二维超声剪切波弹性成像和血清学指标评分诊断慢性乙肝患者肝纤维化的价值

Two-dimensinal shear wave elastography and serological scoring for diagnosis of hepatic fibrosis in patients with chronic hepa-titis B

目的探讨二维超声剪切波弹性成像(2D-SWE)与血清学评分诊断慢性乙肝患者肝纤维化的价值。方法回顾2020年12月至2022年7月义乌市中心医院75例慢性乙肝患者的临床资料,根据经肝穿刺活检病理检查结果的Metavir分期分为纤维化组44例(F2~4期)和无纤维化组31例(F0~1期)。采用2D-SWE测量肝脏硬度(LSM),比较两组患者性别、年龄、病程、病毒载量、血生化指标、血清学指标评分,采用单因素和多因素logistic回归筛选肝纤维化的预测因素,绘制ROC曲线分析各项指标诊断肝纤维化的效能。结果与无纤维化组患者比较,纤维化组患者年龄较大,病程较长,病毒载量、ALT、AST、ALP、γ-谷氨酰转肽酶(γ-GT)、TBil、Ⅲ型前胶原、Ⅳ型胶原、透明质酸和LSM水平均明显较高,而球蛋白和PLT均明显较低(均P<0.05)。多因素logistic回归显示,LSM(OR=2.656,95%CI:2.103~3.562,P<0.01)和Ⅲ型前胶原(OR=1.546,95%CI:1.124~1.968,P<0.05)是发生肝纤维化的预测因素。ROC曲线分析得出LSM和Ⅲ型前胶原诊断肝纤维化的AUC分别为0.801和0.746,最佳截断值分别为12.6 kPa和7.7 ng/mL,即LSM≥12.6 kPa或者Ⅲ型前胶原≥7.7 ng/mL均提示肝纤维化。4个血清学评分包括AST-血小板比值指数(APRI)、King评分、Forns指数和基于4个因素的纤维化指数(FIB-4)诊断肝纤维化的AUC分别为0.772、0.703、0.685、0.621。选择性诊断(LSM≥12.6 kPa或者Ⅲ型前胶原≥7.7 ng/mL)和联合诊断(LSM≥12.6 kPa且Ⅲ型前胶原≥7.7 ng/mL)的AUC分别为0.874和0.778。logistic回归模型(0.124+1.021×LSM+0.741×Ⅲ型前胶原)的AUC为0.886,显著高于4个血清学指标评分(均P<0.05),与单一指标诊断和LSM诊断肝纤维化的效能相当(P>0.05)。结论2D-SWE定量检测慢性乙肝患者LSM可作为无创诊断肝纤维化的新型指标,结合血清Ⅲ型前胶原的选择性诊断或者logistic回归模型的诊断效能可能优于4个血清学评分。

Objective To explore the clinical value of two-dimensional shear wave elastography(2D-SWE)and serological scoring for diagnosis of liver fibrosis secondary to chronic hepatitis B(HBV).Methods A total of 75 patients with HBV admitted in Yiwu Central Hospital from December 2020 to July 2022 were included in a retrospective study.Patients were divided into fibrosis group(stage F2-4,n=44)and non-fibrosis group(stage F0-1,n=31)according to the Metavir staging through pathological results after liver biopsy.The liver stiffness measurement(LSM)was measured by 2D-SWE,the gender,age,course of disease,viral load,blood biochemical indicators,and serological index scores were documented in two groups,and the risk factors of liver fibrosis were examined by univariate and multivariate logistic regression,the value of various indicators in diagnosis of liver fibrosis was analyzed with ROC curve.Results Age,course of disease,viral load,serum alanine transferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(γ-GT),total bilirubin,typeⅢprocollagen,typeⅣcollagen,hyaluronic acid and LSM in the fibrosis group were significantly increased compared with non-fibrosis group(all P<0.05),while globulin and platelet count significantly decreased(P<0.05).Multivariate logistic regression showed that LSM(OR=2.656,95%CI:2.103-3.562,P<0.01)and typeⅢprocollagen(OR=1.546,95%CI:1.124-1.968,P<0.05)were independent predictive factors for HBV liver fibrosis.The areas under ROC curve(AUC)of LSM and typeⅢprocollagen for liver fibrosis were 0.801 and 0.746,respectively.The cut-off values were 12.6 kPa and 7.7 ng/mL,respectively;LSM≥12.6 kPa or typeⅢprocollagen≥7.7 ng/mL suggested liver fibrosis.The AUC of four serological scoring including AST/platelet ratio index(APRI),King score,Forns index and fibrosis index based on four factors(FIB-4)were 0.772,0.703,0.685 and 0.621,respectively.The AUC of LSM≥12.6 kPa and typeⅢprocollagen≥7.7 ng/mL alone or in combination were 0.874 and 0.778,respectively.The AUC of logistic regression model(0.124+1.021×LSM+0.741×typeⅢprocollagen)was 0.886,which was significantly higher than that of 4 serological scoring methods(P<0.05).Conclusion The 2D-SWE quantitative detection of LSM in chronic hepatitis B patients can be used as a new index for noninvasive diagnosis of liver fibrosis,the diagnostic performance of LSM combined with serum typeⅢprocollagen or the logistic regression model may be better than 4 serological scoring methods.