基于磁共振和血清学指标的肝纤维化诊断模型的建立与评估

Establishment and evaluation of liver fibrosis diagnosis model based on MRI and serological markers

目的检测慢性乙型肝炎患者血清学指标水平,同时对其进行磁共振检查,构建肝纤维化诊断模型并评估模型的诊断价值。方法选取2018年1月至2020年6月抚顺市中心医院收治的267例慢性乙型肝炎患者为研究对象。采用磁共振体素内不相干运动(IVIM)成像测定表观弥散系数(ADC),并检测血清学相关指标;采用Pearson法分析Frons指数、天冬氨酸转氨酶/血小板比值指数(APRI)、基于4因子的纤维化指数(Fib-4)、红细胞体积分布宽度/血小板比值指数(RPR)、ADC间的相关性;采用logistic回归分析建立新的肝纤维化诊断模型;采用受试者工作特征(ROC)曲线分析肝纤维化诊断模型的诊断价值。结果267例慢性乙型肝炎患者经病理检查显示,F0期35例、F1期47例、F2期58例、F3期66例、F4期61例,其中轻度肝纤维化期(F0~F1期)、中度肝纤维化期(F2~F3期)、重度肝纤维化期(F4期)患者PLT、ALT、GGT、AST、PTA、CⅣ、LN、HA、PCⅢ、Frons指数、APRI、Fib-4、RPR、ADC比较差异均有统计学意义(均P<0.05)。经Pearson法分析显示,Frons指数、APRI、Fib-4、RPR、ADC之间均具有相关性,且均呈正相关(P<0.05)。通过将logistic概率预测模型(PRE)与Frons指数、APRI、Fib-4、RPR对慢性乙型肝炎肝纤维化的诊断价值进行比较显示,Frons指数、Fib-4、APRI诊断中度肝纤维化的曲线下面积(AUC)高于轻度和重度肝纤维化,AUC分别为0.903、0.928、0.957;RPR诊断轻度和中度肝纤维化的AUC较高,均为0.861,而PRE对轻度、中度、重度肝纤维化诊断的AUC分别为0.860、0.861、0.865,其灵敏度分别为64.6%、76.6%、73.8%,特异度分别为96.3%、89.5%、95.1%,均具有较高的价值。结论Frons指数、APRI、Fib-4、RPR、PRE肝纤维化诊断模型均有一定的诊断价值,其中以磁共振和血清学指标联合预测的肝纤维化诊断模型的综合效能最好,临床应根据实际情况选择最佳的诊断方案。

Objective To detect the level of serological indexes in patients with chronic hepatitis B and carry out magnetic resonance imaging(MRI)examination at the same time,so as to construct a diagnostic model for liver fibrosis and evaluate its diagnostic value.Methods A total of 267 patients with chronic hepatitis B in Fushun Central Hospital from January 2018 to June 2020 were selected as the research objects.The apparent diffusion coefficient(ADC)was measured by introvoxel incoherent motion(IVIM)magnetic resonance imaging,and the related serological indexes were detected;Pearson method was used to analyze the correlation among Frons index,aspartate aminotransferase to platelet ratio index(APRI),fibrosis index based on the 4 factor(Fib-4),red blood cell volume distribution width to platelet ratio(RPR)and ADC;Logistic regression analysis was used to establish a new diagnosis model of hepatic fibrosis;receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of liver fibrosis model.Results The pathological examination of 267 patients with chronic hepatitis B showed that there were 35 cases in F0 stage,47 cases in F1 stage,58 cases in F2 stage,66 cases in F3 stage and 61 cases in F4 stage.There were significant differences in platelet(PLT),alanine aminotransferase(ALT),gamma glutamyl transferase(GGT),aspartate aminotransferase(AST),prothrombin activity(PTA),collagenⅣ(CⅣ),laminin(LN),hyaluronic acid(HA),precollagenⅢ(PCⅢ),Frons index,aspartate aminotransferase to platelet ratio index(APRI),fibrosis index based on the 4 factor(Fib-4),red blood cell volume distribution width to platelet ratio(RPR)and ADC in patients with mild liver fibrosis(F0-F1),moderate liver fibrosis(F2-F3)and severe liver fibrosis(F4)(P<0.05).Pearson analysis showed that Frons index,APRI,Fib-4,RPR and ADC were positively correlated(P<0.05).The comparison of value of logistic probability risk estimating(PRE)and Frons index,APRI,Fib-4,RPR in the diagnosis of chronic hepatitis B liver fibrosis showed that the area under the curve(AUC)of Frons index,Fib-4 and APRI in the diagnosis of moderate liver fibrosis were higher than that of mild and severe liver fibrosis,with AUC of 0.903,0.928 and 0.957,respectively;the AUC of RPR in the diagnosis of mild and moderate hepatic fibrosis was higher(0.861);the AUC of PRE in the diagnosis of mild,moderate and severe liver fibrosis was 0.860,0.861 and 0.865,respectively;the sensitivity was 64.6%,76.6%,73.8%,and the specificity was 96.3%,89.5%and 95.1%,respectively.Conclusions Frons index,APRI,Fib-4,RPR and PRE liver fibrosis diagnostic models have certain diagnostic value.Among them,the liver fibrosis diagnostic model predicted by MRI and serological indexes has the best comprehensive efficiency.The best diagnostic scheme should be selected according to the actual situation.