肝脏硬度检测联合血清肝纤维化标志物评估慢性乙型肝炎患者肝纤维化程度价值研究*

doi:10.3969/j.issn.1672-5069.2026.01.005

摘要/Abstract

摘要： 目的探讨肝脏硬度检测(杨氏模量值)联合血清肝纤维化标志物诊断慢性乙型肝炎(CHB)患者肝纤维化的价值。方法 2022年3月～2025年3月我院诊治的116例CHB患者,均接受肝穿刺活检,常规检测血清透明质酸(HA)、层粘连蛋白(LN)、三型前胶原N末端肽(PⅢNP)和四型胶原(CⅣ),使用超声剪切波技术检测杨氏模量值,应用多因素Logistic回归分析影响因素,应用ROC曲线评估诊断效能。结果在116例CHB患者中,肝组织病理学检查诊断S0者35例,S1者16例(即无显著性肝纤维化51例),S2者(显著性纤维化)35例,S3者(进展性肝纤维化)22例和S4(肝硬化)8例;肝硬化组杨氏模量值为(20.6±4.0)kPa,显著高于进展性肝纤维化组【(17.2±2.5)kPa,P＜0.05】或显著性肝纤维化组【(15.6±3.8)kPa,P＜0.05】或非显著性肝纤维化组【(10.9±2.2)kPa,P＜0.05】;显著性或进展性肝纤维化组血清HA、CⅣ或/和PⅢNP水平显著高于非显著性肝纤维化组(P＜0.05);多因素Logistic回归分析结果显示部分血清肝纤维化标志物和杨氏模量值升高是CHB患者发生显著性肝纤维化的危险因素(P＜0.05);ROC曲线分析显示, 杨氏模量值联合至少两种血清肝纤维化标志物升高诊断CHB患者显著性肝纤维化的效能较高,预测的准确度为98.8%。结论杨氏模量值诊断CHB患者显著性肝纤维化的效能较高,而血清肝纤维化标志物水平变化较大,与杨氏模量值联合可能提高诊断的准确性。

关键词: 慢性乙型肝炎, 肝纤维化, 肝纤维化标志物, 肝脏硬度检测, 诊断

Abstract: Objective The aim of this study was to investigate assessment of liver fibrosis by Yang’s modules in combination with serum liver fibrosis markers in patients with chronic hepatitis B (CHB). Methods A total of 116 patients with CHB were encountered in our hospital between March 2022 and March 2025, and all underwent liver biopsies. Serum hyaluronic acid (HA), laminin (LN), N-terminal propeptide of type Ⅲ procollagen (PⅢNP) and type Ⅳ collagen (CⅣ) levels were detected routinely. Yang’s modules was measured by shear wave elastography. Multivariate Logistic regression analysis was used to find impacting factors for liver fibrosis, and receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of liver fibrosis in patients with CHB. Results Of the 116 patients with CHB, liver histopathological examination proved liver fibrosis S0 in 35 cases, S1 in 16 cases [e.g., non-significant liver fibrosis (NSLF) in 51 cases], S2[(significant liver fibrosis(SLF)in 35 cases], S3 [advanced liver fibrosis (AdLF) in 22 cases and S4(liver cirrhosis) in 8 cases; Yang’s modules in patients with liver cirrhosis was (20.6±4.0)kPa,much greater than [(17.2±2.5)kPa,P＜0.05] in patients with AdLF or [(15.6±3.8)kPa,P＜0.05] in those with SLF or [(10.9±2.2)kPa,P＜0.05] in those with NSLF;serum HA, CⅣ and/or PⅢNP levels in patients with SLF or AdLF elevated greatly(P＜0.05);multivariate Logistic regression analysis showed that increases serum liver fibrosis markers and Yang’s modules were impacting factors for SLF in patients with CHB (P＜0.05);ROC analysis demonstrated that the predicting performance for SLF by Yang’s modules in combination with at least two increased serum liver fibrosis markers was satisfactory, with accuracy of 98.8% in patients with CHB. Conclusion Serum liver fibrosis markers could play an auxiliary role to Yang’s modules in predicting liver fibrosis in patients with CHB.

Key words: Hepatitis B, Liver fibrosis, Liver fibrosis markers, Shear wave elastography, Diagnosis

王金平, 赵霞, 李伟明, 孙小惠, 王梦瑶, 李媛. 肝脏硬度检测联合血清肝纤维化标志物评估慢性乙型肝炎患者肝纤维化程度价值研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 17-20.

Wang Jinping, Zhao Xia, Li Weiming, et al. Assessment of liver fibrosis by Yang’s modules in combination with serum liver fibrosis markers in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2026, 29(1): 17-20.

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肝脏硬度检测联合血清肝纤维化标志物评估慢性乙型肝炎患者肝纤维化程度价值研究^*

Assessment of liver fibrosis by Yang’s modules in combination with serum liver fibrosis markers in patients with chronic hepatitis B

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