肝硬度值在ALT低于2倍正常值上限慢性HBV感染者肝纤维化中的应用价值

Value of liver stiffness measurement in diagnosis of liver fibrosis in chronic HBV-infected patients with ALT less than double upper limit of normal

目的探讨肝硬度值(liver stiffness measurement,LSM)在丙氨酸氨基转移酶(alanine amino transferase,ALT)低于2×正常值上限(2×ULN)的乙型肝炎病毒(hepatitis B virus,HBV)感染者肝纤维化中的应用价值。方法选择2014年3月至2018年7月入住沈阳市第六人民医院的128例ALT持续低于2×ULN并进行肝活检的慢性HBV感染者,所有患者在肝活检前检测了LSM(单位为kPa)以及肝脏生化指标。利用受试者工作特征曲线下面积(AUC)评价LSM对肝纤维化程度的诊断价值。结果ALT正常组(<40 U/L)与ALT<2×ULN组(40~80 U/L)的LSM分别在同一肝纤维化分期中差异无统计学意义(P>0.05)。两组LSM分别在F2、F3、F4不同纤维化分期中差异有统计学意义(P<0.05),LSM与肝组织炎症分级和纤维化分期均有相关性(相关系数为0.572和0.721,P<0.05),但与ALT水平不相关(相关系数0.012,P>0.05)。LSM诊断肝纤维化(F2~F3)和早期肝硬化(F4)的AUC为0.804和0892,高于模型APRI(Z=3.065和Z=2.053,均P<0.05)。其中以7.9 kPa作为LSM诊断F2~F3的最优界值时,灵敏度为70.6%,特异度为78.4%,准确率为74.5%;以10.3 kPa作为诊断F4的最优界值时,灵敏度92.3%,特异度为73.5%,准确率为77.3%。结论在ALT<2×ULN的HBV感染者中,ALT水平对LSM的影响较小。LSM对F2以上的明显纤维化以及肝硬化具有较高的诊断准确率,适宜临床推广应用。

Objective To evaluate the clinical value of liver stiffness measurement(LSM)in the diagno sis of liver fibrosis in chronic HBV infected patients with ALT less than double upper limit of normal.Methods A total of 128 patients with chronic hepatitis B and ALT less than double upper limit of normal were administered from March 2014 to July 2018 in Shenyang Sixth People′s Hospital.All patients underwent FS for LSM(kPa as the unit),liver function test and liver biopsy.The diagnostic value of LSM to liver fibrosis were evaluated by area under the receiver operating characteristic curves(AUC).Results No significant difference of LSM was found between normal ALT group and group with ULN less than 2 fold in the same stage of liver fibrosis(P>0.05).But,it was obviously different among group F2,F3 and F4(P<0.05).LSM were related to both the degree of in flammation and the fibrosis stage of liver(correlation coefficient was 0.572,0.721,respectively,P<0.05),but no to ALT levels(correlation coefficient was 0.012,P>0.05).The AUROC of 0.804 was the value for diagnosis significant liver fibrosis(F2~F3)whereas 0.892 for early stage liver cirrhosis(F4).The AUC of LSM was higher than that of APRI in diagnosis of liver fibrosis(Z=3.065,2.053,all P<0.05).The optimal cutoff value for diagnosing F2~3 was 7.9 kPa while the sensitivity was 70.6%,the specificity was 78.4%and the accuracy rate was 74.5%.The optimal cutoff value for diagnosing S4 was 10.3 kPa while the sensitivity was 92.3%,the specificity was 73.5%and the accuracy rate was 77.3%.Conclusions ALT level had no significant red relationship with LSM.LSM had a high accuracy rate in diagnosis of fibrosis F2 and above,as well as in liver cirrhosis among the HBV infected patients with ULN less than 2 fold of ALT.The clinical application is recommend.