超声弹性成像结合血清学指标诊断慢性乙型肝炎患者肝纤维化价值评价

目的 探讨应用超声弹性成像结合血清学指标诊断慢性乙型肝炎(CHB)患者肝纤维化的价值。方法 2015年1月～2018年6月我院诊治的CHB患者358例,接受肝穿刺和超声检查,记录肝组织剪切波速度(SWV),使用化学发光免疫分析仪测定血清透明质酸(HA)、Ⅳ型胶原(ⅣⅣ-Col)和Ⅲ型前胶原(PⅢNP),计算天冬氨酸氨基转移酶/血小板比值(APRI)和基于四因子指数(FIB-4),应用多因素Logistic回归分析影响肝纤维化发生的独立危险因素,应用受试者工作特征(ROC)曲线下面积(AUC)评估各项指标诊断肝纤维化的准确性。 结果 经肝组织病理学检查,发现F0期42例,F1期96例,F2期86例,F3期72例和F4期62例;220例≥F2期患者肝组织SWV为(3.12±0.65)m/s,显著大于138例≤F1期患者【(1.72±0.51)m/s,P<0.05】;≥F2期患者血清HA水平为(128.1±14.7)μg/L,显著高于≤F1期患者【(75.4±10.1)μg/L,P<0.05】,AST/ALT比值为(0.96±0.41),显著大于≤F1期患者【(0.80±0.27),P<0.05】,血清Ⅳ-Col水平为(36.7±14.3)μg/L,显著高于≤F1期患者【(24.9±9.2)μg/L,P<0.05】,APRI评分为(0.83±0.52)分,显著大于≤F1期患者【(0.61±0.49)分,P<0.05】,FIB-4指数为(1.70±0.98),显著大于≤F1期患者【(1.23±0.67),P<0.05】;多因素Logistic回归分析结果表明,SWV、AST/ALT比值、HA、Ⅳ-Col、APRI和FIB-4为影响肝纤维化发生的危险因素(P<0.05),SWV诊断肝纤维化的正确率为86.9%,血清HA为84.2%,APRI和FIB-4分别为82.5%和81.8%。结论 应用SWV联合血清学指标可提高CHB患者肝纤维化诊断的准确性,值得进一步研究。

Diagnostic value of ultrasonic elastography combined with serological indexes in evaluation of liver fibrosis in patients with chronic hepatitis B

Objective The aim of this study was to investigate the diagnostic value of ultrasonic elastography combined with serological indexes in evaluation of liver fibrosis in patients with chronic hepatitis B (CHB). Methods There were 358 patients with CHB enrolled in our hospital between January 2015 and June 2018, and all of them received liver biopsies, sonography for shear wave velocity (SWV) and serum HA, AST, ALT and Ⅳ-Col were assayed, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 were calculated. Multivariate Logistic regression analysis was used to analyze the independent risk factors for hepatic fibrosis occurrence, and the area under ROC curve (AUC) was used to evaluate the accuracy of each index in the diagnosis of hepatic fibrosis. Results There were 42 cases with F0, 96 cases with F1, 86 cases with F2, 72 cases with F3 and 62 cases with F4 by histopathological examination; the SWV in 220 patients with ≥F2 was (3.12±0.65)m/s, significantly higher than 【(1.72±0.51)m/s, P<0.05】 in 138 patients with ≤F1, serum HA levels was (128.1±14.7) μg/L, significantly higher than 【(75.4±10.1)μg/L, P<0.05】, the AST/ALT ratio was (0.96±0.41), much higher than 【(0.80±0.27), P<0.05】, serum Ⅳ-Col level was (36.7±14.3)μg/L, much higher than 【(24.9±9.2)μg/L, P<0.05】, the APRI score was (0.83±0.52), much higher than 【(0.61±0.49), P<0.05】, the FIB-4 index was (1.70±0.98), much higher than【(1.23±0.67), P<0.05】 in patients with ≤F1; multivariate Logistic analysis showed than SWV, AST/ALT ratio, serum HA and Ⅳ-Col levels, APRI and FIB-4 were the independent risk factors for the occurrence of hepatic fibrosis; the accuracy by SWV in diagnosis of liver fibrosis was 86.9%, by HA was 84.2%, and by APRI and FIB-4 were 82.5% and 81.8%, respectively. Conclusion SWV combined with serological markers might improve the accuracy of hepatic fibrosis diagnosis in patients with CHB, which warrants further investigation.