实时二维定量剪切波弹性成像、APRI、FIB-4对慢性乙型肝炎肝纤维化的诊断价值

The application value of real-time two-dimensional shear wave elastography,APRI,APRI and FIB-4 in diagnosis of liver fibrosis in patients with chronic hepatitis B

目的研究实时二维定量剪切波弹性成像(SWE)、天门冬氨酸氨基转氨酶与血小板比率指数(APRI)、FIB-4指数(FIB-4)对慢性乙型肝炎(CHB)肝纤维化诊断的价值。方法94例CHB患者纳为研究对象,入院患者均行SWE检查,血常规及肝功能实验室检查。以病理检查结果为金标准,行METAVIR分级,将患者分为F0组(无肝纤维化,n=13)、F1(轻度肝纤维化,n=20)、F2(明显肝纤维化,n=36)、F3(进展性肝纤维化,n=16)及F4(肝硬化,n=9)5组,比较5组SWE参数肝脏硬度值(LSM)、APRI及FIB-4水平,分析各指标在诊断CHB肝纤维化中的应用效果。结果不同肝纤维化程度CHB患者ALT、AST及PLT水平差异无统计学意义(P>0.05);不同肝纤维化程度CHB患者APRI、FIB-4及LSM水平差异均有统计学意义(P<0.05),F0及F1组APRI、FIB-4及LSM水平差异无统计学意义(P>0.05),其均显著低于F2、F3、F4组(P<0.05),F2、F3、F4组APRI及FIB-4水平差异无统计学意义(P>0.05),F4组LSM水平较F3组显著升高(P<0.05);相关性分析提示,APRI、FIB-4及LSM与γ-球蛋白间均呈正相关(r值分别为0.458、0.441、0.541,P<0.05);APRI、FIB-4及LSM单独应用时,以LSM诊断明显肝纤维化的效能最高,AUC=0.868,95%CI(0.783~0.953),三者联合应用诊断效能最高,AUC=0.933,95%CI(0.889~0.997)。结论SWE、ARPI及FIB-4在诊断CHB明显肝纤维化中均具有一定效能,三者单独应用时,SWE诊断效能最高,三者联合应用可有效提高CHB患者肝纤维化诊断效果。

Objective To investigate the application value of real-time two-dimensional shear wave elastography(SWE),aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis 4 index(FIB-4)in diagnosis of liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 94 patients with CHB were enrolled in the study,who received SWE examination.The clinical data including blood routine and liver function laboratory examination results were collected.METAVIR classification was performed according to the results of intraoperative pathological examination,these patients were divided into F0 group(without liver fibrosis,n=13),F1 group(with mild liver fibrosis,n=20),F2 group(obvious liver fibrosis,n=36),F3 group(with progressive liver fibrosis,n=16),and F4 group(with cirrhosis,n=9).The liver stiffness measurement(LSM),APRI and FIB-4 levels were observed and compared among the five groups.Moreover the application value of each index in diagnosis of liver fibrosis in patients with CHB was analyzed.Results There were no significant differences in the levels of ALT,AST and PLT in CHB patients with different degrees of liver fibrosis(P>0.05),however,there were significant differences in the levels of APRI,FIB-4 and LSM in CHB patients with different degrees of liver fibrosis(P>0.05).There were no significant differences in the levels of APRI,FIB-4 and LSM between F0 group and F1 group,but,which in the two groups were significantly lower than those in F2 grup,F3 group and F4 group(P<0.05).There were no significant differences in the levels of APRI and FIB-4 among F2 grup,F3 group and F4 group(P>0.05),but,the LSM levels in F4 group were significantly higher than those in F3 group(P>0.05).Correlation analysis showed that APRI,FIB-4 and LSM levels were positively correlated with those ofγ-globulin(P<0.05).In the diagnosis of liver fibrosis in CHB patients,LSM had the higher diagnostic efficacy by single index detection[AUC=0.868,95%CI(0.783~0.953)],while the combination detection of the three indexes had highest diagnostic efficacy than that by single index detection[AUC=0.933,95%CI(0.889~0.997)].Conclusion SWE,ARPI,and FIB-4 have certain efficacy in diagnosis of obvious liver fibrosis in patients with CHB,and SWE has the higher diagnostic efficacy in single index detection,however,the combination detection of the three indexes can effectively improve the diagnosis effects for obvious liver fibrosis in patients with CHB.