(32.00%),G2度128例(51.20%),G3度42例(16.80%),不同炎症活动度患者的LSM比较,差异有统计学意义(P<0.05),LSM从低到高分别为G1期<G2期<G3期。LSM在不同年龄、ALT、AST、PT值、脾脏厚度、脾脏长度的患者中比较,差异有统计学意义(P<0.05);多元线性回归分析显示,年龄、ALT、AST、PT、炎症活动程度、肝纤维化分期、脾脏厚度、脾脏长度为影响LSM的相关因素(P<0.05)。结论Fibroscan硬度测定对ALT<2倍ULN慢性乙型肝炎患者肝纤维化评估有一定参考价值,患者肝脏炎症活动程度、肝纤维化分期、年龄、ALT、AST、PT、脾脏厚度、脾脏长度等可能影响LSM。

Objective To analyze the influence factors of liver stiffness measurement(LSM)in chronic hepatitis B patients with alanine aminotransferase(ALT)<2 times the upper limit of normal value(ULN).Methods A total of 250 patients with chronic hepatitis B with ALT<2 times ULN admitted to Yichun People's Hospital from June 2019 to December 2021 were selected as the study objects.All patients underwent liver transient elastic ultrasound(Fibroscan)examination and pathological examination.The degree of liver fibrosis and the degree of inflammatory activity of the patients were known through pathological examination,and clinical data[gender,course of disease,age,body mass index(BIM),ALT,aspartate aminotransferase(AST),albumin(ALB),total bilirubin(TBil),prothrombin time(PT),Hepatitis B virus DNA(HBV-DNA)]were collected.LSM was compared in patients with different hepatic fibrosis and inflammatory activity,and the related factors affecting LSM were analyzed.Results The liver fibrosis stages of 250 patients were S0 in 4 cases(1.60%),S1 in 144 cases(57.60%),S2 in 75 cases(30.00%),and S3 in 27 cases(10.80%).The overall comparison of LSM in patients with different stages of liver fibrosis showed statistically significant differences(P<0.05),among which,there was statistically significant difference between the S1 stage,S2 stage and S3 stage(P<0.05),but there was no statistically significant difference between the S0 stage and the S1 stage(P>0.05),and the LSM from low to high was S1 stage<S2 stage<S3 stage.Among the 250 patients,the inflammatory activity levels were 80 cases(32.00%)of G1 degree,128 cases(51.20%)of G2 degree and 42 cases(16.80%)of G3 degree.There was statistical significance in the comparison of LSM among patients with different inflammatory activity levels(P<0.05),and the LSM levels were G1<G2<G3 stage from low to high.LSM was compared in patients with different ages,ALT,AST,PT values,spleen thickness and spleen length,and the differences were statistically significant(P<0.05).Multiple linear regression analysis showed that age,ALT,AST,PT,degree of inflammatory activity,stage of liver fibrosis,spleen thickness and spleen length were related factors affecting LSM(P<0.05).Conclusion Fibroscan stiffness measurement has a good diagnostic value for the evaluation of cirrhosis in patients with chronic hepatitis B with ALT<2 times ULN.The degree of liver inflammatory activity,stage of liver fibrosis,age,ALT,AST,PT,spleen thickness and spleen length may affect LSM.