关键词: 慢性乙型肝炎, 肝纤维化, 瞬时弹性成像, 门静脉血流动力学指标, 门静脉直径, 受试者工作特征曲线, 诊断

Abstract: Objective The aim of this study was to investigate the clinical application of transient elastography (TE) and portal hemodynamic parameters in the diagnosis of liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods 98 patients with CHB were admitted to our hospital between February 2016 and September 2019, and liver biopsies were performed in all the patients. The liver stiffness measurement (LSM) was detected by TE, and the diameter of portal vein (PVD), the maximum velocity of portal vein (Vmax) and mean velocity of portal vein (Vmean) were obtained by sonography. The multivariate Logistic analysis was conducted for the influencing factors of LF, and the diagnostic efficacy was evaluated by AUROC. Results Out of 98 patients with CHB, the liver histopathological examination showed that LF F0 in 6, F1 in 22, F2 in 34, F3 in 28 and F4 in 8 patients; the LSM, PVD, Vmax and Vmean in patients with liver cirrhosis were (28.6±7.8)kPa, (1.4±0.4)cm, (27.4±2.5)cm/s and (22.8±3.1)cm/s, significantly different as compared to[(6.1±0.4)kPa, (1.0±0.2)cm, (33.8±1.4)cm/s and (28.5±1.4)cm/s, respectively, P<0.05] in patients with F1; the LSM, PVD, Vmax and Vmean in 70 patients with significant LF (>F2 stage) were (14.2±3.8)kPa, (1.4±0.4)cm, (29.1±2.1)cm/s and (24.1±2.1)cm/s, significantly different as compared to [(5.9±0.4)kPa, (1.0±0.2)cm, (36.8±1.5)cm/s and (30.5±1.4)cm/s, respectively, P<0.05] in 28 patients without significant LF (less than or equal to F1 stage); the Logistic regression analysis demonstrated that the LSM and PVD were the independent predicting factors for significant LF(P<0.05), and when LSM equal to 8.4 kPa was set as the cut-off-value, its diagnostic AUC was 0.84(95%CI :0.80-0.89), the sensitivity (Se) was 82%(95%CI:76%-85%) and the specificity (Sp) was 89%(95%CI:81%-93%), and as the PVD equal to 1.4 cm was set as the cut-off-value, its AUC was 0.83(95%CI :0.78-0.89), the Se was 81%(95%CI:75%-86%) and the Sp was 90%(95%CI:85%-94%). Conclusion The usefulness of LSM and PVD in non-invasively diagnosing LF in patients with CHB is feasible and efficacious, which warrants further clinical investigation.

Key words: Hepatitis B, Liver fibrosis, Transient elastography, Liver stiffness measurement, Portal hemodynamic indexes, Receiver operator characteristic curve, Diagnostic trial