肝脏剪切波弹性成像对慢性乙型肝炎患者肝纤维化的评估价值

Evaluation of significant liver fibrosis in patients with chronic hepatitis B by ultrasonic elastography and serological indexes

目的探讨应用剪切波弹性成像(SWE)诊断慢性乙型肝炎(CHB)患者肝纤维化的效能。方法2017年1月~2020年1月我院收治的CHB患者76例,使用超声检测肝脏杨氏模量值,同时行肝活检病理学检查。计算谷草转氨酶/血小板比率指数(APRI)和肝纤维化-4因子指数(FIB-4)。采用多因素Logistic回归分析影响肝纤维化发生的独立危险因素,应用受试者工作特征曲线(ROC)下面积(AUC)评估各项指标诊断肝纤维化的效能。结果在76例CHB患者中,病理学检查诊断肝纤维化F0期8例,F1期22例,F2期25例,F3期12例,F4期9例。将肝纤维化F0/F1期定义为非显著性肝纤维化(n=30),将F2~F4期定义为显著性肝纤维化(n=46);非显著组杨氏模量值为(6.6±1.2)kPa,显著低于显著组[(12.7±2.1)kPa,P<0.05];非显著组血清HA水平为36.4(23.1~70.6)μg/L,显著低于显著组[92.3(67.2~192.5)μg/L,P<0.05],血清LN水平为42.9(26.4~58.4)μg/L,显著低于显著组[75.8(36.8~142.0)μg/L,P<0.05],血清Ⅳ-C水平为36.6(24.0~75.3)μg/L,显著低于显著组[102.2(47.2~245.8)μg/L,P<0.05],PⅢP为8.2(7.2~10.5)μg/L,显著低于显著组[17.0(7.7~26.8)μg/L,P<0.05];非显著组APRI为(0.5±0.2),显著低于显著组[(1.0±0.4),P<0.05],FIB-4为(1.2±0.9),显著低于显著组[(2.1±1.3),P<0.05];多因素Logistic回归分析结果表明杨氏模量值、APRI和FIB-4是影响CHB患者发生显著肝纤维化的独立预测因素(P<0.05);杨氏模量值诊断显著肝纤维化的AUC为0.89,显著高于APRI(0.80,P<0.05)或FIB-4(0.77,P<0.05),其诊断显著性肝纤维化的截断点、敏感度和特异度分别为7.5 kPa、84.5%和88.4%。结论检测肝脏杨氏模量值能够有效诊断CHB患者显著肝纤维化,具有临床应用价值,值得进一步研究。

Objective To investigate the shear wave elastography(SWE,or E imaging)and serological markers in the evaluation of significant liver fibrosis in patients with chronic hepatitis B(CHB).Methods A total of 76 patients with CHB were enrolled in our hospital between January 2017 and January 2020,and all of them received liver biopsies and hepatic SWE examination.The APRI and FIB-4 scores were calculated.Multivariate Logistic regression analysis was applied to analyze the independent risk factors of liver fibrosis,and the area under receiver operating characteristic curve(AUROC)was used to evaluate the accuracy of each index in the diagnosis of liver fibrosis.Results Among the 76 patients with CHB,there were 8 cases of F0 stage,22 cases of F1 stage,and 25 cases of F2 stage,12 cases of F3 stage and 9 cases of F4 stage by histopathological examination;We combined F0 and F1 stages of liver fibrosis as non-significant liver fibrosis group(n=30),and defined F2,F3 and F4 stages as significantly group(n=46);the Young's modulus of patients in non-significant group was(6.6±1.2)kpa,significantly lower than that in significant group[(12.7±2.1)kpa,P<0.05];serum HA level in patients with non-significant group was 36.4(23.1-70.6)g/L,significantly lower than that in significant group[92.3(67.2-192.5)g/L,P<0.05],serum LN level was 42.9(26.4-58.4)μg/L,significantly lower than[75.8(36.8-142.0)μg/L,P<0.05],serumⅣ-C level was 36.6(24.0-75.3)μg/L,significantly lower than[102.2(47.2-245.8)μg/L,P<0.05],and serum PⅢP level was 8.2(7.2-10.5)μg/L,significantly lower than[17.0(7.7-26.8)μg/L,P<0.05]in patients with significant liver fibrosis;the APRI score in patients without significant fibrosis was(0.5±0.2),significantly lower than that in those with significant fibrosis[(1.0±0.4),P<0.05],and the FIB-4 score was(1.2±0.9),significantly lower than that in with significant group[(2.1±1.3),P<0.05];multivariate Logistic regression analysis showed that Young’s modulus,APRI and FIB-4 were the independent predictors of significant liver fibrosis in CHB patients(P<0.05);the AUC of Young's modulus was 0.89,significantly higher than 0.80(P<0.05)by APRI or 0.77(P<0.05)by FIB-4,in diagnosing significant liver fibrosis,with the diagnostic cut-off value,sensitivity and specificity being of 7.5 kPa,84.5%and 88.4%,respectively.Conclusion The detection of Young's modulus of liver by ultrasound E-imaging might effectively diagnose significant hepatic fibrosis in patients with CHB,which is of great clinical value.