关键词: 慢性乙型肝炎, 肝纤维化, 剪切波弹性成像, Logistic回归分析, ROC曲线

Abstract: Objective To investigate the shear wave elastography (SWE, or E imaging) and serological markers in the evaluation of significant liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 76 patients with CHB were enrolled in our hospital between January 2017 and January 2020, and all of them received liver biopsies and hepatic SWE examination. The APRI and FIB-4 scores were calculated. Multivariate Logistic regression analysis was applied to analyze the independent risk factors of liver fibrosis, and the area under receiver operating characteristic curve (AUROC) was used to evaluate the accuracy of each index in the diagnosis of liver fibrosis. Results Among the 76 patients with CHB, there were 8 cases of F0 stage, 22 cases of F1 stage, and 25 cases of F2 stage, 12 cases of F3 stage and 9 cases of F4 stage by histopathological examination; We combined F0 and F1 stages of liver fibrosis as non-significant liver fibrosis group (n = 30),and defined F2, F3 and F4 stages as significantly group (n = 46); the Young's modulus of patients in non-significant group was (6.6±1.2) kpa, significantly lower than that in significant group [(12.7±2.1) kpa, P<0.05]; serum HA level in patients with non-significant group was 36.4 (23.1-70.6) g/L, significantly lower than that in significant group [92.3 (67.2-192.5) g/L, P <0.05], serum LN level was 42.9(26.4-58.4)μg/L, significantly lower than [75.8(36.8-142.0)μg/L, P<0.05], serum Ⅳ-C level was 36.6(24.0-75.3)μg/L, significantly lower than [102.2(47.2-245.8)μg/L, P<0.05], and serum PⅢP level was 8.2(7.2-10.5)μg/L, significantly lower than [17.0(7.7-26.8)μg/L, P<0.05] in patients with significant liver fibrosis; the APRI score in patients without significant fibrosis was (0.5±0.2) , significantly lower than that in those with significant fibrosis [(1.0±0.4), P<0.05], and the FIB-4 score was (1.2±0.9), significantly lower than that in with significant group [(2.1±1.3), P<0.05]; multivariate Logistic regression analysis showed that Young’s modulus, APRI and FIB-4 were the independent predictors of significant liver fibrosis in CHB patients (P<0.05); the AUC of Young's modulus was 0.89, significantly higher than 0.80 (P<0.05) by APRI or 0.77 (P<0.05) by FIB-4, in diagnosing significant liver fibrosis, with the diagnostic cut-off value, sensitivity and specificity being of 7.5 kPa, 84.5% and 88.4%, respectively. Conclusion The detection of Young's modulus of liver by ultrasound E-imaging might effectively diagnose significant hepatic fibrosis in patients with CHB, which is of great clinical value.

Key words: Chronic hepatitis B, Liver fibrosis, Shear wave elastography, Logistic regression analysis, ROC curve