CT测量肝外基质体积分数评估慢性乙型肝炎患者肝纤维化临床应用研究*

doi:10.3969/j.issn.1672-5069.2020.04.010

摘要/Abstract

摘要： 目的应用多期动态CT检查测量肝外基质体积分数(fECV)评估慢性乙型肝炎(CHB)患者肝纤维化(HF)程度。方法 2015年1月～2020年1月我院诊治的CHB患者138例,接受肝活检和CT增强扫描检查,并测定肝外基质体积分数(fECV),绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),评估fECV诊断肝纤维化的效能。结果在本组138例CHB患者中,经组织病理学诊断F0期14例,F1期28例,F2期45例,F3期36,F4期15例,即F0～1组42例,F2～4组96例,F3～4组51例;F0～1组肝实质CT强化值为(24.6±8.8)HU,与F2～4组的(25.2±5.6)HU比,差异无统计学意义(P>0.05),但主动脉CT强化值、fECV和红细胞压积分别为(44.8±9.4)HU、(27.8±4.5)%和(40.8±5.2)%,与F2～4组比,差异显著【分别为(40.6±7.2)HU、(37.5±4.8)%和(37.6±6.2)%,P<0.05】;fECV诊断CHB患者F2～4、F3～4和F4的截断点、AUC及95%CI、敏感度、特异度和准确度分别为30.2%、0.71(0.59～0.84)、65.5%、78.0%和74.5%;34.0%、0.76(0.62～0.89)、75.8%、74.2%和75.0%和36.8%、0.81(0.67～0.96)、90.5%、72.6%和86.8%。结论采用多期动态CT增强扫描检查测量fECV可以帮助诊断CHB患者HF,值得临床进一步验证。

关键词: 慢性乙型肝炎, 肝纤维化, CT检查, 肝外基质体积分数, 诊断

Abstract: Objective The aim of this study was to investigate the hepatic extracellular volume fractions (fECV) measured by CT scan as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with chronic hepatitis B virus infection. Methods A total of 138 patients with chronic hepatitis B (CHB) were recruited in our hospital between January 2015 and January 2020, and all underwent routine multi-stage enhanced liver CT scan and liver biopsies. The fECV were measured. The ROC curve and the area under the curve (AUC) were calculated and the sensitivity, specificity and accuracy were obtained. Results Out of our series of 138 patients with CHB, the histopathological examination showed the F0 in 14, F1 in 28, F2 in 45, F3 in 36 and F4 in 15, e.g. F0-1 in 42, F2-4 in 96 and F3-4 in 51; the absolute enhancement of liver parenchyma in patients with F0-1 was(24.6±8.8)HU, not significantly different compared to (25.2±5.6)HU in F2-4 (P>0.05), while the absolute enhancement value of aorta, fECV and hematokrit were (44.8±9.4)HU, (27.8±4.5)% and (40.8±5.2)%, significantly different compared to 【(40.6±7.2)HU,(37.5±4.8)% and (37.6±6.2)%, respectively, P<0.05】 in F2～4 group; the cut-off-value, the AUC (95% CI) , sensitivity, specificity and accuracy of fECV in diagnosing F2-4, F3-4 and F4 in patients with CHB were 30.2%, 0.71(0.59 to 0.84), 65.5%, 78.0% and 74.5%; 34.0%, 0.76(0.62 to 0.89), 75.8%, 74.2% and 75.0%; and 36.8%, 0.81(0.67 to 0.96), 90.5%, 72.6% and 86.8%. Conclusion The measurement of fECV by multi-phase dynamic CT scan might be applied as an effective noninvasive index for the diagnosis of HF in patients with CHB, which needs further investigation.

Key words: Hepatitis B, Hepatic fibrosis, Hepatic extracellular volume fractions, CT scan, Receiver operating characteristic curve, Diagnosis

周莹, 陈娇, 叶龙, 刘启榆, 钟唐力. CT测量肝外基质体积分数评估慢性乙型肝炎患者肝纤维化临床应用研究^*[J]. 实用肝脏病杂志, 2020, 23(4): 492-495.

Zhou Ying, Chen Jiao, Ye Long, et al. Hepatic extracellular volume fractions measured by CT scan as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with chronic hepatitis B virus infection[J]. Journal of Practical Hepatology, 2020, 23(4): 492-495.

参考文献

[1]Sebastiani G, Ghali P, Wong P, et al. Physicians’ practices for diagnosing liver fibrosis in chronic liver diseases: a nationwide, Canadian survey. Can J Gastroenterol Hepatol, 2014, 28:23e30.
[2]Yan LT, Wang LL, Yao J, et al.Total bile acid-to-cholesterol ratio as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with non-cholestatic chronic hepatitis B virus infection. Medicine (Baltimore), 2020, 99(8):e19248.
[3]葛善飞, 程娜, 余燕青, 等. 肝纤维化形成中高迁移率族蛋白1与肝细胞核因子1α的表达变化及相关性的实验研究. 中华肝脏病杂志, 2017, 25(5):386-388.
[4]Sripongpun P, Tangkijvanich P, Chotiyaputta W, et al. Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores for hepatic fibrosis assessment compared with transient elastography in chronic hepatitis C patients. JGH Open, 2019, 4(1):69-74.
[5]Buonomo AR, Scotto R, Coppola C, et al.Direct acting antivirals treatment for hepatitis C virus infection does not increase the incidence of de novo hepatocellular carcinoma occurrence: Results from an Italian real-life cohort (LINA cohort). Medicine (Baltimore), 2020, 99(6):e18948.
[6]孙玉洁, 贾因棠. 直接抗病毒药物抗丙型肝炎病毒治疗改善肝纤维化程度的疗效. 中华实验和临床感染病杂志(电子版), 2019, 13(5): 414-420.
[7]Huang YS, Sun HY, Chang SY, et al.Long-term virological and serologic responses of chronic hepatitis B virus infection to tenofovir disoproxil fumarate-containing regimens in patients with HIV and hepatitis B coinfection. Hepatol Int, 2019, 13(4):431-439.
[8]Darweesh SK, Elsaeed K, Omar H, et al. High SVR rate following retreatment of non-sustained virological responders to sofosbuvir based anti-HCV therapies regardless of RAS testing: A real-life multicenter study. Expert Rev Gastroenterol Hepatol, 2019, 13(9):907-914.
[9]李阿利, 陈华忠, 邵辉, 等. 血清可溶性甘露糖受体在慢性乙型肝炎患者中的表达及诊断肝纤维化的价值. 中华临床感染病杂志, 2019, 12(5): 354-358.
[10]Lin Y, Li H, Jin C, et al.The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis. PLoS One, 2020, 15(1):e0227358.
[11]Lin MT, Wang CC, Cheng YF, et al.Comprehensive comparison of multiple-detector computed tomography and dynamic magnetic resonance imaging in the diagnosis of hepatocellular carcinoma with varying degrees of fibrosis. PLoS One, 2016, 11(11):e0166157.
[12]Lewis S, Roayaie S, WardSC, et al. Hepatocellular carcinoma in chronic hepatitis C in the absence of advanced fibrosis or cirrhosis. AJR, 2013, 200(6):W610-616.
[13]Sersté T, Barrau V, Ozenne V, et al. Accuracy and disagreement of computed tomography and magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma and dysplastic nodules: role of biopsy. Hepatology, 2012, 55(3):800-806.
[14]Zissen MH, Wang ZJ, Yee J, et al. Contrast-enhanced CT quantification of the hepatic fractional extracellular space: correlation with diffuse liver disease severity.Am J Roentgenol, 2013, 201:1204e10.
[15]中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015 年版). 实用肝脏病杂志, 2016, 19(3):389-400.
[16]Arheden H, Saeed M, Higgins CB, et al. Measurement of the distribution volume of gadopentetate dimeglumine at echo-planar MR imaging to quantify myocardial infarction: comparison with ⁹⁹mTc-DTPA autoradiography in rats. Radiology, 1999, 211:698e708.
[17]Wong TC, Piehler K, Meier CG, et al. Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation, 2012, 126(10):1206-1216.
[18]Guo SL, Su LN, Zhai YN, et al. The clinical value of hepatic extracellular volume fraction using routine multi-phasic contrast enhanced liver CT for staging liver fibrosis. Clin Radiol, 2017, 72:242-246.
[19]Yoon JH, Lee JM, Klotz E, et al. Estimation of hepatic extracellular volume fraction using multiphasic liver computed tomography for hepatic fibrosis grading. Invest Radiol, 2015, 50:290-296.
[20]Fukuda W, Hanyu T, Katayama M, et al. Risk stratification and clinical course of hepatitis B virus reactivation in rheumatoid arthritis patients with resolved infection: final report of a multicenter prospective observational study at Japanese Red Cross Hospital. Arthritis Res Ther, 2019,21(1):255.

CT测量肝外基质体积分数评估慢性乙型肝炎患者肝纤维化临床应用研究^*

Hepatic extracellular volume fractions measured by CT scan as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with chronic hepatitis B virus infection

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	文琼花, 唐敏云, 魏玉, 陈少文. 血清腺苷脱氨酶和淀粉样蛋白A辅助诊断自身免疫性肝炎患者临床价值分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 508-511.
[2]	程源, 张洋, 毛海洲, 段红光. 自身免疫性肝炎患者血清抗延胡索酸水合酶抗体检测及其临床意义探讨^*[J]. 实用肝脏病杂志, 2020, 23(4): 512-515.
[3]	李文渊, 叶超, 李磊, 方芳, 陈思, 王陆军, 张开光. 原发性胆汁性胆管炎患者血清自身抗体和临床特征分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 516-519.
[4]	李娜, 郑少秋, 赵守松. FibroScan联合多种预测模型预测肝硬化患者食管静脉曲张程度应用价值探讨[J]. 实用肝脏病杂志, 2020, 23(4): 560-563.
[5]	汪志亮, 胡磊, 刘啸峰. 多层螺旋CT对比剂注射流率对肝硬化患者门静脉成像延迟时间的影响^*[J]. 实用肝脏病杂志, 2020, 23(4): 564-567.
[6]	宋丽俊, 袁雁, 王伟. 定量磁共振成像诊断原发性胆汁性肝硬化患者门静脉高压症价值分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 568-571.
[7]	陆伦根. 重视肝纤维化的诊断和评估[J]. 实用肝脏病杂志, 2020, 23(3): 305-306.
[8]	李文渊,李磊. 肝纤维化非创伤性诊断与评估[J]. 实用肝脏病杂志, 2020, 23(3): 312-315.
[9]	艾国,王鸣,朱纪玲,邢铭友. 应用N-乙酰半胱氨酸治疗慢性乙型肝炎重度患者临床疗效初步研究[J]. 实用肝脏病杂志, 2020, 23(3): 336-339.
[10]	王丽君,靳广甫,王齐,吴丹,李素娟. 代谢综合征患儿肝前脂肪厚度和腰围变化[J]. 实用肝脏病杂志, 2020, 23(3): 376-379.
[11]	康晓,俞力,王蕾,霍江波,黄莉. 超声内镜检查诊断乙型肝炎肝硬化患者食管胃底静脉曲张价值分析[J]. 实用肝脏病杂志, 2020, 23(3): 397-400.
[12]	曹东明,景香香,林运旺. 肝转移癌超声造影增强模式表现分析[J]. 实用肝脏病杂志, 2020, 23(3): 431-434.
[13]	兰方荣,洪可. 肝脓肿患者超声造影特点及诊断价值分析[J]. 实用肝脏病杂志, 2020, 23(3): 435-438.
[14]	薛芮,范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介[J]. 实用肝脏病杂志, 2020, 23(3): 0-S58.
[15]	温博, 王炳元. Wilson’s病:一个潜在的可治疗的遗传性疾病^*[J]. 实用肝脏病杂志, 2020, 23(2): 156-158.