慢性乙型肝炎患者二维剪切波肝脏弹性成像定量和外周血ALP/PLT比值的变化研究

Correlation of liver Young's modulus by two-dimensional shear wave elastography and ALP/PLT ratio to liver fibrosis in patients with chronic hepatitis B

目的探讨慢性乙型肝炎(CHB)患者二维剪切波弹性成像(SWE)定量和外周血碱性磷酸酶(ALP)/血小板(PLT)比值变化及其与肝纤维化程度的关系。方法2019年5月~2022年5月内蒙古自治区人民医院诊治的CHB患者120例,均接受肝活检病理学检查,使用超声检测肝脏杨氏模量值,常规检测血清ALP水平和全血PLT计数。采用Spearman相关性分析法分析ALP/PLT比值和杨氏模量值与肝纤维化程度的相关性。结果在120例CHB患者中,经肝组织病理学检查,发现F0/F1期38例(31.7%),F2期32例(26.7%),F3期32例(26.7%)和F4期18例(15.0%);F4期CHB患者血清ALP、外周血PLT计数、ALP/PLT比值和杨氏模量值分别为(197.1±39.7)U/L、(114.2±35.1)×10^(9)/L、(1.7±0.3)和(11.7±1.7)kPa,显著不同于F3期【分别为(180.9±43.8)U/L、(137.1±38.6)×10^(9)/L、(1.3±0.4)和(8.6±1.5)kPa,P均<0.05】或F2期【分别为(162.7±41.1)U/L、(154.6±39.8)×10^(9)/L、(0.9±0.2)和(6.4±1.0)kPa,P均<0.05】或F0/F1期【分别为(150.5±36.4)U/L、(181.7±37.2)×10^(9)/L、(0.7±0.2)和(5.3±1.1)kPa,P均<0.05】;经Spearman相关性分析显示,杨氏模量值和ALP/PLT比值与肝纤维化分期均呈显著性正相关(r=0.79,P<0.05;r=0.75,P<0.05)。结论CHB患者肝脏超声杨氏模量值和ALP/PLT比值水平均与肝纤维化分期呈显著性正相关,或对诊断肝纤维化分期有帮助,值得进一步研究。

Objective The aim of this study was to explore the correlation of liver Young's modulus by two-dimensional shear wave elastography(SWE)and alkaline phosphatase(ALP)/platelet(PLT)ratio to liver fibrosis in patients with chronic hepatitis B(CHB).Methods 120 patients with CHB were admitted to the Provincial People's Hospital,Inner Mongolia Autonomous Region between May 2019 and May 2022,and all patients underwent liver biopsy.The liver Young's modulus was obtained by ultrasonography,and serum ALP and whole blood PLT counts were detected routinely.The correlation of ALP/PLT ratio and Young's modulus to liver fibrosis was determined by Spearman correlation analysis.Results Out of the 120 patients with CHB,the liver histopathological examination showed F0/F1 stage in 38 cases(31.7%),F2 stage in 32 cases(26.7%),F3 stage in 32 cases(26.7%)and F4 stage in 18 cases(15.0%);serum ALP,blood PLT counts,ALP/PLT ratio and Young's modulus in patients with F4 were(197.1±39.7)U/L,(114.2±35.1)×10^(9)/L,(1.7±0.3)and(11.7±1.7)kPa,all significantly different compared to[(180.9±43.8)U/L,(137.1±38.6)×10^(9)/L,(1.3±0.4)and(8.6±1.5)kPa,respectively,all P<0.05]in patients with F3 or[(162.7±41.1)U/L,(154.6±39.8)×10^(9)/L,(0.9±0.2)and(6.4±1.0)kPa,respectively,all P<0.05]in patients with F2 or[(150.5±36.4)U/L,(181.7±37.2)×10^(9)/L,(0.7±0.2)and(5.3±1.1)kPa,respectively,all P<0.05]in patients with F0/F1;the Spearman analysis showed that the Young's modulus and ALP/PLT ration in patients with CHB were positively correlated to liver fibrosis staging(r=0.79,P<0.05;r=0.75,P<0.05).Conclusion The Young's modulus and ALP/PLT ratio in patients with CHB are correlated to liver fibrosis,which might help predict the liver fibrosis staging and warrants further clinical investigation.