声触诊弹性成像检测肝脾硬度诊断慢性乙型肝炎患者肝纤维化效能分析

Noninvasive assessment of liver fibrosis via liver and spleen stiffness measurement using acoustic palpation elastography in patients with chronic hepatitis B

目的探讨应用声触诊弹性成像(APE)行肝脏硬度检测(LSM)和脾脏硬度检测(SSM)诊断慢性乙型肝炎(CHB)患者肝纤维化的效能。方法2020年1月~2021年10月我院诊治的CHB患者392例,行肝穿刺组织病理学检查,将≤F1期为非显著性肝纤维化,≥F2期为显著性肝纤维化,F4期为早期肝硬化。使用超声APE计数获得LSM和SSM。计算天冬氨酸氨基转移酶/血小板比值(APRI)、基于4因子指数(FIB-4)和King’s指数。应用受试者工作特征曲线下面积(AUC)评估各项指标诊断肝纤维化的效能。结果在392例CHB患者中,组织病理学检查发现F0期45例、F1期112例、F2期105例、F3期70例和F4期60例,即非显著肝纤维化157例,显著肝纤维化235例;显著肝纤维化患者LSM、SSM、APRI、FIB-4和King’s score分别为(13.4±2.0)kPa、(23.3±4.0)kPa、(2.2±0.4)、(1.8±0.4)和(23.4±7.9)分,显著大于非显著性肝纤维化组[【分别为(9.3±1.7)kPa、(15.0±3.6)kPa、(1.0±0.2)、(0.9±0.2)和(10.4±6.9)分,P<0.05】;多因素Logistic回归分析显示,LSM、SSM、APRI、FIB-4和King’s score均是影响肝纤维化发生的独立因素(P<0.05);LSM联合SSM诊断显著性肝纤维化的敏感度、特异度和准确度分别为79.6%、83.0%和81.6%,诊断早期肝硬化的敏感度、特异度和准确度分别为92.8%、90.0%和92.3%。结论应用APE检测CHB患者LSM和SSM可有效评价肝纤维化程度,作为无创诊断手段,值得进一步研究。

Objective The aim of this study was to investigate the noninvasive assessment of liver fibrosis(LF)via liver(LSM)and spleen stiffness measurement(SSM)using acoustic palpation elastography(APE)in patients with chronic hepatitis B(CHB).Methods A total of 392 patients with CHB were encountered in our hospital between January 2020 and October 2021,and all underwent liver biopsies.The LF was defined by METAVIR’s score,and was divided into non-significant(less than F1)and significant(equal to or greater than F2).The LSM and SSM were obtained by using APE.The aspartate aminotransferase to platelet ratio index(APRI),FIB-4 and King’s score were calculated.The diagnostic efficacy was evaluated by the the area under receiver operating characteristic curve(AUC).Results Out of the 392 patients with CHB,the histopathological examination showed F0 in 45 cases,F1 in 112 cases(non-significant LF in 157 cases),F2 in 105 cases,F3 in 70 cases and F4(early cirrhosis)in 60 cases(significant LF in 235 cases);the LSM,SSM,APRI,FIB-4 and King’s score in patients with significant LF were(13.4±2.0)kPa,(23.3±4.0)kPa,(2.2±0.4),(1.8±0.4)and(23.4±7.9),significantly greater than[(9.3±1.7)kPa,(15.0±3.6)kPa,(1.0±0.2),(0.9±0.2)and(10.4±6.9),respectively,P<0.05]in patients with non-significant LF;the multivariate Logistic regression analysis showed that the LSM,SSM,APRI,FIB-4 and King’s score were all the independent factors impacting LF in patients with CHB(P<0.05);the sensitivity,specificity and accuracy of LSM and SSM combination in predicting significant LF were 79.6%,83.0%and 81.6%,and in predicting early liver cirrhosis were 92.8%,90.0%and 92.3%.Conclusion The application LSM and SSM by using APE in predicting the degree of liver fibrosis in patients with CHB is efficacious,which is worthy of further clinical investigation.