血清胆红素对2D-SWE评估肝纤维化分期的影响

Effect of serum bilirubin on 2d-SWE evaluation of liver fibrosis stage

目的探讨血清胆红素水平对实时二维剪切波弹性成像(2D-SWE)评估肝纤维化分期的影响,为临床诊疗提供指导。方法选择2019年1月-2020年6月浙江省磐安县人民医院诊治的68例慢性乙型肝炎患者,根据血清胆红素水平分为胆红素正常组(<23.9μmol/L)47例和胆红素升高组(≥23.9μmol/L)21例。对比两组临床资料及相同肝纤维化分期下肝杨氏模量值的差异,采用Spearman相关分析探讨胆红素水平与肝杨氏模量值的相关性,并用ROC曲线分析血清胆红素水平对肝纤维化分期的影响。结果两组年龄、性别及体质量指数(BMI)比较,差异无统计学意义(P>0.05);两组肝硬度测定值(LSM)及肝纤维化分期比较,差异有统计学意义(P<0.05);肝纤维化分期为F0时,两组肝杨氏模量值比较差异无统计学意义(P>0.05),且不存在相关性(r=0.006,P>0.05);肝纤维化分期为F1-F4时,胆红素升高组肝杨氏模量值分别为(8.25±1.26)kPa、(10.93±1.60)kPa、(15.19±2.32)kPa、(25.54±4.21)kPa,均明显高于胆红素正常组[(6.47±0.85)kPa、(8.05±1.21)kPa、(10.10±1.47)kPa、(15.73±2.36)kPa],差异有统计学意义(P<0.05),且呈正相关(r=0.330、0.249、0.501、0.438,P<0.05);胆红素升高组对肝纤维化分期(≥F2、≥F3、F4)的诊断阈值分别为10.47kPa、10.95kPa、15.90kPa,假阳性率分别为44.62%、45.14%、39.63%,均明显高于胆红素正常组7.63kPa、8.28kPa、11.02kPa及20.68%、17.11%、14.39%,胆红素升高组对肝纤维化分期(≥F3、F4)的准确度分别为70.93%、70.02%,均明显低于胆红素正常组80.24%、84.55%。结论慢性乙型肝炎患者的血清胆红素水平与肝杨氏模量值有一定相关性,患者胆红素水平升高会降低2D-SWE评估肝纤维化分期的准确度,提高诊断的假阳性率。

Objective To explore the effect of serum bilirubin level on the diagnostic value of real-time two-dimensional shear wave elastography(2D-SWE)in evaluating liver fibrosis staging,and provide relevant guidance for clinical diagnosis and treatment of patients.Methods The 68 patients with chronic hepatitis B who were diagnosed and treated in our hospital from January 2019 to June 2020 were selected as the research objects.According to the serum bilirubin level of pa-tients,they were divided into normal bilirubin group(TBit<23.9μmol/L,47 cases)and elevated bilirubin group(TBit≥23.9μmol/L,21 cases).The clinical data of the two groups of patients and the difference in liver Young’s modulus values under the same liver fibrosis stage were compared,and the Spearman method was used to analyze the correlation between the bilirubin level and the liver Young’s modulus value,and ROC curves were used to analyse the effect of serum bilirubin level on the diagnostic value of 2D-SWE in evaluating the staging of liver fibrosis.Results There was no statistically significant difference in the age,gender and body mass index(BMI)of the two groups of patients(P>0.05).There was a statistically significant difference in liver stiffness measurement(LSM)and liver fibrosis staging between the two groups(P<0.05);When the liver fibrosis stage is F0,there is no statistically significant difference in the Young’s modulus of the liver between the two groups of patients(P>0.05),and there is no correlation(r=0.006,P>0.05);When the liver fibrosis stages are F1-F4,the Young’s modulus values of the liver of patients in the elevated bilirubin group are(8.25±1.26)kPa、(10.93±1.60)kPa、(15.19±2.32)kPa、(25.54±4.21)kPa,which were significantly higher than the normal bilirubin group[(6.47±0.85)kPa、(8.05±1.21)kPa、(10.10±1.47)kPa、(15.73±2.36)kPa],the difference was statistically significant(P<0.05),and there is a positive correla-tion(r=0.330、0.249、0.501、0.438,P<0.05);The diagnostic threshold and false positive rate of 2 D-SWE in evaluating liver fibrosis stage(F2、F3、F4)in the elevated bilirubin group were 10.47 kPa、10.95 kPa、15.90 kPa and 44.62%、45.14%、39.63%respectively,which were significantly higher than those in the normal bilirubin group[(7.63 kPa、8.28 kPa、11.02 kPa)(20.68%、17.11%、14.39%)].The accuracy of 2 D-SWE in evaluating liver fibrosis stage(≥F3、F4)in the elevated bilirubin group were 70.93%,70.02%,respectively,which were significantly lower than those in normal group(80.24%、84.55%).Conclusion The serum bilirubin level in patients with chronic hepatitis B is correlated with Young’s modulus of the liver.The increase of bilirubin level in patients will reduce the accuracy of 2 D-SWE in evaluating the stage of liver fibrosis and improve the false positive rate of diagnosis.