肝组织炎症对FibroScan诊断慢性乙型肝炎患者肝纤维化的影响

Effects of liver inflammation on FibroScan diagnosis of hepatic fibrosis in patients with chronic hepatitis B

目的探讨肝组织学炎症对瞬时弹性扫描仪(FS)诊断慢性乙型肝炎患者肝纤维化的影响。方法应用FS对124名慢性乙型肝炎患者进行肝穿刺前肝脏弹性测量值(LSM)的测定,采用肝穿刺活组织病理诊断技术进行肝纤维化分期(S)和炎症分级(G)。对同一肝纤维化分期不同肝组织炎症分级组间LSM进行比较,并对各肝纤维化分期中LSM与肝组织炎症分级进行相关性分析。结果肝组织纤维化逐渐发展伴随肝炎症程度加重,如肝纤维化S1期患者中以G1为主(81.8%),S2期以G2为主(54.2%),S3期以G3为主(47.4%),S4期以G3、G4为主(40%,33.4%),S1～S4每一纤维化分期水平上,不同炎症分级LSM差异均具有统计学意义(P<0.05),且LSM与不同炎症分级之间均呈显著正相关(P<0.01)。结论肝组织炎症程度是影响FS诊断的一个重要因素,炎症活动程度加重可使LSM增加。

Objective To investigate the influence of liver inflammation on the ability of the FibroScan non-invasive elastrography scanner to diagnose hepatic fibrosis in patients with chronic hepatitis B（CHB）.Methods A total of 124 CHB patients who received liver biopsy and concomitant liver stiffness measurement（LSM） by FibroScan between June 2011 and February 2012 were enrolled in the study.The liver puncture biopsies were subjected to histological analysis to determine fibrosis stage（S1 to S4,mild fibrosis to severe fibrosis or cirrhosis） and inflammation grade（G1 to G4,low to high extent of inflammation）.Differences between groups were assessed by Kruskal-Wallis H test or Mann-Whitney U test.The correlations between LSM and fibrosis stages and inflammation grades were evaluated by Spearman＇s rank correlation coefficient.Results The progressive fibrosis stages were accompanied by increased inflammatory grades,such that the significant majority of S1 samples showed G1 inflammation（81.8%,n=55;P0.01）,of S2 showed G2 inflammation（54.2%,n=13;P0.01）,of S3 showed G3 inflammation（47.4%,n=9;P0.05）,and of S4 showed G3 and G4 inflammation（40.0%,n=6 and 33.4%,n=5;both P0.01）.LSM and inflammation grade were positively correlated within each fibrosis stage group（P0.01）,suggesting that the degree of liver inflammation affects the FibroScan measured value.Conclusion Liver inflammation influences LSM by FibroScan and may impact the ability of this technology to diagnose hepatic fibrosis,with more severe inflammatory activity affecting the LSM to a greater extent.