肝脏超声弹性指标联合APRI、FIB-4、GP在自身免疫性肝炎合并肝硬化诊断中的价值

Value of liver ultrasonic elasticity index combined with APRI,FIB-4 and GP in the diagnosis of autoimmune hepatitis complicated with liver cirrhosis

目的探讨肝脏超声弹性指标联合天冬氨酸氨基转移酶/血小板比值指数(APRI)、基于4因子的肝纤维化指数(FIB-4)、球蛋白-血小板模型(GP)在自身免疫性肝炎合并肝硬化诊断中的价值。方法选取四川大学华西医院2020年1月至2022年1月治疗的自身免疫性肝炎合并肝硬化患者82例(观察组),同时选取自身免疫性肝炎患者90例作为对照(对照组),均行肝脏超声弹性检查,并计算患者的APRI、FIB-4、GP,比较两组剪切波速度(SWV)、肝脏硬度值(LSM)、应变率比值(SR)、APRI、FIB-4、GP等差异,同时分析自身免疫性肝炎不同肝纤维化程度、炎症程度患者间SWV、LSM、SR、APRI、FIB-4、GP等差异。采用受试者工作特征(ROC)曲线评估肝脏超声弹性指标、APRI、FIB-4、GP预测自身免疫性肝炎合并肝硬化的价值。结果观察组SWV、LSM、FIB-4和GP分别为(1.60±0.21)m/s、(13.98±1.82)kPa、(8.10±1.43)和(4.15±1.05),明显高于对照组(均P<0.05),而SR和APRI分别为(5.04±0.98)和(2.41±0.92),明显低于对照组(均P<0.05)。随着肝纤维化程度越重,自身免疫性肝炎患者SWV、LSM、FIB-4和GP水平越高(均P<0.05),而SR和APRI越低(均P<0.05)。自身免疫性肝炎G1~G2和G3~G4炎症程度患者SWV、LSM、SR、APRI、FIB-4、GP指标比较差异无统计学意义(均P>0.05)。将SWV、LSM、SR、APRI、FIB-4、GP纳入二元logistic回归分析,最终筛选出SWV、FIB-4与GP为诊断自身免疫性肝炎合并肝硬化的独立预测因子(均P<0.05)。SWV、FIB-4与GP联合预测自身免疫性肝炎合并肝硬化的ROC曲线下面积为0.931,明显高于其他指标(均P<0.05),预测灵敏度和特异度分别为95.00%和84.00%。结论肝脏超声弹性指标、APRI、FIB-4、GP与自身免疫性肝炎患者肝纤维化程度有关,SWV、FIB-4联合GP预测自身免疫性肝炎合并肝硬化有较高的应用价值。

Objective To investigate the value of liver ultrasonic elasticity index combined with aspartate aminotransferase to platelet ratio index(APRI),fibrosis index based on the four factors(FIB-4)and globulin platelet model(GP)in the diagnosis of autoimmune hepatitis complicated with liver cirrhosis.Methods From January 2020 to January 2022,82 patients with autoimmune hepatitis and cirrhosis treated in West China Hospital of Sichuan University were selected as observation group,and 90 patients with autoimmune hepatitis were selected as controls(control group).All of them underwent liver ultrasound elastic examination,and the APRI,FIB-4,GP of patients were calculated.The differences of shear wave velocity(SWV),liver hardness value(LSM),strain rate ratio(SR),APRI,FIB-4,GP between the two groups were compared.At the same time,the differences of SWV,LSM,SR,APRI,FIB-4 and GP among patients with autoimmune hepatitis with different degrees of liver fibrosis and inflammation were analyzed.The value of liver ultrasound elasticity index,APRI,FIB-4 and GP in predicting autoimmune hepatitis complicated with cirrhosis was evaluated by the receiver operating characteristic(ROC)curve.Results The SWV,LSM,FIB-4 and GP in the observation group were(1.60±0.21)m/s,(13.98±1.82)kPa,(8.10±1.43)and(4.15±1.05)respectively,which were significantly higher than those in the control group(all P<0.05),while SR and APRI were(5.04±0.98)and(2.41±0.92)respectively,which were significantly lower than those in the control group(all P<0.05).With the aggravation of liver fibrosis,the levels of SWV,LSM,FIB-4 and GP in patients with autoimmune hepatitis were higher(all P<0.05),while the SR and APRI were lower(all P<0.05).There was no statistically significant difference in SWV,LSM,SR,APRI,FIB-4 and GP between patients with G1-G2 and G3-G4 inflammatory degree of autoimmune hepatitis(all P>0.05).SWV,LSM,SR,APRI,FIB-4 and GP were included in the binary logistic regression analysis,and SWV,FIB-4 and GP were finally selected as independent predictors for diagnosis of autoimmune hepatitis with cirrhosis(all P<0.05).The area under the ROC curve of combined prediction of SWV,FIB-4 and GP for autoimmune hepatitis with cirrhosis was 0.931,which was significantly higher than other indicators(all P<0.05),and the sensitivity and specificity were 95.00%and 84.00%respectively.Conclusions Liver ultrasonic elasticity index,APRI,FIB-4 and GP are related to the degree of liver fibrosis in patients with autoimmune hepatitis.SWV,FIB-4 combined with GP have high application value in predicting autoimmune hepatitis complicated with liver cirrhosis.