剪切波弹性成像和γ-谷氨酰转肽酶/血小板比用于诊断慢性乙型肝炎患者肝纤维化

Shear wave elastography andγ-glutamyl transpeptidase/platelet ratio in diagnosis of liver fibrosis in chronic hepatitis B patients

目的探讨剪切波弹性成像(SWE)和γ-谷氨酰转肽酶/血小板比值(GPR)用于诊断慢性乙型肝炎(CHB)患者肝纤维化的应用价值。方法选择116例CHB患者,在肝脏穿刺活检前行SWE检测及血常规及肝功能检验,记录肝脏硬度(LSM),计算GPR。根据Metavir评分系统将活检所示肝纤维化分为F0~F4共5期,分析Elast PQ和GPR与肝脏纤维化分期的相关性。绘制受试者工作特征(ROC)曲线,比较Elast PQ和GPR诊断CHB患者肝纤维化效能的差异,分析Elast PQ诊断丙氨酸氨基转移酶(ALT)≤2倍正常值上限(ULN)患者肝纤维化的价值。结果Elast PQ和GPR与肝脏纤维化分期均呈正相关(r=0.94,P<0.01;r=0.92,P<0.01)。对于F1~F3期肝纤维化,Elast PQ的诊断效能优于GPR(Z=2.21,P=0.03;Z=2.16,P=0.03;Z=2.27,P=0.02)。Elast PQ对ALT≤1×ULN患者的诊断效能优于其对1×ULN<ALT≤2×ULN者。结论Elast PQ和GPR对ALT≤2×ULN的CHB患者早期肝纤维化分期具有较高价值,Elast PQ的诊断效能更好。

Objective To explore the application value of shear wave elastography(SWE)andγ-glutamyl transpeptidase/platelet ratio(GPR)in diagnosis of liver fibrosis in chronic hepatitis B(CHB)patients.Methods A total of 116 patients with CHB were collected.SWE examinations and blood routine and liver function tests were performed before liver biopsy.Liver hardness measurement(LSM)was recorded,and GPR was calculated.According to the Metavir scoring system,liver fibrosis was classified as F0,F1,F2,F3 and F4 in the pathologic examinations.The correlations of SWE,GPR and liver fibrosis stages were analyzed.Receiver operating characteristic curve(ROC)was drawn,and Elast PQ and GPR for diagnosis of liver fibrosis in patients with CHB were compared.The diagnostic value of Elast PQ of liver fibrosis in patients with ALT below 2 times of the upper limit of normal(ULN)value was analyzed.Results Elast PQ and GPR were all positively correlated with liver fibrosis staging(r=0.94,P<0.01;r=0.92,P<0.01).The diagnostic efficiency of Elast PQ was superior to that of GPR for F1-F3 fibrosis stages(Z=2.21,P=0.03;Z=2.16,P=0.03;Z=2.27,P=0.02),of Elast PQ in patients with ALT≤1×ULN was better than that in patients with 1×ULN<ALT≤2×ULN.Conclusion Both Elast PQ and GPR had good diagnostic value for staging of liver fibrosis in patients with ALT≤2×ULN,and Elast PQ was better than GPR.