瞬时弹性成像技术联合血清学标志物评估慢性乙型肝炎早期肝纤维化的应用研究

Application of transient elastography combined with serological markers to distinguish early hepatic fibrosis of chronic hepatitis B

目的探讨瞬时弹性成像(transient elastography,TE)技术联合血清学标志物评估慢性乙型肝炎(chronic hepatitis B,CHB)患者早期肝纤维化的临床应用价值。方法回顾性分析2020年1月至2022年11月浙江中医药大学附属杭州西溪医院收治的176例CHB患者的临床资料,将纳入患者分为训练组(n=123)和测试组(n=53),基于训练组数据通过最小绝对收缩和选择算子算法对临床特征进行筛选,使用多因素Logistic回归构建早期肝纤维化模型。使用测试组数据及受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)评估模型的性能,最终使用校准曲线和决策曲线分别评估模型的稳定性和临床效能。结果预测模型基于肝脏硬度、脂肪衰减指数、红细胞和谷草转氨酶构建,模型在训练组和测试组中的曲线下面积分别为0.824和0.819,敏感度分别为82.1%和80.6%,特异性分别为71.8%和68.8%。校准曲线在训练组和测试组中显示出良好的校准性能,无论在训练组还是测试组,决策曲线均显示模型良好的临床效能。结论TE技术联合血清学标志物的混合模型可为识别CHB患者早期肝纤维化提供一种潜在的新方法,有助于临床监测和治疗。

Objective To explore the clinical value of transient elastography(TE)combined with serological markers to distinguish early hepatic fibrosis of chronic hepatitis B(CHB).Methods Clinical data of 176 CHB patients admitted to Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from January 2020 to November 2022 were retrospectively analyzed,and the included patients were divided into training group(n=123)and test group(n=53).Based on the data of the training group,the clinical features were screened by the least absolute shrinkage and selection operator algorithm,and the early liver fibrosis model was constructed by multivariate Logistic regression.The performance of the model was evaluated using test group data and receiver operating characteristic(ROC)curve.Finally,the stability and clinical efficacy of the model were evaluated using calibration curve and decision curve,respectively.Results The prediction model was constructed based on liver stiffness measurement,fat attenuation index,red blood cells and glutamic-oxaloacetic transaminase.The area under the curve of the model in training group and test group was 0.824 and 0.819,the sensitivity was 82.1%and 80.6%,and the specificity was 71.8%and 68.8%,respectively.The calibration curve showed good calibration performance in training group and test group,and the decision curve showed good clinical efficacy of the model in training group and test group.Conclusion A hybrid model of TE technology combined with serological markers provides a potential new way to identify early liver fibrosis in patients with CHB,which could aid in clinical monitoring and treatment.