瞬时弹性成像联合APRI诊断自身免疫性肝炎患者肝纤维化效能研究*

doi:10.3969/j.issn.1672-5069.2023.06.016

摘要/Abstract

摘要： 目的探讨应用天冬氨酸氨基转移酶/血小板计数比值(APRI)联合瞬时弹性成像行肝硬度检测(LSM)诊断自身免疫性肝炎(AIH)患者肝纤维化的效能。方法 2019年8月～2022年8月我院诊治的AIH患者67例和同期健康体检者54例。AIH患者接受肝活检,所有受试者接受FibroScan肝脏弹性成像和血液检测,获得LSM和APRI。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估参数诊断显著性肝纤维化的效能。结果 AIH组血清AST水平为(104.3±21.9)U/L,显著高于对照组【(30.5±5.1)U/L,P<0.05】,APRI和LSM分别为(1.4±0.1)和(8.1±1.2)kPa,显著大于对照组【分别为(0.4±0.1)和(4.3±0.7)kPa,P<0.05】,而外周血PLT计数为(157.8±23.1)×10⁹/L,显著低于对照组【(208.5±20.7)×10⁹/L,P<0.05】;肝组织病理学检查显示,67例AIH患者存在肝纤维化S0期10例、S1期17例、S2期19例、S3期13例和S4期8例;S4期患者APRI和LSM分别为(2.1±0.3)和(13.9±2.8)kPa,S3期分别为(1.8±0.2)和(11.2±2.1)kPa,S2期分别为(1.5±0.2)和(7.6±1.5)kPa,均显著高于S1期【分别为(1.1±0.2)和(6.1±1.2)kPa,P<0.05】或S0期【分别为(0.8±0.1)和(4.0±0.5)kPa,P<0.05】;经ROC分析显示,分别以APRI=1.5和LSM=7.5 kPa为截断点,两者联合诊断显著性肝纤维化的AUC为0.950,其敏感度和特异度分别为95.0%和85.2%,显著优于APRI(其敏感度和特异度分别为90.0%和81.5%)或LSM(其敏感度和特异度分别为75.0%和96.3%)诊断。结论应用LSM联合APRI诊断AIH患者显著性肝纤维化具有较高的临床应用价值,或可用于初筛检查。

关键词: 自身免疫性肝炎, 肝纤维化, 天冬氨酸氨基转移酶/血小板计数比值, 瞬时弹性成像, 诊断

Abstract: Objective The aim of this study was conducted to explore the clinical prediction of significant liver fibrosis by transient ultrasound elastography and the aspartate aminotransferase/platelet ratio index (APRI) combination in patients with autoimmune hepatitis (AIH). Methods 67 patients with AIH and 54 healthy individuals at physical examination were enrolled in our hospital between August 2019 and August 2022, and all received FibroScan detection for liver stiffness measurement (LSM) and blood routine for the calculation of APRI. The patients with AIH underwent liver biopsies. The receiver operating characteristic curve (ROC) was applied to analyze the diagnostic performance of APRI and LSM for predicting significant liver fibrosis (SLF, >=S2) in patients with AIH. Results Serum AST level in patients with AIH was (104.3±21.9)U/L, significantly higher than [(30.5±5.1)U/L, P<0.05], the APRI and LSM were (1.4±0.1) and (8.1±1.2)kPa, both significantly greater than [(0.4±0.1) and (4.3±0.7)kPa, P<0.05], while the peripheral blood platelet count was (157.8±23.1)×10⁹/L, significantly less than [(208.5±20.7)×10⁹/L, P<0.05] in the healthy control; the liver histopathological examination showed the liver fibrosis S0 stage in 10 cases, S1 in 17 cases, S2 in 19 cases, S3 in 13 cases and S4 in 8 cases in our series; the APRI and LSM in patients with liver fibrosis S4 were(2.1±0.3) and (13.9±2.8)kPa, in S3 were (1.8±0.2) and (11.2±2.1)kPa, and in S2 were (1.5±0.2) and (7.6±1.5)kPa, all significantly higher than(1.1±0.2) and (6.1±1.2)kPa in S1 (P<0.05) or (0.8±0.1) and (4.0±0.5)kPa in S0 (P<0.05); the ROC analysis showed that the AUC was 0.950, with the sensitivity (Se) of 95.0% and the specificity (Sp) of 85.2%, when the APRI (with the cut-off-value of 1.5) and the LSM (with the cut-off-value of 7.5 kPa) were combined in predicting SLF, much superior to that by APRI(with the Se of 90.0% and the Sp of 81.5%) or by the LSM(with the Se of 75.0% and the Sp of 96.3%)diagnosis. Conclusion The combination of LSM and APRI might a high diagnostic efficacy in predicting SLF in patients with AIH, and warrants further clinical investigation.

Key words: Autoimmune hepatitis, Liver fibrosis, Aspartate aminotransferase/platelet ratio index, Transient ultrasound elastography, Diagnosis

阎道博, 朱海超, 闪海霞. 瞬时弹性成像联合APRI诊断自身免疫性肝炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 831-834.

Yan Daobo, Zhu Haichao, Shan Haixia. Assessment of significant liver fibrosis by transient ultrasound elastography and APRI combination in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2023, 26(6): 831-834.

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瞬时弹性成像联合APRI诊断自身免疫性肝炎患者肝纤维化效能研究^*

Assessment of significant liver fibrosis by transient ultrasound elastography and APRI combination in patients with autoimmune hepatitis

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