血清IL-34联合超声弹性成像诊断慢性乙型肝炎患者肝纤维化的效能分析

Diagnostic efficacy of serum IL-34 level and transient elastography in predicting liver fibrosis in patients with chronic hepatitis B

目的研究应用血清IL-34和肝脏硬度检测(LSM)诊断慢性乙型肝炎(CHB)患者肝纤维化的效能。方法2018年6月~2019年6月我院接受经皮肝穿刺活检的CHB患者100例,采用ELISA法检测血清IL-34和血清HBsAg水平,采用实时荧光定量PCR法检测血清HBV DNA,使用雅培公司生产的全自动生物化学分析仪检测血生化指标,计算谷草转氨酶(AST)/血小板(PLT)比率指数(APRI)和肝纤维化-4因子指数(FIB-4)评分,使用FibroTouch检测LSM,采用单因素和多因素Logistic回归分析影响CHB患者显著性肝纤维化的独立预测因素,应用受试者工作特征(ROC)曲线下面积(AUC)分析CHB患者显著肝纤维化发生的独立影响因素。结果经肝组织学检查,诊断肝纤维化F0/F1期(非显著性肝纤维化)组32例,>F2(显著性肝纤维化)组68例。非显著性肝纤维化组年龄为(35.2±8.0)岁,显著小于显著性肝纤维化组[(42.6±8.6)岁,P<0.05],血清IL-34水平为(10.8±3.6)pg/ml,显著低于显著性肝纤维化组[(17.4±4.1)pg/ml,P<0.05],LSM为(6.1±1.4)kPa,显著小于显著组[(14.2±5.4)kPa,P<0.05],APRI评分为(0.5±0.2),显著低于显著组[(1.0±0.5),P<0.05],FIB-4评分为(1.2±1.0),显著低于显著组[(2.2±1.5),P<0.05];多因素Logistic回归分析发现血清IL-34、LSM、APRI和FIB-4是影响CHB患者发生显著性肝纤维化的独立影响因素(P<0.05);血清IL-34、LSM、APRI和FIB-4诊断显著性肝纤维化的AUC分别为0.84、0.89、0.74和0.72,当联合应用IL-34和LSM诊断显著性肝纤维化时,其AUC、敏感度和特异度分别为0.92、89.4%和94.0%。结论应用血清IL-34和LSM联合诊断CHB患者显著性肝纤维化的效能较为理想,值得进一步研究。

Objective The aim of this study was to investigate the diagnostic efficacy of serum IL-34 level and transient elastography in predicting liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 100 patients with CHB underwent percutaneous liver biopsies in our hospital from June 2018 through June 2019.Serum IL-34 levels were detected by ELISA and the liver stiffness measure(LSM)were obtained by elastography.The asparate aminotransferase/platelet ratio index(APRI)and the liver fibrosis-4 factor index(FIB-4)were calculated.The univariate and multivariate Logistic regression analysis were performed to determine the independent predictors of significant liver fibrosis in patients with CHB.The receiver operating characteristic(ROC)curve was used to analyze the cutoff value of independent predictors,and the area under the curve(AUC),diagnostic sensitivity(Se)and specificity(Sp)were calculated.Results Out of 100 patients with CHB,the liver histopathological examination showed fibrosis 0(F0)in 7 cases,F1 in 25(non-significant liver fibrosis in 32),and F2 in 32,F3 in 28 and F4in 8 cases(>F2 as significant liver firobosis in 68);the age in non-significant liver fibrosis was(35.2±8.0)yr,much younger than[(42.6±8.6)yr,P<0.05],serum IL-34 level was(10.8±3.6)pg/ml,much lower than[(17.4±4.1)pg/ml,P<0.05],the LSM was(6.1±1.4)kPa,much lower than[(14.2±5.4)kPa,P<0.05],the APRI score was(0.5±0.2),much lower than[(1.0±0.5),P<0.05]and the FIB-4 score was(1.2±1.0),much lower than[(2.2±1.5),P<0.05]in patients with significant liver fibrosis;the multivariate Logistic regression analysis showed that serum IL-34 levels,the LSM,the APRI and FIB-4 scores were the independent factors affecting liver fibrosis(P<0.05);the AUC in diagnosing liver fibrosis by serum IL-34 levels,the LSM,the APRI and FIB-4 scores were 0.84,0.89,0.74 and 0.72,and the AUC,the Se and Sp by serum IL-34 and LSM combination were 0.92,89.4%and 94.0%,respectively.Conclusion The application of serum IL-34 levels might be used as an efficacious index for the diagnosis of liver fibrosis in patients with CHB,and its combination with LSM could improve the diagnostic efficacy.