慢性乙型肝炎和肝硬化患者肝脏硬度检测值的变化及其影响因素分析

doi:10.3969/j.issn.1672-5069.2019.03.023

摘要/Abstract

摘要： 目的探讨西藏地区慢性乙型肝炎（CHB）和乙型肝炎肝硬化（LC）患者肝脏硬度检测（LSM）值的变化与其影响因素。方法 2017年1月~2018年3月在西藏自治区藏医院门诊就诊的CHB患者70例,LC患者30例,使用肝脏瞬时弹性探测仪检测LSM,常规行彩超检查和血生化指标检测,采用Spearman相关性分析,建立多元逐步回归方程行多因素分析影响LSM的因素。结果 CHB患者LSM为（7.17±12.19） kPa,显著低于LC患者【（14.92±14.01）kPa,P<0.05】, CAP值为（210.70±66.22） db/m,与LC患者的（212.00±69.20） db/m比,无显著性差异（P>0.05）;APTT、AST、ALP、GGT、GLOB、TBIL和TBA与LSM呈正相关（P<0.05）,WBC、PLT、HGB、PTA、FIB、ALB、GFR和LDL-C与LSM呈负相关（P<0.05）,而体质量、ALT、UREA、CREA、UA、TG、HDL-C、GLU、AMY和CAP值与LSM无显著性相关（P>0.05）;肝脏表面光滑情况、肝脏实质回声情况、肝脏血管走形清晰情况、脾脏大小情况等因素与LSM显著相关（P<0.05）,多元线性回归分析显示年龄（P=0.003）、肝脏回声增强（P=0.020）、肝脏回声结节（P=0.000）、凝血酶原时间（P=0.007）和总胆汁酸（P=0.004）是影响LSM值的独立因素。结论了解影响慢性HBV感染患者接受Fibroscan检测的LSM值的因素将有助于帮助临床医生尽早对病情作出正确的判断,给予合适的处理。

关键词: 肝硬化, 慢性乙型肝炎, 肝脏硬度检测, 影响因素

Abstract: Objectiv To analyze the factors influencing liver stiffness measurement （LSM） in patients with chronic hepatitits B （CHB） and liver cirrhosis （LC） in Tibet. Methods 70 patients with CHB and 30 with LC were recruied in Traditional Tibetan Medicine Hospital between January 2017 and March 2018,and FibroScan was used to detect LSM in all the patients. Serum markers of liver function,renal function,blood lipids,blood glucose,blood coagulation function and blood routine examination,and ultrasonic examination were evaluated. Result The LSM was（7.17±12.19） kPa in patients with CHB,significantly lower than 【（14.92±14.01）kPa,P<0.05】 in patients with LC,and the CAP was （210.70±66.22） db/m,not significantly different as compared to （212.00±69.20） db/m in patients with LC（P>0.05）;the APTT,AST,ALP,GGT,GLOB,TBIL and TBA were positively correlated,and WBC,PLT,HGB,PTA,FIB,ALB,GFR and LDL-C were negatively correlated to LSM（P<0.05）,while body mass,ALT,UREA,CREA,UA,TG,HDL-C,GLU,AMY and controlled attenuation parameter were not statistically significantly correlated to LSM（P>0.05）;multivariate regression analysis showed that age（P=0.003）,hepatic echo enhancement （P=0.020）,hepatic echo nodule （P=0.000）,PT （P=0.007）and TBA （P=0.004） were the independent factors influencing the LSM in patients with hepatitis B viral infection. Conclusion Clinicians should take the influencing factors of LSM into consideration in clinical practice in order to deal with the patients properly in time.

Key words: Liver cirrhosis, Hepatitis B, Liver stiffness measurement, Influencing factors

德吉, 白玛, 白央, 米玛仓决. 慢性乙型肝炎和肝硬化患者肝脏硬度检测值的变化及其影响因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 401-404.

De Ji, Bai Ma, Bai Yang. Factors influencing liver stiffness measurement in patients with chronic hepatitits B and cirrhosis in Tibet[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 401-404.

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