瞬时弹性成像对HIV合并HCV感染者肝纤维化的诊断效能

Efficiency of transient elastography in diagnosis of liver fibrosis in patients with HIV/HCV co-infection

目的探讨瞬时弹性成像对HIV合并HCV感染者肝纤维化分期的诊断效能。方法选取2013年1月-2018年12月在新疆维吾尔自治区第六人民医院住院的HIV合并HCV感染者,采集所有患者的血常规、肝功能、肾功能、凝血、肝纤维化相关血生化、HIV及HCV病毒载量等指标,计算血清学无创模型(APRI及FIB-4),并且所有患者均接受肝组织病理学检查,活检前3 d内进行瞬时弹性成像检测,结果以肝硬度值(LSM)表示。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H检验,Spearman分析LSM、APRI、FIB-4及肝纤维化相关血生化指标、HCV RNA定量与肝活检纤维化分期的相关性,应用受试者工作特征曲线(ROC曲线)评价LSM对于合并感染者肝纤维化分期的诊断效能,确定其诊断界值。结果共纳入76例肝活检并确诊的HIV合并HCV感染者。相关性分析显示LSM与肝纤维化分期相关性最好(r=0.526,P<0.001),优于APRI(r=0.403,P<0.001)及FIB-4(r=0.441,P<0.001),而肝纤维化相关血生化指标中,仅有Ⅳ型胶原与肝纤维化分期相关(r=0.339,P<0.05),而HCV RNA定量与肝纤维化分期无相关性。且对于显著肝纤维化阶段,LSM诊断S2、S3和S4的ROC曲线下面积分别为0.809、0.929和0.906,最佳诊断界值分别为11.6、12.7和14.5 kPa。结论瞬时弹性成像能够较准确的诊断HIV合并HCV感染者肝纤维化分期,在避免肝活检的条件下,对于抗病毒治疗方案的制订及肝纤维化进展的判断提供更加可靠的依据,具有较好的临床应用价值。

Objective To investigate the efficiency of transient elastography(TE)in the diagnosis of liver fibrosis in patients with human immunodeficiency virus(HIV)/hepatitis C virus(HCV)co-infection.Methods The patients with HIV/HCV co-infection who were hospitalized in The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region from January 2013 to December 2018 were enrolled and related indices were collected,including routine blood test results,liver function,renal function,coagulation,biochemical parameters for liver fibrosis,and viral load of HIV and HCV.Noninvasive models for liver fibrosis[aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB-4)]were calculated,and liver biopsy was performed for all patients.TE was performed within 3 days before biopsy,and the results were expressed as liver stiffness measurement(LSM).A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison between multiple groups;a Spearman correlation analysis was used to investigate the correlation of LSM,APRI,FIB-4,biochemical parameters for liver fibrosis,HCV RNA quantification,and liver biopsy results with the stage of liver fibrosis;the receiver operating characteristic(ROC)curve was used to evaluate the efficiency and cut-off value of LSM in determining the stage of liver fibrosis.Results A total of 76 patients with chronic HCV/HIV co-infection who underwent liver biopsy and were diagnosed with liver fibrosis were enrolled.The correlation analysis showed that LSM had the best correlation with the stage of liver fibrosis(r=0.526,P<0.001)and had a better correlation than APRI(r=0.403,P<0.001)and FIB-4(r=0.441,P<0.001),and among the biochemical parameters for liver fibrosis,only type IV collagen was correlated with the stage of liver fibrosis(r=0.339,P<0.05).HCV RNA quantification had no correlation with the stage of liver fibrosis.For marked liver fibrosis,LSM had an area under the ROC curve of 0.809,0.929,and 0.906,respectively,in the diagnosis of S2,S3,and S4 liver fibrosis at the optimal cut-off values of 11.6 kPa,12.7 kPa,and 14.5 kPa,respectively.Conclusion TE can accurately determine the stage of liver fibrosis in patients with HCV/HIV co-infection,which might help to avoid liver biopsy and provide a more reliable basis for developing antiviral regimen and judging the progression of liver fibrosis,and therefore,it holds promise for clinical application.