瞬时弹性成像技术在慢性乙型肝炎病毒感染者诊治过程中的评估作用

Transient elastography technology role assessment during the diagnosis and treatment of patients with chronic hepatitis B virus infection

目的探讨瞬时弹性成像技术在慢性乙型肝炎病毒(HBV)感染者的疾病分期及治疗过程中评估作用。方法收集北京清华长庚医院于2018年1月至2021年12月就诊,临床诊断为慢性HBV感染者,并行1次以上瞬时弹性成像检查获得肝脏硬度值(LSM)。计数资料以例(%)表示并进行χ^(2)检验,理论频数小于5,用Fisher’s检验。计量资料两组比较用t检验,多组比较方差分析。结果本研究纳入1055例患者,其中男性669例(63.4%),女性386例(36.6%)。757例(71.8%)为未治疗的患者。未治疗患者中免疫清除期的LSM为(10.2±3.8)kPa(187例,40.4%),再活动期(114例,24.6%)LSM为(9.1±3.4)kPa明显高于免疫耐受期的(8.7±3.6)kPa(78例,16.8%)和免疫控制期的(8.4±3.5)kPa(84例,18.1%),4组比较,F=5.31,P=0.03,差异有统计学意义。以ALT男性:30 U/L,女性:19 U/L来界定免疫耐受期和免疫控制期,其LSM分别为(5.8±0.9)kPa、(7.1±2.5)kPa,显著低于现用的ALT正常值界定的免疫耐受期和免疫控制期的患者LSM,P值均<0.01,差异均有统计学意义。不确定期患者294例(38.8%),除外合并脂肪肝的患者,不确定期的患者分为灰色区(GZ)的4组:免疫耐受期:LSM为(5.1±1.3)kPa明显低于GZ-A的(6.5±2.4)kPa,t=2.06,P=0.03,差异有统计学意义;免疫控制期:LSM为(5.6±1.5)kPa也低于GZ-C的(6.8±1.3)kPa,t=3.08,P=0.02,差异有统计学意义;免疫清除期:LSM>8.0 kPa。扩大适应证的患者开始抗病毒治疗随访3年LSM均呈逐年下降。结论ALT正常高值下降后界定的慢性HBV感染的免疫耐受期和免疫控制期患者的LSM显著下降,慢性HBV感染不确定期GZ-A、GZ-C患者LSM高于免疫耐受期和免疫控制期患者的LSM。

Objective To explore the role of transient elastography technology in the assessment of disease staging and treatment in patients with chronic hepatitis B virus(HBV)infection.Methods Patients who were clinically diagnosed with chronic HBV infection at Beijing Tsinghua Changgung Hospital from January 2018 to December 2021 was collected.Liver stiffness measurement(LSM)examination was performed more than once by transient elastography.The count data were expressed as cases(%)and theχ^(2) test was made.Fisher’s exact test was used with theoretical frequency less than 5.The measurement data between two groups was compared by t-test.Multiple groups were compared with an analysis of variance.Results 1055 patients were included in this study,including 669(63.4%)males and 386(36.6%)females.757(71.8%)patients were untreated.Among the untreated patients,the LSM value in the immune clearance(10.2±3.8)kPa(187 cases,40.4%),and the reactivation stages(9.1±3.4)kPa(114 cases,24.6%)was significantly higher than that in the immune tolerance(8.7±3.6)kPa(78 cases,16.8%)and immune control stages(8.4±3.5)KPa(84 cases,18.1%),and the difference between the four groups was statistically significant(F=5.31 and P=0.03).With ALT(male:30 U/L,female:19 U/L)as defined the normal value,the LSM value in the immune tolerance and the immune control stages were(5.8±0.9)kPa and(7.1±2.5)kPa,respectively,which were significantly lower than those of patients in the immune tolerance and immune control stages,and the difference was statistically significant(P<0.01).There were 294(38.8%)patients with uncertain period,excluding patients with fatty liver.Patients with uncertain periods were divided into four gray zone(GZ)groups:immune tolerance stage:LSM(5.1±1.3)kPa was significantly lower than GZ-A(6.5±2.4)kPa,t=2.06,P=0.03,and the difference was statistically significant;immune control stage:LSM was(5.6±1.5)kPa,which was also lower than GZ-C(6.8±1.3)kPa,t=3.08,P=0.02,and the difference was statistically significant;immune clearance stage:LSM>8.0 kPa.LSM values showed a year-by-year reduction in patients with expanded indications who started antiviral treatment and were followed up for three years.Conclusion The LSM value is significantly lower after the decrease of the defined high-normal ALT value in patients with the immune tolerance and immune control stages of chronic HBV infection.The LSM values of GZ-A and GZ-C in the uncertain periods of chronic HBV infection are higher than those of patients in the immune tolerance and immune control stages.