基于肝脏病理学对慢性乙型肝炎肝硬化患者FibroTouch测量值的影响因素分析

目的分析慢性乙型肝炎患者中CD34、CK7、CK19免疫组化阳性染色量以及纤维胶原沉积量的变化特点,阐述影响FibroTouch测量值的病理基础。方法收集2015年1月-2017年12月于上海中医药大学附属曙光医院肝硬化科就诊的72例慢性乙型肝炎患者的一般资料,计算CD34、CK7、CK19免疫组化染色的阳性染色量,Masson三色染色的纤维胶原沉积量,FibroTouch所测定的肝脏硬度值。符合正态分布的计量资料两组间比较采用t检验;不符合正态分布或方差不齐的计量资料两组间比较用Wilcoxon秩和检验;计数资料组间比较采用χ2检验;等级资料多组间比较采用Kruskal-Wallis H检验。利用受试者工作特征曲线分析肝脏硬度值对乙型肝炎肝硬化的诊断价值。采用logistic回归进行多因素分析。结果随着炎症程度的增加,CD34阳性染色量无明显变化(P> 0. 05),CK19阳性染色量、纤维胶原沉积量呈现升高趋势(H值分别为9. 02、14. 12,P值分别为0. 011、0. 001)。随着纤维化分期的进展,CD34阳性染色量、CK7阳性染色量、纤维胶原沉积量呈现逐渐升高的趋势(H值分别为10. 26、16. 29、22. 97,P值分别为0. 016、0. 001、<0. 001)。logistic回归分析显示,CK7阳性染色量、纤维胶原沉积量均是FibroTouch测量值的独立影响因素(Wald值分别为4. 756、4. 757,P值分别为0. 029、0. 029)。结论纤维胶原沉积量和CK7阳性染色量的增加可能会提高FibroTouch的测量值。

Influencing factors for FibroTouch measurements in chronic hepatitis B patients based on liver pathology

Objective To investigate the changes in positive staining of CD34,CK7,and CK19 and amount of fibrous collagen deposition in patients with chronic hepatitis B(CHB)and the pathological basis affecting FibroTouch measurements.Methods A retrospective analysis was performed for the clinical data of 72 CHB patients who visited Department of Liver Cirrhosis in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2015 to December 2017.The amount of positive immunohistochemical staining of CD34,CK7,and CK19 was calculated,as well as the amount of fibrous collagen deposition in Masson trichrome staining and liver stiffness measurement(LSM)by FibroTouch.The t-test was used for comparison of normally distributed continuous data between two groups.The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups.The chi-square test was used for comparison of categorical data between groups,and the Kruskal-Wallis H test was used for comparison of ranked data between multiple groups.The receiver operating characteristic(ROC)curve was used to analyze the value of LSM in the diagnosis of hepatitis B cirrhosis,and the logistic regression model was used for multivariate analysis.Results With the increase in inflammation degree,there was no significant change in the amount of positive staining of CD34(P >0.05),while there were significant increases in the amount of positive staining of CK19 and the amount of fibrous collagen deposition(H=9.02 and 14.12,P=0.011 and 0.001).With the progression of liver fibrosis,there were significant increases in the amount of positive staining of CD34 and CK7 and the amount of fibrous collagen deposition(H=10.26,16.29,and 22.97,P=0.016,0.001,and<0.001).The logistic regression analysis showed that the amount of positive staining of CK7(Wald=4.756,P=0.029)and the amount of fibrous collagen deposition(Wald=4.757,P=0.029)were independent influencing factors for FibroTouch measurements.Conclusion Increases in the amount of fibrous collagen deposition and the amount of positive staining of CK7 may lead to increased FibroTouch measurements.