瞬时弹性成像技术下肝脏硬度值联合血清肝纤维化标志物在肝功能轻度异常慢性乙型肝炎患者中的应用研究

Application of liver stiffness measurement by transient elastography combined with serum liver fibrosis markers in patients with mild liver dysfunction and chronic hepatitis B

目的探讨瞬时弹性成像技术(Fibro Touch)下肝脏硬度值(LSM)联合血清肝纤维化标志物在肝功能轻度异常慢性乙型肝炎(CHB)患者中的应用。方法选取2019年1月至2022年1月上饶市第二人民医院收治的82例肝功能轻度异常CHB患者作为研究对象,以肝脏穿刺活检为金标准,对患者进行纤维化分期,分为无肝纤维化组(S0期,n=16)、早期肝纤维化组(S1、S2期,n=33)、进展性肝纤维化组(S3、S4期,n=33)。采用Fibro Touch检测患者LSM,并测定肝功能指标[血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)]及血清肝纤维化标志物[透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(CⅣ)],绘制ROC曲线分析LSM、血清肝纤维化标志物单项及联合诊断CHB肝纤维化的诊断效能。结果3组AST、ALT、TBIL水平比较差异有统计学意义(P<0.05),且进展性肝纤维化组AST、ALT水平均高于早期肝纤维化组、无肝纤维化组,TBIL水平低于早期肝纤维化组、无肝纤维化组,早期肝纤维化组AST、ALT水平均高于无肝纤维化组,TBIL水平低于无肝纤维化组,差异有统计学意义(P<0.05)。3组LSM及HA、LN、PⅢP、CⅣ水平比较差异有统计学意义(P<0.05),且进展性肝纤维化组、早期肝纤维化组均高于无肝纤维化组,进展性肝纤维化组高于早期肝纤维化组,差异有统计学意义(P<0.05)。Spearman等级相关分析结果显示,LSM、HA、LN、PⅢP、CⅣ与CHB患者肝纤维化分期呈正相关(r>0,P<0.05)。ROC曲线分析结果显示,LSM、血清纤维化指标联合检测诊断CHB患者肝纤维化的预测效能高于各单项检测(P<0.05)。结论Fibro Touch下LSM联合血清肝纤维化标志物可提高肝功能轻度异常CHB肝纤维化的诊断效能,临床应用价值高。

Objective To investigate the application of liver stiffness measurement(LSM)by transient elastography(Fibro Touch)combined with serum liver fibrosis markers in patients with mild liver dysfunction and chronic hepatitis B(CHB).Methods A total of 82 patients with mild liv-er dysfunction and CHB who were admitted to Shangrao Second People's Hospital from January 2019 to January 2022 were selected as the study subjects.With liver biopsy as the gold standard,the patients were divided into the three groups:no fibrosis group(S0,n=16),early fibrosis group(S1,S2,n=33),and progressive fibrosis group(S3,S4,n=33).Fibro Touch was used to detect LSM,the liver function indicators(serum aspartate amino-transferase[AST],alanine aminotransferase[ALT]and total bilirubin[TBIL])and serum liver fibrosis markers(hyaluronic acid[HA],laminin[LN],typeⅢprocollagen peptide[PⅢP]and type IV collagen[CⅣ])were measured.ROC curve was used to analyze the diagnostic performance of LSM,serum liver fibrosis markers,and their combination for liver fibrosis in CHB.Results There were significant differences in the levels of AST,ALT and TBIL among the three groups(P<0.05).The levels of AST and ALT in the progressive fibrosis group were higher than those in the early fi-brosis group and the non fibrosis group,and the level of TBIL was lower than that in the early fibrosis group and the non fibrosis group.The levels of AST and ALT in the early fibrosis group were higher than those in the non fibrosis group,and the level of TBIL was lower than that in the non fibro-sis group,and the differences were statistically significant(P<0.05).There were significant differences in the levels of LSM,HA,LN,PⅢP and CⅣamong the three groups(P<0.05),and the levels of LSM,HA,LN,PⅢP and CⅣin the progressive fibrosis group and the early fibrosis group were higher than those in the non fibrosis group,and the levels of LSM,HA,LN,PⅢP and CⅣin the progressive fibrosis group were higher than those in the early fibrosis group,the differences were statistically significant(P<0.05).Spearman rank correlation analysis showed that LSM,HA,LN,PⅢP and CⅣwere positively correlated with liver fibrosis stage in CHB patients(r>0,P<0.05).The results of ROC curve analysis showed that the predictive efficacy of combined detection of LSM and serum fibrosis indexes in the diagnosis of liver fibrosis in CHB patients was higher than that of each single detection(P<0.05).Conclusion LSM by FibroTouch combined with serum liver fibrosis markers can improve the diagnos-tic efficacy of liver fibrosis in patients with mild liver dysfunction and CHB,which has high clinical application value.