应用肝脏硬度检测联合多普勒超声检测门静脉血流动力学指标评估慢性乙型肝炎患者肝纤维化效能研究

Concordance between liver biopsy,and the liver stiffness measurement and hemodynamic index combination for the diagnosis of hepatic fibrosis in patients with chronic hepatitis B

目的研究应用瞬时弹性成像技术行肝脏硬度检测(LSM)联合多普勒超声检测门静脉血流动力学指标评估慢性乙型肝炎(CHB)患者肝纤维化程度的效能。方法2018年12月~2022年10月我院收治的96例CHB患者和同期74例健康体检者,接受FibroTouch检测,获得LSM,和超声检测门静脉主干内径(PVD)、最大流速(Vmax)和平均流速(Vmean),CHB患者接受肝活检。绘制受试者工作特征曲线(ROC)评价指标诊断显著性肝纤维化的效能。结果CHB组LSM、PVD、Vmax和Vmean分别为(9.5±1.6)kPa、(12.7±2.1)mm、(35.4±3.1)cm/s和(29.8±2.8)cm/s,显著大于健康人【分别为(4.4±0.5)kPa、(10.7±1.6)mm、(26.1±2.5)cm/s和(21.7±2.2)cm/s,P<0.05】;经肝组织病理学检查,在96例CHB患者中,发现非显著性肝纤维化32例,显著性肝纤维化64例;显著性肝纤维化患者LSM和PVD分别为(14.5±2.6)kPa和(13.3±2.3)mm,显著大于非显著性肝纤维化患者【分别为(5.8±0.8)kPa和(11.2±1.8)mm,P<0.05】,而Vmax和Vmean分别为(29.1±2.6)cm/s和(24.2±1.9)cm/s,显著低于非显著性肝纤维化患者【分别为(36.9±3.8)cm/s和(30.6±2.7)cm/s,P<0.05】;经ROC曲线分析显示,分别以LSM为9.5 kPa和PVD为12.0 mm为截断点,两者联合诊断显著性肝纤维化的敏感度为90.1%,特异度为77.4%,显著优于两指标单独检测诊断(P<0.05)。结论使用FibroTouch检测的LSM联合超声检测的PVD诊断CHB患者显著性肝纤维化具有较高的效能,值得临床进一步验证。

Objective The aim of this study was to explore the evaluation of liver fibrosis by liver stiffness measurement(LSM)and portal vein hemodynamic index combination in patients with chronic hepatitis B(CHB).Methods A total of 96 patients with CHB confirmed by liver biopsy and 74 healthy individuals were enrolled in our hospital between December 2018 and October 2022,the LSM was detected by FibroTouch scan and the portal vein diameter(PVD),maximum flow velocity(Vmax)and average flow velocity(Vmean)of portal veins were detected by ultrasonography.The diagnostic performance was evaluated by the receiver operating characteristic(ROC)curves.Results The LSM,PVD,Vmax and Vmean in patients with CHB were(9.5±1.6)kPa,(12.7±2.1)mm,(35.4±3.1)cm/s and(29.8±2.8)cm/s,all significantly greater than[(4.4±0.5)kPa,(10.7±1.6)mm,(26.1±2.5)cm/s and(21.7±2.2)cm/s,respectively,P<0.05]in healthy persons;the liver histopathological examination showed non-significant liver fibrosis in 32 cases and significant liver fibrosis in 64 cases in our series;the LSM and the PVD in patients with significant liver fibrosis were(14.5±2.6)kPa and(13.3±2.3)mm,both significantly greater than[(5.8±0.8)kPa and(11.2±1.8)mm,respectively,P<0.05],while the Vmax and Vmean of portal vein blood flow were(29.1±2.6)cm/s and(24.2±1.9)cm/s,both significantly slower than[(36.9±3.8)cm/s and(30.6±2.7)cm/s,respectively,P<0.05]in those without significant liver fibrosis;the ROC analysis showed that the diagnostic efficacy was superior to LSM or PVD alone prediction,with the sensitivity of 90.1% and the specificity of 77.4%,when the two parameters were combined to assess the significant liver fibrosis in patients with CHB,with the LSM equal to 9.5 kPa and the PVD equal to 12.0 mm as the cut-off-value(P<0.05).Conclusion The validation of combination of LSM by FibroTouch and PVD by ultrasonography in assessing significant liver fibrosis in patients with CHB might be helpful in clinical practice.