应用瞬时弹性成像技术联合APRI和AAR指数评估慢性乙型肝炎患者肝纤维化临床价值研究

doi:10.3969/j.issn.1672-5069.2021.02.012

摘要/Abstract

摘要： 目的探讨应用瞬时弹性成像技术联合天门冬氨酸氨基转移酶(AST)/血小板指数(APRI)和AST/丙氨酸氨基转移酶(ALT)比值(AAR)评估慢性乙型肝炎(CHB)患者肝纤维化的临床价值。方法 2017年5月～2018年5月我院收治的CHB患者118例,给予所有患者恩替卡韦治疗观察12个月,治疗前接受肝活检,使用法国爱科森公司生产的FibroScan-502型瞬时弹性扫描仪行肝脏硬度检测(LSM),应用受试者工作特征曲线(ROC)评价LSM、APRI和AAR诊断CHB患者大于或等于S2期(显著)肝纤维化的效能。结果在本组118例CHB患者中,经肝组织病理学检查,诊断S_0～1期(无肝纤维化组)65例,S_2～4期(显著肝纤维化组)53例;显著肝纤维化组血清ALT、AST、APRI、AAR和LSM分别为(128.3±31.4)U/L、(133.7±41.9)U/L、(0.5±0.2)、(1.5±0.5)和(9.3±2.7)kPa,与无肝纤维化组比,差异显著【分别为(104.6±26.8)U/L、(93.4±40.2)U/L、(0.3±0.1)、(1.2±0.3)和(5.6±1.6)kPa,P<0.05】,而外周血血小板计数为(123.4±46.4)×10⁹/L,显著低于无肝纤维化组【(184.2±42.8)×10⁹/L,P<0.05】;分别以7.830(kPa)、0.350和1.310为截断点,应用LSM、APRI和AAR诊断CHB患者显著肝纤维化的AUC分别为0.867(95%CI:0.827～0.947)、0.774(95%CI:0.678～0.861)和0.687(95%CI:0.500～0.774),三项指标联合诊断AUC为0.945(95%CI:0.904～0.986),显著高于任何一项单独指标(P<0.05);65例无显著肝纤维化患者治疗前后LSM、APRI和AAR变化不显著(P>0.05),而53例显著肝纤维化患者在治疗12个月后LSM为(7.4±1.2)kPa,显著低于治疗前【(9.3±2.7)kPa,P<0.05】。结论应用瞬时弹性成像技术联合APRI和AAR检测CHB患者显著肝纤维化有一定的临床价值,值得进一步观察和研究。

关键词: 慢性乙型肝炎, 肝纤维化, 瞬时弹性成像技术, 天门冬氨酸氨基转移酶/血小板比值, 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic efficacy of transient elastography in combination with aspartate aminotransferase (AST)/platelet count index (APRI) and AST/ alanine aminotransferase (ALT) ratio(AAR) in evaluating significant liver fibrosis in patients with chronic hepatitis B (CHB). Methods+++++118 patients with CHB were admitted to our hospital between May 2017 and May 2018, all received entecavir for treatment for 12 months, and all underwent liver biopsies. The liver stiffness measurement (LSM) was detected by FibroScan-502 transient elastography scanner. Blood routine and blood biochemical indexes were detected by BX800 full-automatic biochemical analyzer. The predictive value of LSM, evaluated by receiver operatingAPRI and AAR for diagnosing significant liver fibrosis in patients with CHB was characteristic (ROC) curves.Results Out of the 118 patients with CHB in our series, the liver fibrosis stage S_0-1 was found in 65 patients, and the S_2-4 (significant liver fibrosis) was found in 53 patients; serumALT and AST levels, APRI, AAR and LSM in patients with significant liver fibrosis were (128.3±31.4)U/L, (133.7±41.9)U/L, (0.5±0.2), (1.5±0.5) and (9.3±2.7)kPa, all significantly higher than 【(104.6±26.8)U/L, (93.4±40.2)U/L,(0.3±0.1), (1.2±0.3) and (5.6±1.6)kPa, respectively, P<0.05】, while peripheral blood PLC count was (123.4±46.4)×10⁹/L, significantly lower than 【(184.2±42.8)×10⁹/L, P<0.05】 in patients without liver fibrosis; we set the cut-off-value of 7.830(kPa), 0.350 and 1.310, respectively, and the AUC were 0.867(95%CI:0.827-0.947), 0.774(95%CI:0.678-0.861) and 0.687(95%CI:0.500-0.774) for LSM, APRI and AAR in diagnosing significant liver fibrosis, all significantly lower than 0.945(95%CI:0.904-0.986) for the three combination diagnosis (P<0.05); there were no significant changes in LSM, APRI and AAR after 12 month antiviral treatment in 65 patients without significant liver fibrosis, while the LSM was (7.4±1.2)kPa at the end of 12 month observation, significantly decreased as compared to 【(9.3±2.7)kPa, P<0.05】 at presentation in 53 patients with significant liver fibrosis.Conclusion The application of LSM, in combination with APRI and AAR maybe, is of good predictive value in evaluating significant liver fibrosis in patients with CHB, and warrants further investigation.

Key words: Hepatitis B, Liver fibrosis, Transient elastography, Aspartate aminotransferase /platelet count index, AST/ alanine aminotransferase ratio, Diagnosis

代海峰, 王甜, 雷迅, 蔡佳, 黄文祥. 应用瞬时弹性成像技术联合APRI和AAR指数评估慢性乙型肝炎患者肝纤维化临床价值研究[J]. 实用肝脏病杂志, 2021, 24(2): 196-199.

Dai Haifeng, Wang Tian, Lei Xun, et al. Diagnosticefficacy of transient elastography in combination with APRI and AAR in evaluating significant liver fibrosis in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2021, 24(2): 196-199.

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