超声弹性成像联合APRI、INPR、FIB-4对自身免疫性肝炎患者肝纤维化的诊断价值

Diagnostic Value of Ultrasound Elastography Combined with APRI,INPR and FIB-4 for Liver Fibrosis in Patients with Autoimmune Hepatitis

目的:探讨超声弹性成像联合天冬氨酸氨基转移酶与血小板比率指数(APRI)、国际标准化比值/血小板比率(INPR)、基于4因子的肝纤维化指数(FIB-4)对自身免疫性肝炎(AIH)患者肝纤维化的诊断价值。方法:我院2021年1月-2022年12月收治的120例AIH患者均经肝脏组织穿刺活检并依据Metavir评估系统分为显著性肝纤维化组(F2-F4期,n=74)与非显著性肝纤维化组(F0-F1期,n=46),对比两组基线资料、超声弹性成像剪切波速度(SWV)、FIB-4、APRI、INPR。采用Logistic回归分析AIH患者发生显著性肝纤维化的影响因素。采用受试者工作特征(ROC)曲线评估SWV联合APRI、INPR、FIB-4对AIH患者显著性肝纤维化的诊断价值。结果:入组120例AIH患者穿刺活检结果显示:F0期15例(12.50%),F1期31例(25.83%);F2期35例(29.17%),F3期27例(22.50%),F4期12例(10.00%)。与非显著性肝纤维化组相比,显著性肝纤维化组患者INR、SWV、APRI、INPR、FIB-4值均升高,PLT水平降低,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,INPR、APRI、FIB-4及SWV升高是是AIH显著性肝纤维化的危险因素(P<0.05)。ROC结果显示,AIH患者APRI、INPR、FIB-4与SWV诊断肝纤维化程度的AUC均>0.700,且四项联合的诊断效能最高。结论:超声弹性成像参数SWV联合APRI、INPR及FIB-4对AIH患者显著性肝纤维化具有较高的诊断价值。

Objective:To investigate the diagnostic value of ultrasound elastography combined with aspartate aminotransferase to platelet ratio index(APRI),international normalized ratio/platelet ratio(INPR),and four-factor-based liver fibrosis index(FIB-4)for liver fibrosis in patients with autoimmune hepatitis(AIH).Methods:120 AIH patients who were admitted to our hospital from January 2021 to December 2022 underwent liver biopsy and the patients were divided into significant liver fibrosis group(F2-F4,n=74)and non-significant liver fibrosis group(F0-F1,n=46)according to the Metavir evaluation system,the baseline data,ultrasound elastography shear wave velocity(SWV),FIB-4,APRI and INPR were compared between the two groups.Logistic regression was used to analyze the influencing factors of significant liver fibrosis in AIH patients.The diagnostic value of SWV combined with APRI,INPR and FIB-4 for significant liver fibrosis in AIH patients were evaluated by receiver operating characteristic(ROC)curve.Results:The biopsy results of 120 AIH patients showed that:there were 15 cases(12.50%)in F0 stage,there were 31 cases(25.83%)in F1 stage,there were 35 cases(29.17%)in F2 stage,there were 27 cases(22.50%)in F3 stage,there were 12 cases(10.00%)in F4 stage.Compared with non-significant liver fibrosis group,the INR,SWV,APRI,INPR and FIB-4 values of the patients in the significant liver fibrosis group increased,and the PLT level decreased,with statistically significant differences(P<0.05).Logistic regression analysis showed that,elevated INPR,APRI,FIB-4 and SWV were risk factors for significant liver fibrosis in AIH(P<0.05).The results of ROC curve showed that,the AUC of APRI,INPR,FIB-4 and SWV in diagnosing the degree of liver fibrosis in AIH patients was>0.700,and the combination of the four items had the highest diagnostic efficiency.Conclusion:Ultrasound elastography parameters SWV combined with APRI,INPR and FIB-4 have high diagnostic value for significant liver fibrosis in AIH patients.