剪切波弹性成像评估慢性乙型肝炎肝纤维化的价值及影响因素

Diagnostic efficacy of shear wave elastography in evaluating chronic hepatitis B liver fibrosis and related influencing factors

目的探讨剪切波弹性成像(SWE)评估慢性乙型肝炎(CHB)肝纤维化的诊断效能及影响因素。方法收集2016年1月-2017年9月于中国医科大学附属盛京医院就诊的CHB患者147例,所有患者均行剪切波弹性成像(SWE)检查,SWE检查之后1周内均进行肝穿刺活组织检查。同时收集患者的一般资料及血清学检测结果。不服从正态分布的计量资料组间比较采用MannWhitney U检验;计数资料组间比较采用χ~2检验。绘制受试者工作特征曲线(ROC曲线)评估诊断效能,logistic回归模型分析影响SWE诊断肝纤维化分期准确度的因素。结果以肝组织学诊断肝纤维化分期为标准,SWE诊断肝纤维化≥F1期、≥F2期、≥F3期和≥F4期的ROC曲线下面积分别为0. 824、0. 880、0. 914和0. 986,最佳诊断界值分别为6. 1 k Pa、7. 0 k Pa、8. 1 kPa、10. 0 k Pa,敏感度分别为91. 0%、91. 7%、87. 0%、88. 9%,特异度分别为66. 0%、82. 8%、66. 0%、94. 9%,阳性预测值分别为85. 0%、78. 6%、48. 3%、53. 3%,阴性预测值分别为77. 5%、93. 5%、97. 2%、99. 2%。根据肝穿刺活组织检查结果,147例患者中SWE诊断准确的有94例,不准确者有53例,ALT、AST、肝脏炎症分级在2组间比较差异有统计学意义(Z值分别为-4. 211、-4. 649、-3. 513,P值均<0. 01)。肝脏炎症分级是影响SWE诊断肝纤维化分期诊断准确性的独立影响因素[比值比(OR)=0. 552,95%可信区间(95%CI):0. 317~0. 963,P=0. 028],仅在肝纤维化分期为F0期(OR=1. 809,95%CI:2. 305~51. 195)及F2期(OR=1. 345,95%CI:1. 037~13. 647)时肝脏炎症分级对SWE诊断肝纤维化分期的影响明显。结论 SWE测量肝脏弹性值评估肝纤维化分期有良好的诊断效能,评估肝纤维化分期准确性受肝脏炎症分级影响。

Objective To investigate the diagnostic efficiency of shear wave elastography （ SWE）in evaluating chronic hepatitis B （ CHB）liver fibrosis and related influencing factors. Methods A total of 147 CHB patients who visited Shengjing Hospital of China Medical University from January 2016 to September 2017 were enrolled. SWE was performed for all patients,and liver biopsy was performed within oneweek after SWE. General information and serological test results of the patients were collected. The Mann - Whitney U test was used forcomparison of non - normally distributed continuous data;the chi - square test was used for comparison of categorical data between groups.The receiver operating characteristic （ ROC）curve was plotted to evaluate diagnostic efficiency,and the logistic regression model was used todetermine the factors associated with the accuracy of SWE in assessing liver fibrosis stage. Results With liver fibrosis stage determined byliver histology as the standard,the areas under the ROC curve of SWE in the diagnosis of ≥F1,≥F2,≥F3,and ≥F4 liver fibrosis were0 824,0. 880, 0. 914,and 0. 986,respectively,with sensitivities of 91. 0%, 91. 7%, 87. 0%,and 88. 9%,respectively and specificitiesof 66. 0%,82. 8%,66. 0%,and 94. 9%,respectively,at the optimal cut - off values of 6. 1 kPa, 7. 0 kPa, 8. 1 kPa,and 10. 0 kPa,respectively. The positive predictive values were 85. 0%,78. 6%,48. 3%,and 53. 3%,respectively,and the negative predictive values were 77. 5%,93. 5%, 97. 2%,and 99. 2%,respectively. According to the results of liver biopsy,of all 147 patients, 94 had an accuratediagnosis based on SWE,while 53 had an inaccurate diagnosis;there were significant differences between these two groups in alanine aminotransferase,aspartate aminotransferase,and liver inflammation grade （ Z = - 4. 211、- 4. 649、- 3 513,all P 〈 0. 01） . Liver inflammationgrade （ odds ratio [ OR]= 0. 552,95% confidence interval [ CI] ：0. 317 - 0. 963,P = 0. 028）was an independent influencing factor forthe diagnostic accuracy of SWE,and it had a significant effect on SWE in diagnosing liver fibrosis in the case of stage F0 liver fibrosis （ OR= 1. 809,95% CI：2. 305 - 51. 195）and stage F2 liver fibrosis （ OR = 1. 345,95% CI：1. 037 - 13. 647） . Conclusion Liver stiffnessmeasured by SWE has good diagnostic efficacy in assessing liver fibrosis stage,and the accuracy of liver fibrosis stage assessment is affectedby liver inflammation stage.