声触诊弹性成像联合APRI对慢性乙型肝炎肝纤维化的评估价值

Evaluation value of sound touch elastography combined with APRI for liver fibrosis in patients with chronic hepatitis B

目的:探讨声触诊弹性成像(sound touch elastography,STE)联合天冬氨酸转氨酶(aspartate aminotransferase,AST)/血小板比率指数(AST-to-platelet ratio index,APRI)对慢性乙型肝炎(chronic hepatitis B,CHB)患者肝纤维化的评估价值。方法:选取2019年1月至2021年8月在海南医学院第二附属医院就诊的96例CHB患者。患者均完成STE检查(获得弹性模量值),并完成肝功能生化指标[包括AST、血小板计数(platelet count,PLT)]的测定,计算APRI。以肝组织病理学检查结果为金标准,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价各指标对肝纤维化的评估效能。结果:随着肝纤维化程度加重,患者弹性模量值和血清APRI逐渐增大,差异有统计学意义(P<0.05)。Spearman相关性分析显示:弹性模量值与肝纤维病理分期呈正相关(r=0.589,P<0.001),APRI也与肝纤维病理分期呈正相关(r=0.410,P<0.001)。STE弹性模量值诊断肝纤维化≥S2、≥S3及S4期的曲线下面积(area under the curve,AUC)分别为0.852、0.954、0.959,APRI诊断的AUC分别为0.887、0.928、0.935,二者联合诊断的AUC分别为0.918、0.974、0.984。结论:STE和血清APRI对CHB患者肝纤维化有较高评估价值,且二者联合应用可提高诊断效能。

Objective:To investigate the evaluation value of sound touch elastography(STE)combined with aspartate aminotransferase(AST)-to-platelet ratio index(APRI)on liver fibrosis in patients with chronic hepatitis B(CHB).Methods:A total of 96 CHB patients admitted to Second Affiliated Hospital of Hainan Medical College from January 2019 to August 2021 were selected.All patients completed STE examination(elastic modulus value),and the determination of biochemical indexes of liver function[including AST and platelet count(PLT)],then calculated APRI.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each index on liver fibrosis with the results of liver histopathology as the gold standard.Results:With the aggravation of liver fibrosis,the elastic modulus and serum APRI of patients gradually increased,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that the elastic modulus was positively correlated with the pathological stage of liver fiber(r=0.589,P<0.001),and APRI was also positively correlated with the pathological stage of liver fiber(r=0.410,P<0.001).The area under the curve(AUC)of STE elastic modulus in the diagnosis of liver fibrosis≥S2,≥S3,and S4 were 0.852,0.954,and 0.959,respectively.The AUC of APRI were 0.887,0.928,and 0.935,respectively.The AUC of combined diagnosis were 0.918,0.974,and 0.984.Conclusion:STE and serum APRI have high evaluation value for liver fibrosis in CHB patients,and the combination of the two can improve the diagnostic efficacy.