肝纤维化参数模型与肝脏、脾脏弹性模量值对慢性乙型肝炎肝纤维化的诊断意义分析

Evaluation of hepatic fibrosis parameter model and elastic modulus of liver and spleen for the diagnosis of hepatic fibrosis in chronic hepatitis b

目的:探讨肝纤维化参数模型与肝脏、脾脏弹性模量值(SWE值)对慢性乙型肝炎(CHB)肝纤维化恶化程度的的预测价值。方法:选择感染科门诊CHB肝纤维化患者77例,参考肝脏SWE值(正常值2.5~7.0 kPa)分为正常组(31例)和研究组(46例)。检测所有患者肝功能血清学指标,比较两组FIB-4、APRI、GPR模型指数及脾脏SWE值,并分析二者的相关性。结果:研究组肝脏、脾脏SWE值明显高于正常组(P<0.01),两组血清GGT、PLT、AST、门脉流速相比,差异具有统计学意义(P<0.01),其中GGT、PLT与肝脏、脾脏SWE值均存在相关性,差异具有统计学意义(P<0.01)。研究组FIB-4、APRI、GPR模型指标均高于正常组,差异具有统计学意义(P<0.01)。通过Pearson相关性分析发现肝脏SWE值、脾脏SWE值与FIB-4、APRI、GPR均为正相关(P<0.01),其中GPR相关性更高。结论:GGT、PLT及GPR与肝脏、脾脏SWE值成正相关,联合检测可提高肝纤维化早期诊断准确率。

Objective: To investigate the diagnostic value of hepatic fibrosis parameter model and elastic modulus of liver and spleen in hepatic fibrosis of chronic hepatitis B.Methods: Totally 77 patients with hepatic fibrosis of chronic hepatitis in the infection clinic were recruited from July 2016 to December 2018.According to the classification of hepatic fibrosis,23 patients were classified as S1,20 as S2,18 as S3 and 16 as S4.The serum indexes of liver function in all patients were tested,FIB-4,APRI and GPR model indexes were calculated.SWE values of liver and spleen were evaluated,and the correlation between FIB-4,APRI,GPR and SWE was analyzed.Results:The SWE values of liver and spleen in the study group were significantly higher than those in the normal group(P<0.01),and the differences in serum GGT,PLT,AST and portal vein velocity between the two groups were statistically significant(P<0.01).GGT and PLT were correlated with SWE values of liver and spleen,which were statistically significant(P<0.01).The model indexes of fib-4,APRI and GPR in the study group were all higher than those in the normal group,with statistically significant differences(P<0.01).Pearson correlation analysis showed that liver SWE value and spleen SWE value were positively correlated with fib-4,APRI and GPR,and the differences were significant(P<0.01),with a higher correlation with GPR.Conclusion:GGT,PLT and GPR are positively correlated with SWE of liver and spleen,and combined detection can improve the early diagnosis accuracy of liver fibrosis.