实时组织弹性成像技术诊断肝纤维化的影响因素

The influential factors of real time tissue elastography quantitative analysis on the diagnosis of hepatic fibrosis

目的:探讨实时组织弹性成像技术肝纤维化指数(LFI)诊断肝纤维化程度的影响因素。方法:选取温州医科大学附属第一医院2015年1月至2016年12月诊断为慢性乙型肝炎的患者262例,各研究对象均行实时组织弹性成像技术检测并计算LFI。采用Pearson相关分析研究LFI与各变量之间的关系,将筛选出的变量纳入逐步多元线性回归分析,最终筛选出影响LFI的独立影响因子。结果:Pearson相关分析结果显示体质量指数(BMI)、血小板计数、门静脉内径、肝动脉内径、肝动脉最大流速、脾脏厚度、脾脏长径、脾脏指数、脾门指数、脾动脉内径、脾静脉内径及脾静脉平均流速与LFI显著相关(P<0.05)。逐步多元线性回归分析结果显示BMI、血小板计数、脾静脉内径及脾静脉平均流速是LFI诊断肝纤维化的独立影响因子(P<0.01)。结论:BMI、血小板计数、脾静脉内径及脾静脉平均流速可能会对LFI判断肝纤维化产生影响,应参考临床资料及实验室数据,尤其是超声参数综合考虑,不能单纯根据LFI判断肝脏纤维化的程度。

Objective： To identify the factors which could influence the liver fibrosis index （LFI） based on real-time tissue elastography for liver fibrosis staging. Methods： Two hundred and sixty-two consecutive patients with chronic hepatitis B were prospectively recruited between January 2015 and December 2016 in the First Affiliated Hospital of Wenzhou Medical University. Real-time tissue elastograpby was performed and the LFI was calculated for the patients. The relationships between the LFI and clinical or morphological parameters were analyzed using pearson correlation analysis. Thereafter, a stepwise multiple linear regression analysis was used to identify the variables to be independent associated with LFI. Results： Pearson correlation analysis showed that body mass index （BMI）, platelet count, portal vein diameter, hepatic artery diameter, hepatic artery velocity, spleen thickness, spleen diameter, splenic index, splenoportal index, splenic artery diameter, splenic vein diam- eter, and splenic vein velocity were significantly associated with LFI （P〈0.05）. BMI, platelet count, splenic vein diameter, and splenic vein velocity were identified as the independent variables associated with LFI by stepwise multiple linear regression analysis （P〈0.01）. Conclusion： BMI, platelet count, splenic vein diameter, and splenic vein velocity are identified as the independent variables associated with LFI. Clinical data and laboratory data, especially the ultrasonic parameters may improve the performance of LFI in staging liver fibrosis in patients with chronic hepatitis B.