二维实时剪切波弹性成像诊断慢性肝病肝纤维化的危险因素分析

The risk factors affecting 2D-SWE in diagnosis of liver fibrosis due to chronic liver disease

目的分析影响二维实时剪切波弹性成像技术(2D-SWE)诊断慢性肝病肝纤维化的危险因素。方法选择2018年1月至2020年12月慢性乙型肝炎患者338例进行二维实时剪切波弹性成像检查,且所有患者在7 d内进行肝脏穿刺活检并按病理学分期诊断。同时采集患者临床资料,采用ROC曲线评价二维实时剪切波弹性成像技术诊断慢性肝病肝纤维化的价值。再采用多因素回归性分析影响二维实时剪切波弹性成像技术诊断患者的危险因素。并分析肝脏病理分期、临床资料与LSM值的相关性。结果2组比较,年龄、脾脏厚度、长度、门静脉宽度、谷丙转氨酶、谷草转氨酶差异有统计学意义(P<0.05);年龄、病程、脾脏厚度、脾脏长度、谷丙转氨酶、谷草转氨酶与LSM值呈正相关(P<0.05);肝脏病理分期与LSM值呈正相关(P<0.05);LSM值在肝纤维化的AUC分别为0.762,最佳诊断界值10.08 kPa,敏感性为83.3%,特异性为71.2%。结论慢性肝病肝纤维化患者病程、年龄是影响2D-SWE诊断LSM值的危险因素,且2D-SWE诊断肝纤维化分期有较高的诊断价值。

Objective To investigate the risk factors affecting two-dimensional shear wave elastography(2D-SWE)in diagnosis of liver fibrosis due to chronic liver disease.Methods A total of 338 patients with chronic hepatitis B who underwent 2D-SWE and liver biopsy in our hospital from January 2018 to December 2020 were enrolled in the study.The clinical data were collected and ROC curve was used to evaluate the value of 2D-SWE in diagnosis of chronic liver fibrosis.Multivariate regression analysis was used to analyze the risk factors affecting 2D-SWE in diagnosis of fibrosis due to chronic liver disease.Moreover the correlation between liver pathological stage,clinical data and LSM value was analyzed.Results There were significant differences in patient’s age,course of disease,thickness of spleen,length of spleen,alanine aminotransferase and aspartate aminotransferase between the two groups(P<0.05).The patient’s age,course of disease,thickness of spleen,length of spleen,alanine aminotransferase and aspartate aminotransferase as well as liver pathological stage were positively correlated with LSM valus(P<0.05).The AUC,best cut-off value,sensitivity and specificity of LSM in diagnosis of fibrosis due to chronic liver disease were 0.762,10.08kpa,83.3%,and 71.2%,respectively.Conclusion The course of disease and age of patients with chronic liver disease are the risk factors affecting LSM value in 2D-SWE diagnosis,and 2D-SWE has higher diagnostic value in the fibrosis stage.