肝脏剪切波弹性成像联合GGT/PLT比值诊断慢性乙型肝炎患者肝纤维化价值研究

Early diagnosis of significant liver fibrosis by liver shear wave elastography and GGT/PLT ratio in patients with chronic hepatitis B

目的 探讨肝脏超声剪切波弹性成像(SWE)联合γ-谷氨酰转肽酶(GGT)/血小板(PLT)比值(GPR)诊断慢性乙型肝炎(CHB)患者肝纤维化的效能。方法 2021年2月~2022年12月我院收治的CHB患者130例,均接受肝穿刺活组织检查。使用超声检测肝脏杨氏模量值,常规检测血清GGT和全血PLT计数,计算GGT/PLT比值。采用Kappa检验分析各诊断方法与病理学诊断CHB患者肝纤维化结果的一致性,应用受试者工作特征曲线下面积(AUROCs)评估各指标诊断CHB患者肝纤维化的效能。结果 在130例CHB患者中,经肝组织学检查,诊断F0、F1、F2、F3和F4期肝纤维化分别93例、14例、8例、12例和3例,其中显著性肝纤维化23例;F3期肝纤维化患者GGT/PLT比值和杨氏模量值分别为0.5(0.4,0.7)和(10.4±1.5)kPa, F2期分别为0.4(0.3,0.6)和(8.9±1.6)kPa,均显著大于F1期[分别为0.4(0.3,0.5)和(7.3±1.2)kPa,P<0.05];经AUROCs分析结果显示,GGT/PLT比值、杨氏模量值或两者联合诊断CHB患者肝纤维化与组织病理学诊断结果一致性较好(Kappa=0.42,Kappa=0.50和Kappa=0.63,P<0.05);应用GGT/PLT比值联合杨氏模量值诊断CHB患者显著性肝纤维化的AUC为0.83(95%CI:0.76~0.94),其灵敏度和特异度分别为83.8%和83.9%,显著优于两指标单一诊断(P<0.05)。结论 应用GGT/PLT比值和SWE检测辅助诊断CHB患者肝纤维化有一定的临床价值,值得进一步探讨。

Objective The aim of this study was to investigate the diagnostic efficacy of significant liver fibrosis(SLF)by two-dimensional shear wave elastography(SWE)andγ-glutamyltransferase(GGT)/platelet(PLT)ratio(GPR)in patients with chronic hepatitis B(CHB).Methods 130 patients with CHB were encountered in our hospital between February 2021 and December 2022,and all underwent liver biopsy.The Young's modulus of livers was detected by SWE of ultrasonography,serum GGT levels and whole blood PLT counts were detected routinely,and the GPR was calculated.The consistency between the Young's modulus and GPR and the pathological diagnosis was evaluated by Kappa test,and the diagnostic efficacy was assessed by the area under the receiver operating characteristic curve(AUROCs).Results Out of the 130 patients with CHB,the liver histopathological examination showed F0,F1,F2,F3 and F4 in 93 cases,14 cases,8 cases,12 cases and 3 cases,with SLF in 23 cases;the GPR and the Young's modulus in patients with stage F3 liver fibrosis were 0.5(0.4,0.7)and(10.4±1.5)kPa,and in patients with F2 were 0.4(0.3,0.6)and(8.9±1.6)kPa,all significantly greater than[0.4(0.3,0.5)and(7.3±1.2)kPa,respectively,P<0.05]in patients with F1;the AUROCs analysis showed the good consistency between the Young's modulus,GPR or the combination of the two parameters,and the pathological diagnosis(Kappa=0.42,Kappa=0.50 and Kappa=0.63,respectively,P<0.05);the AUC was 0.83(95%CI:0.76-0.94),with the sensitivity and the specificity of 83.8%and 83.9%by the combination of GPR and Young's modulus in predicting SLF in patients with CHB,much superior to that by any one of the two alone(P<0.05).Conclusion The GPR and the SWE by ultrasonography might be applied to predict the SLF in patients with CHB clinically,and warrants further investigation.