声辐射力脉冲成像评价不同丙氨酸氨基转移酶水平酒精性肝病肝纤维化程度的研究

Effect of alanine transaminase levels on liver fibrosis degree in patients with alcoholic liver disease assessed by acoustic radiation force impulse

目的探讨声辐射力脉冲成像(ARFI)技术评价不同丙氨酸氨基转移酶(ALT)水平酒精性肝病患者肝纤维化程度的临床价值。方法选取经肝脏穿刺活检确诊的酒精性肝病患者99例,根据血清ALT水平分为ALT升高组55例和ALT正常组44例,应用ARFI技术检测两组肝脏弹性,以病理诊断结果为金标准,比较不同ALT水平的酒精性肝病患者的肝脏弹性值;绘制ARFI诊断酒精性肝病肝纤维化程度的受试者工作特征曲线并计算曲线下面积,确定其诊断界值,分析ARFI值与肝纤维化程度和炎症程度的相关性。结果 99例患者中,肝纤维化S0期～S4期的ARFI值分别为(0.99±0.11)m/s、(1.15±0.12)m/s、(1.42±0.36)m/s、(1.89±0.67)m/s、(2.11±0.54)m/s,差异有统计学意义(P<0.01);除S0期与S1期、S3期与S4期外其余各期两两比较差异均有统计学意义(均P<0.05)。ALT正常组中诊断肝纤维化程度≥S3期和S4期的曲线下面积均稍高于ALT升高组(0.979 vs. 0.837,0.981 vs. 0.839),但差异均无统计学意义。ALT正常组ARFI诊断肝纤维化≥S2期、≥S3期和S4期的界值分别为1.237 m/s、1.269 m/s、1.413 m/s,ALT升高组相应界值分别为1.330 m/s、1.395 m/s、1.653 m/s。相关性分析结果表明,肝脏ARFI测值与肝纤维化程度和肝脏炎症程度均呈正相关(r=0.685、0.636,均P<0.001)。结论酒精性肝病患者肝脏ALT水平对ARFI技术诊断其肝纤维化程度有一定影响,建议临床应用ARFI诊断时需综合考虑患者的肝功能水平。

Objective To investigate the effect of different alanine transaminase （ALT）levels on liver fibrosis degreeassessed by acoustic radiation force impulse （ARFI）elastography in patients with alcoholic liver disease （ALD） .Methods Accordingto ALT levels, 99 cases with ALD confirmed by liver biopsy were divided into high ALT level group （n=55）and normal ALT levelgroup （n=44） .The liver stiffness of all patients was assessed by ARFI elastography.Referring to the histologic fibrosis stage on liverbiopsy, the effect of different ALT levels on diagnosis of liver fibrosis degree in ALD by ARFI were compared.All the ARFI valueswere assessed by ROC curve analysis, the corresponding cut-off values was calculated and compared.The correlations of ARFIvalues and liver histological fibrosis, necroinflammatory activity were also analyzed.Results The ARFI values of S0-S4 of liverfibrosis in 99 cases were（0.99±0.11）m/s,（1.15±0.12）m/s,（1.42±0.36） m/s,（1.89±0.67） m/s,（2.11±0.54） m/s, respectively.Thedifference was statistically significant （P〈0.01） .Except for S0 and S1, S3 and S4, there were significant difference between any twogroups （all P〈0.05） .The area under ROC curve （AUROC）of severe fibrosis （≥S3）and cirrhosis （S4）in normal ALT level groupwere higher than those in high ALT level group （0.979 vs. 0.837, 0.981 vs. 0.839） .But the difference had no statistical significance.The cut-off values for ARFI elastography in high ALT level group were 1.330 m/s for ≥S2, 1.395 m/s for ≥S3 and 1.653 m/s forS4, these in normal ALT level group decreased to 1.237 m/s for ≥S2, 1.269 m/s for ≥S3 and 1.413 m/s for S4.Relevant analysis results showed that the relationships were significant positive between ARFI values and liver histological fibrosis,necroinflammatory activity in patients with ALD（r=0.685, 0.636, all P〈0.001） .Conclusion The ALT levels has a certaininfluence in the diagnosis of liver fibrosis degree in ALD by ARFI, so we should consider the patient＇ s liver function in the clinic.