肝脏硬度检测联合吲哚菁绿滞留率测定对血清转氨酶正常或轻度升高的慢性乙型肝炎患者肝组织学病变进展的预测价值

doi:10.3969/j.issn.1672-5069.2021.02.009

实用肝脏病杂志 ›› 2021, Vol. 24 ›› Issue (2): 184-187.doi: 10.3969/j.issn.1672-5069.2021.02.009

肝脏硬度检测联合吲哚菁绿滞留率测定对血清转氨酶正常或轻度升高的慢性乙型肝炎患者肝组织学病变进展的预测价值

张思薇, 孔银, 刘天府, 刘元元, 麻爱娣, 李永芳, 李娟, 张岭漪

730030 兰州市兰州大学第二医院肝病科

收稿日期:2020-06-10 出版日期:2021-03-10 发布日期:2021-04-30
通讯作者: 张岭漪,E-mail:ery_zhangly@lzu.edu.cn
作者简介:张思薇,女,28岁,硕士研究生。主要从事慢性肝脏病诊治研究。E-mail:593879874@qq.com
基金资助:
吴阶平医学基金会临床科研专项基金资助项目(编号:LDWJPMF-104-002);王宝恩肝纤维化研究基金资助项目(编号:CFHPC2020023);兰州大学第二医院“萃英科技创新”计划临床拔尖技术研究项目(编号:CY2018-BJ17)

Predictive value of histological activity index and fibrosis by liver stiffness measurement and ICGR15 in patients with hepatitis B and normal or minimally elevated serum ALT levels

Zhang Siwei, Kong Yin, Liu Tianfu, et al

Department of Hepatology, Second Affilated Hospital, Lanzhou University, Lanzhou 730030, Gansu Province, China

Received:2020-06-10 Online:2021-03-10 Published:2021-04-30

摘要/Abstract

摘要： 目的探讨肝硬度检测(LSM)和吲哚菁绿15分钟血浆滞留率(ICGR15)对慢性乙型肝炎(CHB)患者肝组织病理学损伤的预测价值。方法 2016年7月～2018年11月我院诊治的血清 ALT正常或＜2 倍正常值上限(ULN)的CHB患者,接受肝活检行METAVIR评分,依据评分分为非进展期和进展期。使用日本光电工业株式会社生产的DDG-3300K脉动脉式色素浓度分析仪检测ICGR15,使用Echosens 502肝脏瞬时弹性成像仪检测LSM。应用受试者工作特征曲线(ROC)下面积(AUC)评估指标预测肝组织病变进展的效能。结果经肝组织学检查,发现肝组织进展期196例,非进展期113例,两组年龄、性别、血小板计数、血清HBeAg阳性是否阳性和血清ALT水平无显著性差异(P>0.05),而进展期患者血清HBV DNA、ALB、LSM和ICGR15与非进展期患者比,差异显著(P<0.05);LSM、ICGR15及LSM-ICGR15联合模型与METAVIR评分均存在正相关性(P值均<0.05);ROC曲线分析显示LSM 、ICGR15和LSM-ICGR15联合模型预测肝组织进展期的曲线下面积(AUC)分别为0.655、0.617和0.686。当以LSM等于7.35 kPa为截断点,其诊断肝组织进展期的灵敏度为55.4%,特异性为68.1%,当以ICGR15等于4.15%为截断点,其诊断肝组织进展期的灵敏度为34.4%,特异性为90.3%,以LSM-ICGR15联合预测的灵敏度为59.5%,特异性为78.8%。结论应用LSM、ICG-R15或者两者联合预测血清ALT正常或轻度升高的CHB患者肝组织病变进展有一定的价值,值得临床进一步研究。

关键词: 慢性乙型肝炎, 丙氨酸氨基转移酶, 肝脏硬度检测, 吲哚菁绿15分钟血浆滞留率, METAVIR评分, 诊断

Abstract: Objective The aim of this study was to investigate the predictive value of histological activity index and fibrosis by liver stiffness measurement (LSM) and indocyanine green retention at 15 minutes (ICGR15) in patients with chronic hepatitis B (CHB) and normal or minimally elevated serum ALT levels.Methods A total of 309 patients with CHB with normal or minimally elevated serum ALT were recruited in this study, and all of them underwent liver biopsies. LSM and ICGR15 were detected. The area under receiver operating characteristic curve(AUC) was applied to estimate the efficacy of diagnosis.Results Out the 309 patients with CHB, the stable disease was found in 113 patients, and the progressive disease defined as histological activity index being grading 2 or more or fibrosis being staging 2 or more in 196 patients; there were no significant differenceswith respect to age, gender, platelet counts, serum HBeAg positive and serum ALT levels(P>0.05), while there were significant differences as for serum HBV DNA loads, albumin, LSM and ICGR15 comparison between the two groups (P<0.05); the LSM, ICGR15 or LSM/ICGR15 combination was positively correlated to hepatic METAVIR score(P<0.05); the ROC analysis showed that the AUC of LSM, ICGR15 or LSM/ICGR15 combiantion in predicting progressive liver disease were 0.655, 0.617 and 0.686, e.g., when the LSM equal to 7.35 kPa as the cut-off-value, the diagnosic sencitivity was 55.4%, and the specificity was 68.1%, when the ICGR15 equal to 4.15% as the cut-off-value, they were 34.4% and 90.3%, and when the LSM/ICGR15 combined, they were 59.5% and 78.8%.Conclusion The application of LSM and ICGR15 might have a predictive value for prediction of hepatic grading and staging in patients with CHB, especially in those with normal serum ALT levels or mild liver injury, which needs further investigation.

Key words: Hepatitis B, Alanine aminotransaminase, Liver stiffness measurement, Indocyanine green retention, METAVIR score, Diagnosis

张思薇, 孔银, 刘天府, 刘元元, 麻爱娣, 李永芳, 李娟, 张岭漪. 肝脏硬度检测联合吲哚菁绿滞留率测定对血清转氨酶正常或轻度升高的慢性乙型肝炎患者肝组织学病变进展的预测价值[J]. 实用肝脏病杂志, 2021, 24(2): 184-187.

Zhang Siwei, Kong Yin, Liu Tianfu, et al. Predictive value of histological activity index and fibrosis by liver stiffness measurement and ICGR15 in patients with hepatitis B and normal or minimally elevated serum ALT levels[J]. Journal of Practical Hepatology, 2021, 24(2): 184-187.

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肝脏硬度检测联合吲哚菁绿滞留率测定对血清转氨酶正常或轻度升高的慢性乙型肝炎患者肝组织学病变进展的预测价值

Predictive value of histological activity index and fibrosis by liver stiffness measurement and ICGR15 in patients with hepatitis B and normal or minimally elevated serum ALT levels

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