肝脏弹性模量值与四种无创血清评分系统对慢性乙型肝炎患者肝脏纤维化程度诊断的效果评价

Comparison of the efficacy of liver elastic modulus with noninvasive serum score systems in diagnosis of liver fibrosis of patients with chronic hepatitis B

目的研究实时剪切波弹性成像(SWE)技术测量的肝脏弹性模量值(EI)及四种常用纤维化评分指标[天冬氨酸转氨酶一血小板比值指数(APRI)、Forns指数、S指数、FIB-4]评估慢性乙型肝炎患者肝脏明显纤维化的临床意义。方法运用SWE技术对2016年5月至2018年7月我院120例经超声引导下肝脏穿刺活检证实的慢性乙型肝炎患者,测量其肝脏EI,同时抽血检测患者的血清生化指标,计算患者的APRI、Forns指数、S指数和FIB-4。根据患者肝组织病理检查结果将其纤维化程度分为S0-S4,若≥S2者定义肝脏有明显纤维化。采用受试者工作特征(ROC)曲线评价肝脏弹性模量值、四种纤维化评分指标对肝脏明显纤维化的诊断价值。结果肝脏EI与肝纤维化程度分级有较好的相关性(r=0.776,P<0.05)。肝脏EI与四种纤维化评分指标诊断肝脏明显纤维化的ROC曲线下面积分别为:0.86、0.68、0.72、0.74、0.72。结论肝脏EI可以作为一种无创评估肝脏纤维化程度的指标,其数值与纤维化评分指标具有明显的相关性,其评估肝脏纤维化的敏感性及特异性较四种纤维化评分指标高,能够对肝脏纤维化程度进行定性评估,为临床诊断及治疗提供依据。

Objective To study the liver elastic modulus index(EI)measured by SWE and the four commonly used fibrosis score indexes[Aspartic acid transaminase platelet ratio index(APRI),Forns,S index,FIB-4]to evaluate the clinical significance of liver fibrosis in patients with chronic hepatitis B.Methods One hundred and twenty patients with chronic hepatitis B who were confirmed by liver biopsy guided by ultrasound from May 2016 to July 2018 were measured with SWE technology,and the relevant serum biochemical indicators were detected.Calculate the patient's APRI,Forns,S index,and FIB-4.The degree of liver fibrosis in all patients was divided into S0-S4,and those who≥S2 were considered to have significant liver fibrosis.Using the ROC curve to evaluate the value of liver elastic modulus and four fibrosis scores in the diagnosis of liver fibrosis.Results Liver elastic modulus had a good correlation with liver fibrosis classification(R=0.776,P&lt;0.05).The area under the ROC curve for the diagnosis of liver fibrosis with liver elastic modulus and four fibrosis evaluation indicators is:0.86,0.68,0.72,0.74,and 0.72 respectively.Conclusion The elastic modulus of liver is a noninvasive index to evaluate liver fibrosis,and it is related to the fibrosis score index.Its sensitivity and specificity are better than the fibrosis score index,and it can qualitatively evaluate the liver fibrosis degree,and provide basis for clinical diagnosis and treatment.