实时组织弹性成像及血清学指标评估乙型肝炎患者肝纤维化程度及门静脉压力研究

Evaluation of Hepatic Fibrosis and Portal Venous Pressure of Patients With Hepatitis B Using Real-time Tissue Elastography and Serological Indicators

目的探讨使用实时组织弹性成像（RTE）、天冬氨酸氨基转移酶与血小板比值指数（APRI）及FIB-4指数评估乙型肝炎患者肝纤维化程度及门静脉压力的可行性。方法选取2014年9月—2015年6月于石河子大学医学院第一附属医院住院的乙型肝炎患者69例,其中31例接受肝组织穿刺,38例接受肝脏切除术。使用RTE测定肝纤维化指数,收集患者血清学指标并计算APRI以及FIB-4指数,肝脏切除术患者术中测定门静脉自由压（FPP）,病理检查进行肝组织纤维化程度分期（肝纤维化Metavir分期）。结果肝纤维化Metavir分期F0 8例（12%）,F1 21例（30%）,F2 23例（33%）,F3 7例（10%）,F4 10例（15%）。RTE测得肝纤维化指数为1.63~4.02,APRI为0.08~2.10,FIB-4指数为0.33~6.31,Spearman秩相关分析结果显示,肝纤维化指数、APRI、FIB-4指数与肝纤维化Metavir分期均呈正相关（rs=0.582,P〈0.001;rs=0.550,P〈0.001;rs=0.444,P〈0.001）。肝纤维化指数与APRI、肝纤维化指数与FIB-4指数、APRI与FIB-4指数诊断肝纤维化Metavir分期F≥2、F≥3、F=4 ROC曲线下面积比较,差异均无统计学意义（P〉0.05）。手术患者术中测得FPP为13.50~36.50 cm H2O（1 cm H2O=0.098 k Pa）,Spearman秩相关分析结果显示,FPP与肝纤维化Metavir分期呈正相关（rs=0.685,P〈0.001）。Pearson相关分析结果显示,肝纤维化指数、APRI、FIB-4与FPP均呈正相关（r=0.596,P〈0.001;r=0.633,P〈0.001;r=0.696,P〈0.001）。将RTE与血清学指标相结合,通过多元线性回归计算得到FPP的预测方程式为：FPP=9.275＋2.992×肝纤维化指数＋1.064×APRI＋1.605×FIB-4指数,r=0.749,P〈0.001。结论 RTE、APRI及FIB-4指数可以在评估乙型肝炎患者肝纤维化程度的同时评估门静脉的压力。

Objective To investigate the feasibility of real- time tissue elastography（ RTE）, aspartate aminotransferases,AST- to- platelet ratio index（ APRI） and FIB- 4 index in the assessment of liver fibrosis and portal venous pressure in hepatitis B patients. Methods A total of 69 patients with hepatitis B who were admitted into the First Affiliated Hospital of Medical College,Shihezi University from September 2014 to June 2015 were enrolled. Of them,31 patients underwent liver biopsy and 38 patients underwent hepatectomy. RTE was used to determine the liver fibrosis（ LF） index,the serological indicators were collected, and APRI and FIB- 4 index were worked out. Free portal pressure（ FPP） was measured as hepatectomy was conducted,and pathological examination was undertaken to determine the stages of liver fibrosis（ Metavir LF stages）. Results The numbers of patients whose Metavir stages were F0,F1,F2,F3 and F4 were 8（ 12%）,21（ 30%）,23（ 33%）,7（ 10%） and 10（ 15%） respectively. The LF index,APRI and FIB- 4 index were within the ranges of 1. 63-4. 02,0. 08- 2. 10 and 0. 33- 6. 31 respectively. The Spearman correlation analysis showed that LF index,APRI and FIB- 4index were positively correlated with the Metavir staging of liver fibrosis（ rs= 0. 582,P〈0. 001; rs= 0. 550,P〈0. 001; rs= 0. 444,P〈0. 001）. The pairwise comparison of the area under ROC curves（ AUC） of diagnosing Metavir staging（ F≥2,F≥3,F = 4） of liver fibrasis among LF index,APRI and FIB- 4 index showed no significant differences（ P〈0. 05）. In the hepatectomy patient group,FPP ranged from 13. 50 cm H2O（ 1 cm H2 O = 0. 098 k Pa） to 36. 50 cm H2 O. Spearman correlation analysis showed that FPP was positively correlated with the Metavir staging of liver fibrosis（ rs= 0. 685,P〈0. 001）. Spearman correlation analysis showed that LF index,APRI and FIB- 4 index were positively correlated with FPP（ r = 0. 596,P〈0. 001;r = 0. 633,P〈0. 001; r = 0. 696,P〈0. 001）. Linear combination of the RTE and serological indicators could predict FPP as follow： FPP = 9. 275 ＋ 2. 992 × LF index ＋ 1. 064 × APRI ＋ 1. 605 × FIB- 4 index,r = 0. 749,P〈0. 001. Conclusion RTE,APRI and FIB- 4 index can not only evaluate the staging of liver fibrosis but also evaluate portal venous pressure.