超声点定量弹性成像技术对AIH和PBC患者肝纤维化诊断价值分析*

doi:10.3969/j.issn.1672-5069.2020.02.021

摘要/Abstract

摘要： 目的探讨应用超声点定量弹性成像(ElastPQ)技术诊断自身免疫性肝病(AILD)患者肝纤维化的效能。方法 2010年1月～2018年12月我院收治的自身免疫性肝炎(AIH)患者58例,原发性胆汁性肝硬化(PBC)患者46例,使用Philips iU22彩色多普勒超声诊断仪行肝脏硬度检查,检测血清指标获得天冬氨酸氨基转移酶/血小板比值指数(APRI)和基于4因子(FIB-4)指数,绘制受试者工作特性曲线(ROC)下面积(AUC),并计算敏感性、特异性和准确性。结果本组AIH与PBC患者血清ALT、AST、ALP和GGT水平存在统计学差异(P<0.05);AIH患者ElastPQ为(5.8±0.9)kPa,显著低于PBC患者【(7.1±1.2)kPa,P<0.05】,而两组APRI【1.6(1.1,2.3)对1.7(1.4,2.0)】和FIB-4【2.8(1.8,3.5)对2.6(1.9,3.2),P>0.05】无显著性差异;以ElastPQ大于/等于6.09 kPa诊断PBC患者存在≥F3肝纤维化的灵敏度、特异度和准确性分别为99.7%、80.9%和91.8%,而诊断AIH患者肝纤维化的效能则较低。结论应用ElastPQ技术诊断显著肝纤维化在PBC患者有指导意义,而在AIH患者则需要进一步研究。

关键词: 自身免疫性肝炎, 原发性胆汁性肝硬化, 肝纤维化, 点定量弹性成像, 诊断

Abstract: Objective The aim of this study was to evaluate the diagnostic efficacy of spot quantitative elastography (ElastPQ) by sonography for hepatic fibrosis in patients with autoimmune liver disease (AILD). Methods 58 patients with autoimmune hepatitis (AIH) and 46 patients with primary biliary cirrhosis (PBC) were admitted to our hospital, and all of them received sonography for ElastPQ detection. Serum parameters were obtained for aspartate aminotransferase to platelet ratio index (APRI) and fibrosis factors-four (FIB-4) calculation. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) were calculated for diagnostic sensitivity (Se), specificity (Sp) and accuracy (Ac). Results There were significantly differences in serum ALT, AST, ALP and GGT levels between patients with AIH and PBC(P<0.05); the ElastPQ in patients with AIH was (5.8±0.9)kPa, significantly lower than 【(7.1±1.2)kPa, P<0.05】, while there were no significantly differences with respect to APRI【1.6(1.1,2.3)vs. 1.7(1.4,2.0)】 and FIB-4【2.8(1.8, 3.5) vs. 2.6(1.9, 3.2), P>0.05】 between the two groups; we set the ElastPQ equal to or greater than 6.09 kPa as the cut-off-value, the Se, Sp and Ac in predicting liver fibrosis ≥F3 in patients with PBC were 99.7%, 80.9% and 91.8%, while the diagnostic efficacy was relatively low in patients with AIH. Conclusions The application of ElastPQ is helpful in diagnosis of hepatic fibrosis in patients with PBC, which warrants further investigation.

Key words: Autoimmune hepatitis, Primary biliary cirrhosis, Elastography point quantification, Hepatic fibrosis, Diagnosis

张玉玲, 周瑾, 董宏伟. 超声点定量弹性成像技术对AIH和PBC患者肝纤维化诊断价值分析^*[J]. 实用肝脏病杂志, 2020, 23(2): 231-235.

Zhang Yuling, Zhou Jing, Dong Hongwei. Verification of elastography point quantification by sonography in the diagnosis of hepatic fibrosis in patients with autoimmune liver diseases[J]. Journal of Practical Hepatology, 2020, 23(2): 231-235.

参考文献

[1] 尤红,孙亚朦,贾继东.自身免疫性肝病的研究进展.中华肝脏病杂志,2013,21(2):87-89.
[2] 占宇,唐腾骞.优化肝移植术后免疫抑制治疗方案.中华消化外科杂志,2013,12(9):652-654.
[3] Van Leeuwen DJ, Balabaud C, Crawford JM, et al. A clinical and histopathologic perspective on evolving noninvasive and invasive alternatives for liver biopsy. Clin Gastroenterol Hepatol, 2008, 6(5):491-496.
[4] Xiao GQ, Yang JY, Yan LA. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fbrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology, 2015, 61(1):292-302.
[5] Ucar F, Sezer S, Ginis Z,et al. APRI, the FIB-4 score, and Forn's index have noninvasive diagnostic value for liver fibrosis in patients with chronic hepatitis B. Eur J Gastroenterol Hepatol, 2013, 25(9):1076-1081.
[6] Lee JE, Shin KS, Cho JS, et al. Non-invasive assessment of liver fibrosis with ElastPQ: comparison with transient elastography and serologic fibrosis marker tests, and correlation with liver pathology results. Ultrasound Med Biol, 2017, 43(11):2515-2521.
[7] Fouad R, Elbaz T, Abdel Alem S, et al. Evaluation of accuracy of elastography point quantification versus other noninvasive modalities in staging of fibrosis in chronic hepatitis C virus patients. Eur J Gastroenterol Hepatol, 2018, 30(8):882-887.
[8] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015版).中华传染病杂志,2016,34(4):193-208.
[9] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015).中华传染病杂志,2016,34(7):385-394.
[10] Wai CT, Greenson JK, Fontana RJ,et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2):518-526.
[11] Sterling RK, Lissen E, Clumeck N,et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology, 2006, 43(6):1317-1325.
[12] 张意珍,马苏亚,方晔,等. 实时二维剪切波弹性成像对慢性乙型肝炎患者≥S2期肝纤维化的评估. 中华医学超声杂志(电子版),2016,13(9):656-660.
[13] Friedrich-Rust M, Nierhoff J, Lupsor M,et al. Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat, 2012, 19(2):E212-E219.
[14] Hu XD, Qiu LY, Liu D,et al. Acoustic radiation force impulse (ARFI) elastography for non-invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematicreview and meta-analysis. Med Ultrason, 2017, 19(1):23-31.
[15] Sporea I, Bota S, Gradinaru-Tascau O,et al. Comparative study between two point shear wave elastographic techniques: acoustic radiation force impulse (ARFI) elastography and ElastPQ. Med Ultrason,2014, 16(4):309-314.
[16] Ma JJ, Ding H, Mao F,et al. Assessment of liver fibrosis with elastography point quantification technique in chronic hepatitis B virus patients: a comparison with liver pathological results. J Gastroenterol Hepatol, 2014, 29(4):814-819.
[17] Ferraioli G, Maiocchi L, Lissandrin R,et al. Accuracy of the ElastPQ technique for the assessment of liver fibrosis in patients with chronic hepatitis C: a "Real Life" single center study. J Gastrointestin Liver Dis, 2016, 25(3):331-335.
[18] Righi S, Fiorini E, De Molo C,et al. ARFI elastography in patients with chronic autoimmune liver diseases: A preliminary study. J Ultrason, 2012, 15(4):226-231.
[19] Lin ZH, Xin YN, Dong QJ,et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology, 2011, 53(3):726-736.
[20] Kim WR, Berge T, Asselah T, et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol, 2016, 64(4):773-780.

超声点定量弹性成像技术对AIH和PBC患者肝纤维化诊断价值分析^*

Verification of elastography point quantification by sonography in the diagnosis of hepatic fibrosis in patients with autoimmune liver diseases

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