2D-SWE、FIB-4指数联合肝脏生化指标在乙型肝炎肝硬化患者中的应用价值

Application value of 2D-SWE,FIB-4 index combined with liver biochemical indexes in the evaluation of patients with hepatitis B virus cirrhosis

目的探讨二维剪切波弹性成像(2D-SWE)、肝纤维化4因子指数(FIB-4)联合肝脏生化指标在乙型肝炎肝硬化患者肝纤维化程度评价中的应用价值。方法选取2018年1—12月潮州市人民医院感染科接诊的乙型肝炎肝硬化患者共72例,分为代偿组(n=34例)和失代偿组(n=38例),予抗病毒治疗,随访6个月,观察比较谷丙转氨酶(ALT)、谷草转氨酶(AST)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)、2D-SWE肝硬度值和FIB-4指数的变化。结果治疗前失代偿组患者血清ALT、AST、HA、PCⅢ、LN明显高于代偿组,差异有统计学意义(P<0.05);治疗后两组患者的ALT、AST、HA、PCⅢ、LN均较治疗前明显下降,差异有统计学意义(P<0.05);治疗前失代偿组2D-SWE肝硬度值高于代偿组,差异有统计学意义(P<0.05),而两组FIB-4指数比较差异无统计学意义(P>0.05);治疗后两组患者2D-SWE肝硬度和FIB-4指数均较治疗前下降,差异有统计学意义(P<0.05)。结论2D-SWE、FIB-4指数联合常规生化指标可更好地评价乙型肝炎肝硬化患者肝纤维化程度,值得在临床推广应用。

Objective To investigate the application value of two-dimensional shear wave elastography(2D-SWE),fibrosis index based on 4 factors(FIB-4)combined with liver biochemical indexes in the evaluation of liver fibrosis in patients with hepatitis B virus(HBV)cirrhosis.Methods A total of 72 patients with HBV cirrhosis admitted to the Department of Infectious Diseases,Chaozhou People’s Hospital from January to December 2018 were selected and divided into the compensation group(n=34)and the decompensation group(n=38).They were given antiviral treatment and followed up for 6 months.Changes in alanine aminotransferase(ALT),aspartate aminotransferase(AST),hyaluronic acid(HA),typeⅢprocollagen(PCⅢ),laminin(LN),liver stiffness measurement(LSM)by 2D-SWE and FIB-4 index were observed and compared between the two groups.Results Before treatment,the serum ALT,AST,HA,PCⅢ,LN of the decompensation group were significantly higher than those of the compensation group,with statistically significant differences(P<0.05).After treatment,the ALT,AST,HA,PCⅢand LN of the two groups were significantly lower than before treatment,with statistically significant differences(P<0.05).Before treatment,the LSM by 2D-SWE of the decompensation group was higher than that of the compensation group,with statistically significant difference(P<0.05).The difference in FIB-4 index between the two groups was not statistically significant(P>0.05).After treatment,the LSM by 2D-SWE and FIB-4 index of the two groups were lower than before treatment,with statistically significant differences(P<0.05).Conclusion 2D-SWE,FIB-4 index combined with conventional biochemical indexes can better evaluate the degree of liver fibrosis in patients with HBV cirrhosis,and it is worthy of clinical application.