肝脏瞬时弹性超声成像评估慢性乙型肝炎患者肝纤维化的应用价值

The application value of hepatic fibrosis in patients with chronic hepatitis B by transient elastography

目的评估肝脏瞬时弹性超声成像在慢性乙型肝炎患者肝纤维化诊断中的价值。方法收集福建医科大学附属泉州第一医院2018年8月至2020年12月收治的慢性乙型肝炎患者152例,所有患者均进行肝脏瞬时弹性超声成像检查并于2周内进行经皮肝脏穿刺活检术。记录经皮肝脏穿刺活检病理结果及肝脏瞬时弹性超声成像测量的肝脏硬度值(LSM),通过Spearman秩相关系数法分析LSM与肝纤维化的相关性,并利用受试者工作特征曲线(ROC)分析肝脏瞬时弹性超声对肝纤维化病理分期的诊断价值。结果①152例患者中,肝脏穿刺活检病理结果为,S0期3例、S1期57例、S2期49例、S3期34例、S4期9例。肝脏瞬时弹性超声成像检测结果显示,LSM≤7.3 kPa 70例、LSM 7.4~9.7 kPa 37例、LSM 9.8~12.4 kPa 28例、LSM 12.5~17.5 kPa 12例、LSM≥17.6 kPa 5例。②以肝脏穿刺活检病理结果为金标准,Spearman等级相关性分析提示LSM与肝纤维化呈正相关,随着肝纤维化的加重,LSM逐渐升高(r=0.539,P=0.000)。③肝脏瞬时弹性超声成像检测≥S3期纤维化的曲线下面积(AUC)为0.814,灵敏度为88.7%,特异度为74.2%。结论肝脏瞬时弹性超声成像在评估慢性乙型肝炎患者肝纤维化的严重程度尤其是S3期以上的肝纤维化准确性较高,在诊断与疗效评估中具有较好的应用价值。

Objective To evaluate the value of hepatic fibrosis in patients with chronic hepatitis B by transient elastography.Methods A total of 152 patients with chronic hepatitis B admitted to and treated in Quanzhou First Hospital Affiliated to Fujian Medical University from August 2018 to December 2020 were collected.All patients underwent hepatic transient elastography and percutaneous liver biopsy within 2 weeks.The pathological results of percutaneous liver biopsy and the liver stiffness measurement(LSM)measured by transient elastography were recorded.The correlation between LSM and hepatic fibrosis was statistically analyzed by Spearman rank correlation coefficient method,and the diagnostic value of hepatic transient elastography in the pathological staging of liver was analyzed by receiver operating characteristic curve(ROC).Results(1)In 152 patients,the pathological results of liver biopsy were:3 cases of S0 stage,57 cases of S1 stage,49 cases of S2 stage,34 cases of S3 stage and 9 cases of S4 stage.The results of transient elastography of the liver showed that 70 cases were LSM≤7.3 kPa,37 cases were LSM 7.4-9.7 kPa,28 cases were LSM 9.8-12.4 kPa,12 cases were LSM 12.5-17.5 kPa,and 5 cases were LSM≥17.6 kPa.(2)Based on the pathological results of percutaneous liver biopsy as the gold standard,Spearman’s grade correlation analysis indicated that LSM had a positive correlation with hepatic fibrosis.With the aggravation of hepatic fibrosis,the LSM value gradually increased(r=0.539,P=0.000).(3)The area under the curve(AUC)of transient elastography in detecting≥S3 stage fibrosis was 0.814,the sensitivity was 88.7%,and the specificity was 74.2%.Conclusion Hepatic transient elastography has high accuracy in evaluating the severity of hepatic fibrosis in patients with chronic hepatitis B,especially in patients with hepatic fibrosis over the S3 stage.It has good application value in diagnosis and therapeutic efficacy evaluation.