Wilson病患者肝脏B超单点剪切波弹性成像与肝纤维化血清学指标及无创诊断评分模型的相关性分析

Analysis of the correlation between liver B-ultrasound single point shear wave elastography and serological indexes of liver fibrosis and noninvasive diagnostic score model in patients with Wilson's disease

目的研究在辅助诊断Wilson病(WD)患者肝纤维化中肝脏B超单点剪切波弹性成像(pSWE)值与肝纤维化血清学指标及肝纤维化无创诊断评分模型得分的相关性。方法选择2020年8月—2021年5月在本院住院的WD患者127例为研究对象,按照仪器厂家提供的pSWE值评判肝纤维化的标准将WD患者分为肝纤维化(0-1.34 m/s)无/轻度组、肝纤维化(1.34-2.20 m/s)中度组和肝纤维化(>2.20 m/s)重度组三组,无/轻度组42例、中度组42例、重度组43例。检测三组患者肝脏B超pSWE值、血清肝功能指标(TBA、TBIL、AST、ALT、GGT、ALB)、肝纤维化血清学指标[透明质酸(HA)、层黏蛋白(LN)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原N端肽(PⅢNP)]、PT、PLT并计算无创诊断评分模型得分[天冬氨酸氨基转移酶和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)、γ-谷氨酰转肽酶和血小板比值(GPR)及Sheth指数],与pSWE值作对照研究和统计学分析。结果肝纤维化重度组WD患者与无/轻度组及中度组比较,指标TBA、TBIL、AST、GGT、PT、HA、LN、CⅣ、PⅢNP、APRI、FIB-4及GPR均显著增加,ALB显著减少,差异有统计学意义(P<0.05);PLT在肝纤维化无/轻度组与中度组、重度组比较,差异有统计学意义(P<0.05);但中、重度组之间差异无统计学意义(P>0.05);ALT在肝纤维化无/轻度组与中度组之间差异无统计学意义(P>0.05),但中、重度组之间差异有统计学意义(P<0.05);三组WD患者的Sheth指数差异无统计学意义(P>0.05);pSWE值与TBA、TBIL、AST、ALT、GGT、PT、HA、LN、CⅣ、PⅢNP、APRI、FIB-4、GPR呈显著正相关(P<0.01),与ALB、PLT呈显著负相关(P<0.01);pSWE值与CⅣ(r=0.730)相关性最高,其次为GPR(r=0.710)。结论WD患者肝脏B超pSWE值与肝纤维化血清学指标及肝纤维化无创诊断评分模型(APRI、FIB-4、GPR)均具有显著相关性;三者联合用于评价WD患者肝纤维化过程具有较高价值,有利于WD患者肝纤维化筛查,避免因患者拒绝肝活检而漏诊,防止WD患者严重肝病的发生。

Objective To study the correlation between the value of point shear wave elastography(pSWE)of liver B-ultrasound and the serological indexes of liver fibrosis and the score of noninvasive diagnostic scoring model of liver fibrosis,which is used in the auxiliary diagnosis of liver fibrosis in patients with Wilson's disease(WD).Methods From August 2020 to May 2021,127 patients with WD who were hospitalized in the hospital were enrolled as study objects.According to the pSWE value standard for judging the degree of liver fibrosis provided by the manufacturer,the objects were divided into non/mild fibrosis group(0-1.34 m/s,n=42),moderate fibrosis group(1.34-2.20 m/s,n=42)and severe fibrosis group(>2.20 m/s,n=43).Detected and compared the pSWE value,serum liver function index(TBA、TBIL、AST、ALT、GGT and ALB),the serological indexes of liver fibrosis[hyaluronic acid(HA),laminin(LN),collagenⅣ(CⅣ),N-terminal propeptide of typeⅢprocollagen(PⅢNP)],PT,PLT and to calculate the score of noninvasive diagnostic score model of liver fibrosis[aspartate aminotransferase to platelet ratio index(APRI),fibrosis 4 score(FIB-4),γ-glutamyl transpeptidase to platelet ratio(GPR)and Sheth index]of the three groups.Results TBA,TBIL,AST,ALT,GGT,PT,HA,LN,CⅣ,PⅢNP,APRI,FIB-4 and GPR in WD severe fibrosis group were significantly higher than those in non/mild fibrosis group and moderate fibrosis group,and ALB was significantly lower than those in the two groups(P<0.05).There was statistical significance in PLT among the non/mild group,the moderate group and the severe group(P<0.05),however,there was no significant difference between moderate and severe groups(P>0.05).There was no significant difference in ALT between the non/mild group and the moderate group(P>0.05),but there was significant difference between the moderate and severe groups(P<0.05).There was no significant difference in Sheth index among the three groups(P>0.05).The pSWE value was positively correlated with TBA、TBIL、AST、ALT、GGT、PT、HA、LN、CⅣ、PⅢNP、APRI、FIB-4、GPR(P<0.01),and negatively correlated with ALB and PLT(P<0.01);and had the highest correlation with CⅣ(r=0.73),followed by GPR(r=0.71).Conclusions There are significant correlation between liver B-ultrasound pSWE value and serum liver fibrosis index and liver fibrosis noninvasive diagnostic score model(APRI,FIB-4 and GPR)in WD patients.The combination of them has high value in evaluating the process of liver fibrosis in WD patients,which is conducive to the screening of liver fibrosis and the prevention of severe liver disease.