剪切波弹性成像在丙氨酸氨基转移酶轻度升高慢性乙型肝炎患者肝纤维化中的诊断价值

Diagnostic value of shear wave elastography in the diagnosis of liver fibrosis in chronic hepatitis B patients with mild ALT elevation

目的:探讨剪切波弹性成像(shear-wave elastography,SWE)技术及四种血清学诊断模型(APRI、FIB-4、Forns指数、S指数)对丙氨酸氨基转移酶(ALT)轻度升高的慢性乙型肝炎(chronic hepatitis B,CHB)患者肝纤维化的诊断价值。方法:选择2017年9月-2019年8月在广州市第八人民医院经肝穿刺活组织检查确诊为CHB且ALT轻度升高患者164例,根据肝纤维化分期分为轻中度肝纤维化组(99例)和重度肝纤维化组(65例)。采用受试者工作特征曲线(ROC)和ROC曲线下面积(AUC)评价血清学诊断模型和SWE对重度肝纤维化的诊断价值。结果:APRI、FIB-4、Forns指数、S指数、SWE杨氏模量值与肝纤维化分期均呈显著正相关(P<0.05)。SWE诊断重度肝纤维化的AUC为0.844[95%可信区间(CI):0.784-0.903],显著高于APRI(P=0.002)、FIB-4(P=0.002)、Forns指数(P=0.001)和S指数(P<0.05)。模型1、模型2、SWE三者之间的AUC无统计学差异(模型1vs模型2,P=0.737;模型1 vs SWE,P=0.370;模型2 vs SWE,P=0.430)。结论:SWE对ALT轻度升高的CHB患者重度肝纤维化诊断具有较高的价值,值得推广。

Objective:To investigate the value of shear wave elastography(SWE)and four serological diagnostic models(APRI,FIB-4,Forns index,S index)for diagnosing liver fibrosis in chronic hepatitis B(CHB)patients with mild ALT elevation.Methods:Included in this study were 164 patients who were diagnosed with CHB by liver biopsy and with mild ALT elevation at the Guangzhou Eighth People's Hospital between September 2017 and August 2019.According to staging of the liver fibrosis,the patients were divided into mild-to-moderate liver fibrosis group(n=99)and severe liver fibrosis group(n=65).The diagnostic value of serological diagnostic model and SWE for severe liver fibrosis was evaluated by receiver operating characteristic curve(ROC)and the area under the ROC curve(AUC).Results:APRI,FIB-4,Forns index,S index,and Young's modulus were in significant positive correlation with liver fibrosis stages(P<0.001).The AUC for SWE in diagnosing severe liver fibrosis was 0.844[95%CI:0.784-0.903],which was significantly higher than that for APRI(P=0.002),FIB-4(P=0.002),Forns index(P=0.001),or S index(P<0.001).There was no statistical difference in AUC between Model 1,Model 2,and SWE(Model 1 vs Model 2,P=0.737;Model 1 vs SWE,P=0.370;Model 2 vs SWE,P=0.430).Conclusion:SWE offers high diagnostic value for severe liver fibrosis in CHB patients with mild ALT elevation,and is therefore worthy of widespread use.