川南地区慢性乙肝患者肝脏硬度值与肝纤维化的相关性研究

Correlation between Liver Stiffness Measurement and Liver Fibrosis in Patients With Chronic Hepatitis B in Southern Sichuan

目的探讨川南地区慢性乙肝患者肝脏硬度值(Liver stiffness measurement,LSM)与肝纤维化的相关性,以评估病情及指导治疗。方法回顾性研究川南地区87例行肝脏穿刺病检的慢性乙肝患者LSM与肝纤维化的相关性,得出该地区慢性乙肝患者肝纤维化和炎症活动度对应的参考LSM值。结果LSM对应显著肝纤维化(S2-S4期)、重度肝纤维化(S3-S4期)、早期肝硬化(S4期)的界值分别为12.20kPa、14.35kPa、17.55kPa,对应炎症活动度(G2-G4)级、(G3-G4)级、G4级的界值分别为9.20kPa、14.05kPa、17.10kPa。肝纤维化S2期以下的LSM值为<12.20kPa,S2期的LSM区间值为12.20-14.35kPa,S3期的LSM区间值为14.35-17.55kPa,S4期的LSM区间值为>17.55kPa。炎症活动度G2级以下的LSM区间值为<9.20kPa,G2级的LSM区间值为9.20-14.05kPa,G3级的LSM区间值为14.05-17.10kPa,G4级的LSM区间值为>17.10kPa。结论①川南地区慢性乙肝患者肝脏硬度值均值较指南标准偏高,具有临床参考价值。②川南地区慢性乙肝患者LSM<9.20kPa,考虑肝脏病理分级<G2S2,可暂不用抗乙肝病毒治疗;LSM>12.20kPa,考虑肝脏病理分级>G2S2,若血清乙肝病毒可检出时,可抗乙肝病毒治疗;9.20kPa<LSM<12.20kPa,可行肝穿刺活检明确。

Objective To investigate the correlation between liver stiffness measurement(LSM)and liver fibrosis in patients with chronic hepatitis B in southern Sichuan,in order to evaluate the condition and guide treatment. Methods A retrospective study was performed on the correlation between LSM and liver fibrosis in 87 patients with hepatitis B who underwent liver biopsy in southern Sichuan.And the corresponding LSM to liver fibrosis and inflammatory activity in patients with chronic hepatitis B in this area was obtained. Results The cutoff value of LSM corresponding to significant liver fibrosis(S2-S4),severe liver fibrosis(S3-S4),and early cirrhosis(S4)were 12.20kPa,14.35kPa,17.55kPa,respectively.And the cutoff value corresponding to inflammatory activity of G2-G4,G3-G4,G4 were 9.20kPa,14.05kPa,17.10kPa respectively.The LSM value of liver fibrosis below S2 is<12.20kPa,the LSM interval of S2 is 12.20-14.35kPa,the LSM interval of S3 is 14.35-17.55kPa,the LSM interval of S4 is>17.55kPa.The LSM value of the inflammatory activity below G2 is<9.20kPa,the LSM interval of G2 is 9.20-14.05kPa,the LSM interval of G3 is 14.05-17.10kPa,the LSM interval of G4 is>17.10kPa. Conclusion ①The mean value of LSM of patients with chronic hepatitis B in southern Sichuan is higher than the standard in the guideline.②Chronic hepatitis B patients with LSM<9.20kPa in southern Sichuan,considering liver pathological grade<G2S2,do not need to be treated with anti-hepatitis B virus,LSM>12.20kPa,considering liver pathological grade>G2S2,if serum hepatitis B virus can be detected,anti-hepatitis B virus treatment could be administrated,9.20kPa<LSM<12.20kPa,liver biopsy should be performed to determined.