剪切波弹性成像与血清肝纤维化指标无创评估慢性乙型肝炎患者肝纤维化效能比较

Comparison of the efficacy between shear wave elastrography and serum fibrosis indexes in non-invasive evaluation of hepatic fibrosis in chronic hepatitis B patients

目的比较剪切波弹性成像(SWE)与血清学纤维化指标无创评价慢性乙型肝炎(CHB)患者肝纤维化的效能。方法 2018年1月至2020年3月淮安市第四人民医院收治CHB患者74例。应用Scheuer评分系统进行肝纤维化分级,定义S0、S1期为非显著肝纤维化(非显著组),S2、S3及S4期为显著肝纤维化(显著组)。计量资料行t检验,计数资料行卡方检验。Logistic回归分析CHB患者显著肝纤维化的独立预测因素。构建SWV及血清学纤维化指标诊断CHB患者显著肝纤维化的ROC曲线,计算曲线下面积(AUC)、敏感度及特异度,取约登指数最大处为各指标诊断时的截断点。结果 CHB肝纤维化S0期7例,S1期18例,S2期27例,S3期11例,S4期11例。非显著组年龄为(37.2±6.0)岁,低于显著组的(42.9±9.6)岁,差异有统计学意义(P<0.05)。非显著组患者ALT、ALP、GGT、总胆固醇、PLT、RDW及INR分别为(42.4±7.9)U/L、(102.4±22.2)U/L、(42.3±11.4)U/L、(3.8±1.0)mg/dL、(182.6±40.8)×10^(9)/L、(13.8±0.9)%及(1.0±0.2),显著纤维化组分别为(58.3±18.2)U/L、(131.5±28.5)U/L、(80.2±16.3)U/L、(5.5±1.4)mg/dL、(92.4±32.4)×10^(9)/L、(11.6±1.8)%及(1.2±0.3),差异均有统计学意义(P<0.05)。非显著组SWV为(1.44±0.22)m/s,低于显著组(1.92±0.38)m/s,差异均有统计学意义(P<0.05)。非显著组患者血清学纤维化指标HA、C-IV、APRI、FIB-4、Forns评分及RPR分别为(70.2±12.6)ng/mL、(63.4±21.5)ng/mL、(0.3±0.2)、(0.8±0.3)、(-0.6±0.5)分及(0.08±0.02),显著纤维化组分别为(55.9±30.8)ng/mL、(42.8±18.9)ng/mL、(0.7±0.5)、(1.3±0.4)、(0.4±0.8)分及(0.11±0.02),差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,GGT、HA、C-IV、PLT、SWV、FIB-4、APRI、FIB-4、Forns评分及RPR为影响显著肝纤维化的独立预测因素。SWE诊断肝纤维化的AUC值为0.86,高于APRI、FIB-4、Forns评分、FobroIndex、RPR的0.74、070、0.74和0.69。结论 SWE是一种可靠的无创性评估CHB患者肝纤维化的方法,其诊断性能优于APRI、FIB-4、Forns评分及RPR等血清学纤维化指标。

Objective To compare the efficacy between shear wave elastrography(SWE)and serological fibrosis markers in non-invasive evaluation of hepatic fibrosis in patients with chronic hepatitis B(CHB).Methods 74 patients(44 males and 30 females)with CHB were admitted to our hospital from January 2018 to March 2020,with an average age of(40.2±7.8)years.The measurement data were analyzed by t-test and the counting data were analyzed by chi-square test.Univariate and multivariate Logistic regression analysis were performed to determine the independent predictors of significant liver fibrosis in patients with CHB.To construct the Receiver operating characteristic(ROC)curve of shear wave velocity(SWV)and serological fibrosis indexes for diagnosing significant hepatic fibrosis in patients with CHB.The area under the curve(AUC),sensitivity and specificity were calculated.The maximum Jordan index was taken as the cutoff point for each diagnostic index.Results Hepatic fibrosis was graded by Scheuer score system.S0 and S1 stages were defined as non-significant hepatic fibrosis(non-significant fibrotic group),and S2,S3 and S4 stages were defined as significant hepatic fibrosis(significant fibrotic group).Among 74 CHB patients,7 cases were in S0 stage of liver fibrosis,18 cases were in S1 stage,27 cases were in S2 stage,11 cases in S3 stage and 11 cases in S4 stage.The average age of the non-significant fibrotic group was(37.2±6.0)years,which was younger than that of the significant fibrotic group[(42.9±9.6)years,P<0.05].The levels of ALT,ALP,GGT,total cholesterol,PLT,RDW and INR in the non-significant fibrotic group were(42.4±7.9)U/L,(102.4±22.2)U/L,(42.3±11.4)U/L,(3.8±1.0)mg/dL,(182.6±40.8)×10^(9)/L,(13.8±0.9)% and(1.0±0.2),respectively,which were significantly different with those of the control group[58.3±18.2)U/L,(131.5±28.5)U/L,(80.2±16.3)U/L,(5.5±1.4)mg/dL,(92.4±32.4)×10^(9)/L,(11.6±1.8)%and(1.2±0.3)],(P<0.05).The SWV in non-significant fibrotic group was(1.44±0.22)m/s,which was significantly lower than that in the significant fibrotic group[(1.92±0.38)m/s,P<0.05].The serological fibrosis indexes HA,CIV,APRI,FIB-4,Forns score and RPR in the non-significant group were(70.2±12.6)ng/mL,(63.4±21.5)ng/mL,(0.3±0.2),(0.8±0.3),(-0.6±0.5)and(0.08±0.02),respectively,which were significantly different with the control group[(55.9±30.8)ng/ml,(42.8±18.9)ng/mL,(0.7±0.5),(1.3±0.4),(0.4±0.8)and(0.11±0.02)](P<0.05).Multivariate Logistic regression analysis was carried out with the existence of significant liver fibrosis in patients with CHB as dependent variables and the above significant differences as independent variables.GGT,HA,C-IV,PLT,SWV,FIB-4,APRI,FIB-4,Forns score and RPR were independent predictors of significant liver fibrosis.When evaluating significant hepatic fibrosis,the AUC values of SWE were significantly higher than those of APRI,FIB-4,Forns,FibroIndex,RPR,HA and C-IV,respectively.Conclusion SWE is a reliable and non-invasive method for evaluating hepatic fibrosis in patients with CHB.The diagnostic performance of SWE is superior to serological fibrosis indexes such as HA,C-IV,APRI,FIB-4,Forns score and RPR.