超声弹性成像检测肝脏、脾脏硬度值与血清肝纤维化指标对慢性乙型肝炎患者肝纤维化的评价

Evaluation of liver fibrosis in patients with chronic hepatitis B by detecting liver and spleen stiffness measurement based on ultrasonic elastography and serum liver fibrosis index

目的评估超声弹性成像(UE)检测肝脏、脾脏硬度值及血清肝纤维化指标(APRI、FIB-4、和King′s评分)对慢性乙型肝炎(CHB)患者肝纤维化程度的表现。方法选取2018年10月至—2021年08月周口市中心医院收治的98例CHB患者为研究对象,男性51例,女性47例,年龄(35.3±7.8)岁。应用UE检测每例招募患者的肝脏硬度值(LSM)和脾脏硬度值(SSM),同时完成UE检查后均接受超声引导下肝活检。结果UE测量成功率为100%,数据可靠。男性AST、LSM和SSM为(86.0±23.1)U/L、(10.6±3.4)kPa和(18.1±4.7)kPa,均显著高于女性[(71.4±19.3)U/L、(8.7±2.7)kPa和(15.5±5.4)kPa,P<0.05];男性年龄和GGT为(34.7±6.4)岁、(70.6±29.3)U/L,与女性[(37.0±6.8)岁、(88.2±34.5)U/L],差异具有统计学意义(P<0.05)。随着肝纤维化程度的增加,LSM、SSM、APRI、FIB-4及King′s评分均显著性增加(P<0.05)。在评估≥S2期肝纤维化时,LSM、SSM诊断AUC值均分别显著高于APRI、FIB-4及King′s评分(P<0.05)。LSM诊断≥S2期肝纤维化时,AUC、截断点、敏感度及特异度分别为0.82、7.8 kPa、77.4%及92.5%;SSM诊断≥S2期肝纤维化时AUC、截断点、敏感度及特异度分别为0.85、8.7 kPa、80.6%及94.0%。结论相较于APRI、FIB-4、和King’s评分,通过UE检测LSM、SSM对CHB肝纤维化分期的诊断效能最为理想。

Objective To assess liver fibrosis in patients with chronic hepatitis B(CHB)by liver and spleen stiffness measurement based on ultrasonic elastography(UE),and serum liver fibrosis indexes(APRI,FIB-4,and King′s score).Methods A total of 98 CHB patients were selected as the research subjects from October 2018 to August 2021.The participants included 51 males and 47 females,with an age of(35.3±7.8)years.UE was used to measure liver hardness(LSM)and spleen hardness(SSM)in each patient.Additionally,all patients underwent ultrasound-guided liver biopsy after the UE examination.Results The success rate of UE measurement was 100%,and the data was reliable.The AST,LSM and SSM of male were(86.0±23.1)U/L,(10.6±3.4)kPa and(18.1±4.7)kPa,which were significantly higher than those of female[(71.4±19.3)U/L,(8.7±2.7)kPa and(15.5±5.4)kPa,P<0.05].The age and GGT of males were(34.7±6.4)years and(70.6±29.3)U/L,respectively,which were significantly different from those of females((37.0±6.8)years and(88.2±34.5)U/L)(P<0.05).With the increase of liver fibrosis,LSM,SSM,APRI,FIB-4 and King′s scores increased significantly(P<0.05).The AUC values of LSM and SSM were significantly higher compared to APRI,FIB-4 and King′s scores(P<0.05)when evaluating≥S2 hepatic fibrosis.The AUC,cut-off point,sensitivity and specificity of LSM in diagnosing≥S2 hepatic fibrosis were 0.82,7.8 kPa,77.4%and 92.5%,respectively.The AUC,cut-off point,sensitivity and specificity of SSM in diagnosis of≥S2 hepatic fibrosis were 0.85,8.7 kPa,80.6%and 94.0%,respectively.Conclusion Compared to APRI,FIB-4,and King′s scores,LSM and SSM detected by UE exhibit superior diagnostic efficiency for CHB liver fibrosis staging.