不同血清ALT水平的乙型肝炎病毒感染者肝纤维化指标变化

doi:10.3969/j.issn.1672-5069.2021.04.009

摘要/Abstract

摘要： 目的研究不同血清谷丙转氨酶(ALT)水平的慢性HBV感染者肝纤维化指标的变化。方法 2018年4月～2020年4月我院诊治的68例慢性HBV感染者(HBV携带者21例,CHB患者47例),根据血清ALT水平不同将患者分为A组(ALT<40 U/L,n=21)、B组(40U/L≤ALT<80U/L,n=24)和C组(ALT≥80U/L,n=23),行肝穿刺活检和FibroScan检查,常规检测血清透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原(ⅣC)和Ⅲ型前胶原(PcⅢ)。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC)判断指标的诊断效能。结果 A、B和C组血清肝纤维化指标水平无显著性差异(P>0.05);肝组织病理学检查诊断肝纤维化S₀期24例,S₁期13例,S₂期13例,S₃期10例,和S₄期8例,不同肝纤维化分组在A组、B组和C组分布无显著性差异(P>0.05);24例S0期肝纤维化患者LSM为(10.9±2.8)kPa,13例S1期LSM为(11.3±3.0)kPa,31例>=S2期 LSM为(12.8±3.3)kPa(P<0.05),而不同肝纤维化病理学分期患者血清肝纤维化指标仍无显著性差异(P>0.05);经ROC分析发现,以血清ALT=63.8 U/L为截断点判断S₂期及以上肝纤维化的AUC为0.400(SE=0.070,95%CI=0.262～0.538,P=0.185),其诊断的灵敏度和特异度分别为0.364和0.370,而以LSM=12.3 kPa为截断点判断S₂期及以上肝纤维化的AUC为0.868(SE=0.042,95%CI=0.785～0.950,P=0.000),其诊断的敏感度和特异度分别为0.955和0.717。结论对于慢性HBV感染者,无论血清ALT水平高低都可能存在显著性肝纤维化,血清ALT或血清肝纤维化指标无诊断肝纤维化的能力,而使用FibroScan检测LSM可能有助于早期发现严重的肝纤维化而给予及时的处理。

关键词: 慢性乙型肝炎, 乙型肝炎病毒携带者, 肝纤维化, FibroScan, 诊断

Abstract: Objective The aim of this study was to investigate the liver stiffness measurement (LSM) in patients with chronic hepatitis B viral infection and different alanineaminotransferase (ALT) levels. Methods 68 patients with chronic hepatitis B viral infections (HBV carriers in 21 and CHB in 47) were enrolled in this study between April 2018 and April 2020,and the patients were divided based on serum ALT levels into group A ( serum ALT level <40 U/L, n=21), group B (40 U/L≤ALT<80 U/L, n=24) and group C (ALT≥80 U/L, n=23). All patients underwent liver biopsies and LSM by Fibroscan. Serum hyaluronic acid (HA), laminin (LN), typeⅣ collagen (ⅣC) and type Ⅲ procollagen (PcⅢ) in the three groups were detected. The efficacy of serum ALT and LSM in predicting theexistence of significant liver fibrosis (≥S2 stage) was determined by the area under receiver operating characteristic (AUC) by MedCalc1 5.1 software. Results There were no significant differences asrespect to serum fibrosis indexes among the three groups (P>0.05); the histopathological examination showed that S₀ liver fibrosis in 24, S₁ in 13, S₂ in 13, S₃ in 10 and S₄ in 8, and there were no significant differences as respect to the distribution of different liver fibrosis among the three groups(P>0.05); the LSM in 24 individuals with S₀ liver fibrosis was (10.9±2.8)kPa, was (11.3±3.0)kPa in 13 patients with S₁, and was (12.8±3.3)kPa in 31 patients with equal to or greater than S2 liver fibrosis (P<0.05), while there were still no significant differences as respect to serum liver fibrosis indexes among thethree different liver fibrosis individuals (P>0.05); the ROC analysis demonstrated that the AUC was 0.400(SE=0.070, 95%CI=0.262-0.538, P=0.185) when serum ALT level equal to 63.8 U/L was set as the cut-off-value in predicting equal to or greater than S₂ liver fibrosis, with the sensitivity (Se) and specificity (Sp) of 0.364 and 0.370, while when the LSM equal to 12.3 kPa was set as the cut-off-value in predicting equal to or greater than S₂ liver fibrosis, the AUC was 0.868(SE=0.042, 95%CI=0.785-0.950,P=0.000), with the Se and Sp of 0.955 and 0.717. Conclusion The individuals with chronic hepatitis B viral infections might have different stage of liver fibrosis no matter how high serum ALT level, and either serum ALT levels or serum so-called liver fibrosis index, such as HA, LN,ⅣC and PcⅢ, couldn’t early warn liver fibrosis, but the LSM might do.

Key words: Hepatitis B, Hepatitis B viral carriers, Liver fibrosis, FibroScan, Diagnosis

孙海荣, 冯伟广, 周冰清, 刘慧敏, 蒋蓓莉. 不同血清ALT水平的乙型肝炎病毒感染者肝纤维化指标变化[J]. 实用肝脏病杂志, 2021, 24(4): 488-491.

Sun Hairong, Feng Weiguang, Zhou Bingqing, et al. Liver stiffness measurement in patients with chronic hepatitis B viral infection and different alanine aminotransferase levels[J]. Journal of Practical Hepatology, 2021, 24(4): 488-491.

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