应用STE/STQ技术评估慢性乙型肝炎患者肝纤维化程度效能研究*

doi:10.3969/j.issn.1672-5069.2024.01.006

摘要/Abstract

摘要： 目的探讨采用声触诊弹性成像(STE)和声触诊弹性测量(STQ)技术评估慢性乙型肝炎(CHB)患者肝纤维化程度的效能。方法 2020年1月～2022年12月我院收治的CHB患者126例,常规进行肝穿刺活检,将组织病理学诊断为F0期和F1期肝纤维化定义为非显著性肝纤维化,将F2期、F3期和F4期肝纤维化定义为显著性肝纤维化。使用STE和STQ技术行肝硬度检测(LSM),常规检测血生化和血常规,计算肝纤维化-4因子指数(FIB-4)和天冬氨酸氨基转移酶/血小板比率指数(APRI),应用Logistic回归分析影响肝纤维化程度的因素,应用受试者工作特征曲线下面积(AUC)评估STE和STQ技术诊断CHB患者显著性肝纤维化的效能。结果在126例CHB患者中,肝组织病理学检查显示F0期肝纤维化7例、F1期38例、F2期42例、F3期34例和F4期5例,即非显著性肝纤维化组45例和显著性肝纤维化组81例;显著性肝纤维化组LSM_STE、LSM_STQ、FIB-4和APRI分别为(13.6±3.4)kPa、(16.8±4.5)kPa、(2.0±0.5)和(1.1±0.3),均显著高于非显著性肝纤维化组【分别为(9.2±2.3)kPa、(10.7±3.1)kPa、(1.4±0.3)和(0.7±0.2),P＜0.05】;多因素Logistic回归分析显示,LSM_STE、LSM_STQ、FIB-4和APRI为影响CHB患者发生显著性肝纤维化的独立因素(P＜0.05);ROC曲线分析显示,LSM_STE和LSM_STQ诊断CHB患者显著性肝纤维化的截断点、AUC、敏感度和特异度分别为11.6 kPa、0.867、76.5%和86.7%,和14.8 kPa、0.856、70.4%和86.7%,均显著优于FIB-4(1.8、0.753、60.5%和80.0%,P＜0.05)或APRI(1.0、0.736、59.3%和77.8%,P＜0.05)诊断。结论采用STE和STQ技术检测肝脏硬度能有效评估CHB患者肝纤维化程度,可为临床诊断和治疗提供无创诊断手段,具有良好的应用价值,值得临床进一步研究。

关键词: 慢性乙型肝炎, 肝纤维化, 声触诊弹性成像, 声触诊弹性测量, 诊断

Abstract: Objective The aim of this study was to explore the evaluation of liver fibrosis by liver stiffness measurement (LSM) revealed by sound touch elastography (STE) and sound touch quantify (STQ) in patients with chronic hepatitis B (CHB). Methods 126 patients with CHB were enrolled in our hospital between January 2020 and December 2022, and all underwent routine liver biopsy. The non-significant liver fibrosis (NSLF) was defined as liver fibrosis at stages F0 and F1, and the significant liver fibrosis (SLF) was defined as liver fibrosis at stages F2, F3 and F4. The LSM was detected by STE and STQ. The blood routine and serum biochemical parameters were routinely obtained, and the fibrosis index based on the four factors (FIB-4) and aspartate aminotransferase /platelet ratio index (APRI) were calculated. The influencing factors of liver fibrosis severity were analyzed by multivariate Logistic regression analysis, and the diagnostic efficacy for the severity of liver fibrosis was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). Results Out of the 126 patients with CHB, the liver histopathological examination showed liver fibrosis at stage F0 in 7 cases, F1 in 38 cases, F2 in 42 cases, F3 in 34 cases and F4 in 5 cases, e.g., the NSLF in 45 cases and SLF in 81 cases; the LSM_STE, LSM_STQ, FIB-4 and APRI in patients with SLF were (13.6±3.4)kPa,(16.8±4.5)kPa, (2.0±0.5) and (1.1±0.3), all significantly greater than [(9.2±2.3) kPa, (10.7±3.1)kPa, (1.4±0.3) and (0.7±0.2), respectively, P＜0.05] in patients with NSLF; the multivariate Logistic regression analysis showed that the LSM_STE, LSM_STQ, FIB-4 and APRI were all the independent risk factors impacting the existence of SLF in patients with CHB (P＜0.05); the ROC analysis demonstrated that the cut-off-value, the AUCs, the sensitivity (Se) and specificity(Sp) by LSM_STE and LSM_STQ in predicting the occurrence of SLF in patients with CHB were 11.6 kPa, 0.867, 76.5% and 86.7%, and 14.8 kPa, 0.856, 70.4% and 86.7%, all much superior to 1.8, 0.753, 60.5% and 80.0% (P＜0.05) by FIB-4 or 1.0, 0.736, 59.3% and 77.8% (P＜0.05) by APRI. Conclusion The detection of SLM obtained by STE and STQ might help evaluate the severity of liver fibrosis in patients with CHB, and warrants further clinical investigation.

Key words: Hepatitis B, Liver fibrosis, Liver stiffness measurement, Sound touch elastography, Sound touch quantify, Diagnosis

李凯, 石波, 程序, 赵凯. 应用STE/STQ技术评估慢性乙型肝炎患者肝纤维化程度效能研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 20-23.

Li Kai, Shi Bo, Cheng Xu, et al. Assessment of liver fibrosis with liver stiffness measurement obtained by STE/STQ in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2024, 27(1): 20-23.

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应用STE/STQ技术评估慢性乙型肝炎患者肝纤维化程度效能研究^*

Assessment of liver fibrosis with liver stiffness measurement obtained by STE/STQ in patients with chronic hepatitis B

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