2D-SWE联合血清学诊断模型评估老年慢性乙肝患者肝纤维化

Evaluation of liver fibrosis in elderly patients with chronic hepatitis B by 2D-SWE combined with serological diagnostic model

目的探讨二维剪切波弹性成像(2D-SWE)联合血清学诊断模型评估老年慢性乙肝(CHB)患者肝纤维化程度的临床价值。方法选择108例老年CHB患者作为研究对象,并依据患者肝组织病理活检分期结果将其分为无明显肝纤维化组(n=36)、明显肝纤维化组(n=60)和早期肝硬化组(n=12)。比较三组患者血清学生化指标、肝脏弹性模量、APRI评分和FIB-4指数与肝纤维化不同分期之间的差异及相关性,并分析2D-SWE和血清学诊断模型单独和联合评估老年CHB患者肝纤维化的诊断效能,计算各无创评估方法的精确度、灵敏度及特异性。结果老年CHB患者AST表达水平、肝脏弹性模量、APRI评分和FIB-4指数随患者肝纤维化程度加重而升高(P<0.05),PLT表达水平随患者肝纤维化程度加重而降低(P<0.05),ALT表达水平各组间不存在统计学差异(P>0.05)。此外,2D-SWE和血清学诊断模型(APRI评分和FIB-4指数)与肝纤维化程度呈正相关性(r值分别为0.617、0.453、0.430,P<0.05)。各种无创评估方法在单独和联合应用时,以2D-SWE联合血清学诊断模型评估肝纤维化准确性(AUC=0.915)、灵敏度(89.5%)和特异性(95.4%)最高。结论2D-SWE联合血清学诊断模型可高度精确评估老年CHB患者的肝纤维化程度,具有较高的临床价值,并值得进一步推广。

Objective To explore the clinical value of two-dimensional shear-wave elastography(2D-SWE)combined with serological diagnosis model in evaluating the degree of liver fibrosis in elderly patients with chronic hepatitis B(CHB).Methods 108 elderly patients with CHB were selected as the research object,and they were divided into no obvious liver fibrosis group(n=36),obvious liver fibrosis group(n=60)and early liver cirrhosis group(n=12)according to the results of liver biopsy.The differences and correlations between serum biochemical indexes,liver elastic modulus,APRI score and FIB-4 index and different stages of liver fibrosis in the three groups were compared.The diagnostic efficacy of 2D-SWE and serological diagnostic model in evaluating liver fibrosis in elderly patients with CHB alone and jointly was analyzed,and the accuracy,sensitivity and specificity of each noninvasive evaluation method were calculated.Results The expression level of AST,liver elastic modulus,APRI score and FIB-4 index in elderly patients with CHB increased with the aggravation of liver fibrosis(P<0.05),and the expression level of PLT decreased with the aggravation of liver fibrosis(P<0.05).There was no significant difference in the expression level of ALT among the groups(P>0.05).In addition,2D-SWE and serological diagnostic model(APRI score and FIB-4 index)were positively correlated with the degree of liver fibrosis(r values were 0.617,0.453 and 0.430,respectively,P<0.05).The accuracy(AUC=0.915),sensitivity(89.5%)and specificity(95.4%)of 2D-SWE combined serological diagnostic model were the highest when various noninvasive evaluation methods were used alone and in combination.Conclusion 2D-SWE combined with serological diagnosis model can highly accurately evaluate the degree of liver fibrosis in elderly patients with CHB.It has high clinical value and is worthy of further promotion.