肝细胞性黄疸对慢性乙型肝炎患者剪切波肝杨氏模量值的影响

Effect of hepatogenous jaundice on liver stiffness measurement in patients with chronic hepatitis B

目的分析肝细胞性黄疸对慢性乙型肝炎(HBV)患者实时二维剪切波弹性成像(two-dimensional shear-wave elastography,2D-SWE)肝杨氏模量值的影响。方法选择2011年6月至2016年12月于中山大学附属第三医院就诊的慢性HBV患者1 188例。所有患者均行2D-SWE和肝穿刺活检检查,同时记录临床及实验室血生化指标。按照胆红素测值水平分为正常组(<23.9 μmol/L)及升高组(≥23.9 μmol/L),比较两组在相同肝纤维化分期、相同丙氨酸转氨酶(ALT)水平、相同炎症活动度分级时肝杨氏模量值的差异,并对总胆红素与肝杨氏模量值进行Spearman相关分析。结果973例慢性HBV患者获得有效肝脏硬度测值纳入研究分析。相同肝纤维化分期(F1-F4)中胆红素升高组的肝杨氏模量值高于胆红素正常组(P<0.05),两者具有一定相关性(r=0.328,0.247,0.495,0.435;均P<0.001)。肝纤维化分期水平≤F2,ALT水平[≥2×正常上限值(upper limit of normal,ULN)];及肝纤维化分期水平≤F2,炎症活动度分级(≤A1,≥A2),胆红素升高组的肝杨氏模量值高于胆红素正常组,两者具有轻度相关性(r=0.266,0.210,0.243;均P<0.001);肝纤维化分期水平≥F3,ALT水平(<2×ULN,≥2×ULN);及肝纤维化分期水平≥F3,炎症活动度≥A2,胆红素升高组的肝杨氏模量值高于胆红素正常组,两者具有轻度相关性(r=0.671,0.200,0.468;均P<0.05)。结论相同肝纤维化分期ALT≥2×ULN,及相同肝纤维化分期炎症活动度分级≥A2,肝细胞性黄疸影响2D-SWE肝杨氏模量值,两者具有轻度相关性。

Objective To evaluate the impact of intrahepatic cholestasis on liver stiffness measurement(LSM) of two-dimensional shear wave elastography (2D-SWE) in patients with chronic hepatitis B. Methods Between June 2011 and December 2016, total of 1 188 patients with chronic hepatitis B infection were enrolled to collect clinical, 2D-SWE, biochemical variables and histological (METAVIR scoring system) datas. LSM was compared between normal total bilirubin group(TB<23.9 μmol/L) versus abnormal TB group(≥23.9 μmol/L). Correlation of TB with LSMs was assessed. Results Nine hundred and seventy-three patients with effective LSM in the study were analyzed. Within the same fibrosis stage (F1-F4), LSM showed significantly higher value in abnormal TB group than those of normal TB group (r=0.328, 0.247, 0.495, 0.435, all P<0.001). Increased LSM for abnormal TB group was generally found within different subset of patients[fibrosis stage≤F2, ALT≥2×upper limit of normal (ULN);fibrosis stage≤F2, METAVIR activity grade ≤A1 or ≥A2], with r=0.266, 0.210, 0.243 (all P<0.001), respectively.Increased LSM for abnormal TB group was also found within different subset of patients [fibrosis stage≥F3, ALT<2×ULN,≥2×ULN;fibrosis stage≥F3, METAVIR activity grade≥A2, with r=0.671, 0.200, 0.468 (all P<0.05)]. Conclusions Hepatogenous jaundice induced to intrahepatic cholestasis shows slight positive correlation with LSMs in patients with chronic hepatitis B.