声触诊组织量化技术联合血清肝纤维化指标诊断肝血吸虫病患者肝纤维化效能分析*

doi:10.3969/j.issn.1672-5069.2025.01.032

摘要/Abstract

摘要： 目的分析声触诊组织量化技术(VTQ)联合血清肝纤维化指标诊断肝血吸虫病患者肝纤维化的价值。方法 2022年2月～2024年4月我院收治的87例肝血吸虫病患者,所有患者均接受肝穿刺活检,使用超声VTQ检查测定剪切波速度(SWV),采用磁微粒化学发光免疫分析法检测血清层黏连蛋白(LN)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)和透明质酸酶(HA)水平。应用受试者工作特征(ROC)曲线评估指标的诊断效能。结果在87例肝血吸虫病患者中,组织病理学检查诊断S0者14例,S1者21例,S2者20例,S3者17例和S4者15例;S0、S1、S2、S3和S4患者肝脏SWV分别为(1.1±0.1)m/s、(1.2±0.1)m/s、(1.6±0.1)m/s、(1.8±0.2)m/s和(2.1±0.2)m/s,不同肝纤维化分期患者SWV差异具有统计学意义(P＜0.05);S2期患者血清LN、PC-Ⅲ、Ⅳ-C和HA水平分别为(125.8±16.6)ng/L、(98.4±12.6)ng/L、(67.3±14.9)ng/L和(110.8±20.6)ng/L,均显著高于S1期【分别为(107.3±22.9)ng/L、(85.6±11.2)ng/L、(55.9±12.6)ng/L和(95.1±16.5)ng/L,P＜0.05】;以>=S2为显著性肝纤维化,以SWV达到诊断的截断点(1.51 m/s)和四项血清肝纤维化指标中任两项达到诊断的截断点(LN=125 ng/L、PC-Ⅲ=98 ng/L、Ⅳ-C=68 ng/L,HA=109 ng/L),ROC曲线分析结果SWV联合血清指标诊断肝血吸虫病患者显著性肝纤维化的效能(敏感性为89.0%,特异性为100.0%)显著优于单一指标诊断。结论采用VTQ技术联合血清肝纤维化指标可帮助临床初步诊断肝血吸虫病患者肝纤维化程度,具有较高的诊断价值,值得临床进一步深入研究。

关键词: 肝血吸虫病, 肝纤维化, 声触诊组织量化技术, 血清肝纤维化指标, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of ultrasound virtual touch tissue quantification ((VTQ)) and serum liver fibrosis markers in predicting liver fibrosis in patients with hepatic schistosomiasis. Methods 87 patients with hepatic schistosomiasis were admitted to our hospital between February 2022 and April 2024, and all of them underwent liver biopsy to determine the stage of liver fibrosis. Ultrasonography was conducted to measure shear wave velocity (SWV). Serum laminin (LN), type III procollagen (PC-III), type IV collagen (IV-C)and hyaluronic acid (HA)levels were measured rountinely. Receiver operating characteristic (ROC) curves were drawn to evaluate diagnostic efficacy for significant liver fibrosis (SLF) in patients with hepatic schistosomiasis. Results Of 87 patients with hepatic schistosomiasis, liver histo-pathological examination showed liver fibrosis stage (S)0 in 14 cases, S1 in 21 cases, S2 in 20 cases, S3 in 17 cases and S4 in 15 cases; SWV in patients with S0, S1, S2, S3 and S4 were (1.1±0.1) m/s, (1.2±0.1)m/s, (1.6±0.1)m/s, (1.8±0.2)m/s and (2.1±0.2)m/s, significantly different among different liver fibrosis group (P＜0.05); serum LN, PC-Ⅲ,Ⅳ-C and HA levels in S2 group were (125.8±16.6)ng/L, (98.4±12.6)ng/L, (67.3±14.9)ng/L and (110.8±20.6)ng/L, all much higher than [(107.3±22.9)ng/L, (85.6±11.2)ng/L, (55.9±12.6)ng/L and (95.1±16.5)ng/L, respectively, P＜0.05] in S1 group;diagnostic efficacy was much superior to any single marker when combination of SWV (with cut-off-value of 1.51 m/s)and any two of four serum liver fibrosis markers (cut-off-value:LN=125 ng/L, PC-Ⅲ=98 ng/L, Ⅳ-C=68 ng/L and HA=109 ng/L)was assumed to predict SLF (>=S2), with the sensitivity of 89.0% and specificity of 100.0%. Conclusion The combination of VTQ and serum liver fibrosis markers has a satisfactory diagnostic performance in predicting SLF in patients with hepatic schistosomiasis, which is worthy of further clinical investigation.

Key words: Hepatic schistosomiasis, Liver fibrosis, Virtual touch tissue quantification, Serum liver fibrosis markers, Diagnosis

姜社甜, 闫卫, 赵磊, 胡园园, 郭蕾, 魏亚睿. 声触诊组织量化技术联合血清肝纤维化指标诊断肝血吸虫病患者肝纤维化效能分析^*[J]. 实用肝脏病杂志, 2025, 28(1): 124-127.

Jiang Shetian, Yan Wei, Zhao Lei, et al. Diagnostic performance of ultrasound virtual touch tissue quantification and serum liver fibrosis markers in predicting liver fibrosis in patients with hepatic schistosomiasis[J]. Journal of Practical Hepatology, 2025, 28(1): 124-127.

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声触诊组织量化技术联合血清肝纤维化指标诊断肝血吸虫病患者肝纤维化效能分析^*

Diagnostic performance of ultrasound virtual touch tissue quantification and serum liver fibrosis markers in predicting liver fibrosis in patients with hepatic schistosomiasis

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