声触诊弹性成像检测脾硬度对诊断慢性乙肝肝纤维化程度的应用价值

Value of sound touch elastography in detecting spleen stiffness for assessment of liver fibrosis in patients with chronic hepatitis B

目的探讨声触诊弹性成像(STE)检测脾硬度对判断慢性乙型肝炎(CHB)患者肝纤维化程度的应用价值。方法回顾性分析2019年1月至2020年3月在浙江大学医学院附属第四医院肝病门诊就诊的73例CHB患者,行血清学检查(血小板、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶)、构建肝纤维化参数模型FIB-4、肝穿刺病理学检查及STE检查,以病理结果为金标准,将患者分成无纤维化组(S0期)、轻度纤维化组(S1+S2期)和中重度纤维化组(S3+S4期),采用t检验比较不同肝纤维化程度组间的差异。绘制受试者操作特征(ROC)曲线,分析脾弹性STE值与FIB-4值诊断不同肝纤维化程度的诊断效能,采用Z检验比较各组FIB-4指数和脾弹性STE值诊断是否具有肝纤维化及中重度肝纤维化诊断价值的差异。结果随着肝纤维化程度的加重,无纤维化组(8例)、轻度纤维化组(41例)、中重度纤维化组(24例)脾弹性STE值逐渐增加[(10.84±2.42)kPavs(16.95±4.95)kPavs(23.25±6.81)kPa],FIB-4指数也逐渐升高[(1.02±0.65)vs(1.74±0.74)vs(2.97±1.34)],各组间差异均具有统计学意义(P均<0.05)。ROC曲线分析显示,脾弹性STE值预测存在肝纤维化的最佳临界值为12.3 kPa,敏感度与特异度分别为88.5%、75.0%;脾弹性STE值预测存在中重度肝纤维化的最佳临界值为21.9 kPa,敏感度与特异度分别为87.5%、83.7%。脾弹性STE值与FIB-4指数对诊断是否具有肝纤维化及中重度肝纤维化均有意义,其中脾弹性STE诊断意义更高,脾弹性STE值曲线下面积高于FIB-4指数(0.871vs0.741;0.798vs0.735),差异具有统计学意义(Z=6.12、6.35,P均=0.001)。结论STE检测脾硬度对CHB患者肝纤维化程度具有一定的诊断价值。

ObjectiveTo explore the value of sound touch elastography(STE)in detecting spleen stiffness for the assessment of liver fibrosis in patients with chronic hepatitis B.MethodsSeventy-three patients with chronic hepatitis B were retrospectively recruited between January 2019 and March 2020 at our hospital.All the patients underwent serological examinations of platelets,aspartate aminotransferase,and alanine aminotransferase to calculate the FIB-4 index,as well as STE examination and pathological examination after liver puncture.The correlation between spleen stiffness and liver fibrosis was judged by taking pathological results as the gold standard.Based on the pathological results,the patients were divided into non-fibrosis group(S0),mild fibrosis group(S1+S2),and moderate and severe fibrosis group(S3+S4),and thet-test was used to compare the differences in splenic STE value and FIB-4 value between these groups.Receiver operating characteristics curve analysis was performed to assess the diagnostic efficacy of splenic STE value and FIB-4 value in the diagnosis of different degrees of liver fibrosis.TheZtest was used to compare the FIB-4 index and splenic STE value in the diagnosis of liver fibrosis and moderate to severe liver fibrosis.ResultsWith the increase of the severity of liver fibrosis,the mean value of spleen elastic modulus[(10.84±2.42)kPavs(16.95±4.95)kPavs(23.25±6.81)kPa]and FIB-4 value[(1.02±0.65)vs(1.74±0.74)vs(2.97±1.34)]in the non-fibrosis group(n=8),the mild fibrosis group(n=41),and the moderate and severe fibrosis group(n=24)increased gradually;the differences between groups were statistically significant(P<0.05).The best critical value of splenic STE value in the diagnosis of hepatic fibrosis was 12.3 kPa,and the corresponding sensitivity and specificity were 88.5%and 75.0%,respectively.The best critical value of splenic STE value in the diagnosis of moderate and severe hepatic fibrosis was 21.9 kPa,and the corresponding sensitivity and specificity were 87.5%and 83.7%.Splenic STE value was positively correlated with FIB-4.Splenic STE value and FIB-4 index were both significant for the diagnosis of liver fibrosis and moderate to severe liver fibrosis,but the area under the curve of splenic STE value was significantly higher than that of the FIB-4 index(0.871vs0.741,Z=6.12,P=0.001;0.798vs0.735,Z=6.35,P=0.001).ConclusionSTE as a noninvasive examination method for the detection of spleen stiffness,has appreciated diagnostic value for liver fibrosis in patients with chronic hepatitis B.