瞬时弹性成像技术和无创诊断模型诊断原发性胆汁性胆管炎患者肝纤维化效能研究*

doi:10.3969/j.issn.1672-5069.2024.05.020

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (5): 725-728.doi: 10.3969/j.issn.1672-5069.2024.05.020

瞬时弹性成像技术和无创诊断模型诊断原发性胆汁性胆管炎患者肝纤维化效能研究^*

任艳, 孔明, 徐曼曼, 白丽, 陈煜

100069 北京市首都医科大学附属北京佑安医院肝病中心四科

收稿日期:2023-09-12 出版日期:2024-09-10 发布日期:2024-09-09
通讯作者: 陈煜,E-mail:chybeyond1071@ccmu.edu.cn
作者简介:任艳,女,37岁,博士研究生。yanzihuakai1226@126.com
基金资助:
^*北京市医院管理中心“登峰”人才培养计划项目(编号:DFL20221501);北京市高层次公共卫生技术人才培养计划项目(编号:2022-2-012);北京市自然科学基金自助项目(编号:7232081)

Predictive performance of transient elastography and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis

Ren Yan, Kong Ming, Xu Manman, et al

Fourth Division, Liver Disease Center, You'an Hospital, Capital Medical University, Beijing 100069, China

Received:2023-09-12 Online:2024-09-10 Published:2024-09-09

摘要/Abstract

摘要： 目的研究瞬时弹性成像技术(TE)和常用的无创诊断模型诊断原发性胆汁性胆管炎(PBC)患者组织学分期的效能。方法 2019年1月～2023年8月首都医科大学附属北京佑安医院就诊的PBC患者117例,均接受肝活检、肝脏硬度检测(LSM)和常规实验室检查,计算天冬氨酸氨基转移酶/血小板比值(APRI)、基于 4 因子的肝纤维化指数(FIB-4)、 γ-谷氨酰转肽酶/血小板比值(GPR)、Sheth指数、King’s评分、哥德堡大学肝硬化指数(GUCI) 评分、白蛋白-胆红素(ALBI)评分和总胆汁酸-红细胞体积分布宽度(TR)评分。应用ROC曲线分析判断各指标的诊断效能。结果在117例PBC患者中,病理学诊断I期17例,II期59例、III期34例和IV期7例;APRI诊断PBC II期以上的AUC最大,为0.875(0.776～0.974),其敏感性为75.8%,特异性为87.5%,阳性预测值为76.5%和阴性预测值为87.0%,其次是GUCI评分,其AUC=0.871(0.766～0.976),其效能分别为88.7%、75.0%、65.6%和92.4%。结论 APRI是一种简便、廉价的非侵入性预测指标,用于判断II以上PBC患者有良好的诊断效能,值得临床扩大验证。

关键词: 原发性胆汁性胆管炎, 无创诊断模型, 瞬时弹性成像, 肝纤维化, 诊断

Abstract: Objective The aim of this study was to investigate the predictive performance of transient elastography (TE)and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis (PBC). Methods This study enrolled 117 patients with PBC in Beijing You’an Hospital, affiliated to Capital Medical University between January 2019 and August 2023, and all patients underwent liver biopsy and liver stiffness measurement (LSM). The aspartate aminotransferase/platelet ratio (APRI), fibrosis index based on the four factors (FIB-4), gamma-glutamyl transferase to platelet ratio (GPR), Sheth index, King's score, Gotebörg university cirrhosis index (GUCI) score,albumin-bilirubin (ALBI) score, total bile acid - red cell volume distribution width (TR) score were calculated. The ROC curve analysis was conducted to evaluate the predictive efficacy of each index. Results Out of the 117 patients with PBC, the histo-pathological examination showed stage I in 17 cases, stage II in 59 cases, stage III in 34 cases and stage IV in 7 cases; the AUC was 0.875(0.776-0.974) by APRI in predicting the stage II and the above disease, with the sensitivity(Se), specificity(Sp), positive predictive value (PPV) and negative predictive value (NPV) of 75.8%, 87.5%, 76.5% and 87.0%, and the other relatively promising index was the GUCI score, with the AUC of 0.871(0.766-0.976), and Se, Sp, PPV and NPV of 88.7%, 75.0%, 65.6% and 92.4%, respectively. Conclusion The APRI is a simple and inexpensive non-invasive index with a good diagnostic efficacy in predicting stage II or above PBC patients, which needs further clinical investigation.

Key words: Primary biliary cholangitis, Non-invasive diagnostic model, Transient elastography, Liver fibrosis, Diagnosis

任艳, 孔明, 徐曼曼, 白丽, 陈煜. 瞬时弹性成像技术和无创诊断模型诊断原发性胆汁性胆管炎患者肝纤维化效能研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 725-728.

Ren Yan, Kong Ming, Xu Manman, et al. Predictive performance of transient elastography and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis[J]. Journal of Practical Hepatology, 2024, 27(5): 725-728.

参考文献

[1] Cheung AC, Larusso NF, Gores GJ, et al. Epigenetics in the primary biliary cholangitis and primary sclerosing cholangitis. Semin Liver Dis, 2017, 37(2): 159-174.
[2] Park JW, Kim JH, Kim SE, et al. Primary biliary cholangitis and primary sclerosing cholangitis: current knowledge of pathogenesis and therapeutics. Biomedicines, 2022, 10(6)633-636.
[3] Lyu T, Chen S, Li M, et al. Regional variation and temporal trend of primary biliary cholangitis epidemiology: a systematic review and meta-analysis. J Gastroenterol Hepatol, 2021, 36(6): 1423-1434.
[4] 尤红, 段维佳, 李淑香, 等. 原发性胆汁性胆管炎的诊断和治疗指南(2021年). 临床肝胆病杂志, 2022, 38(1): 35-41.
[5] You H, Ma X, Efe C, et al. APASL clinical practice guidance: the diagnosis and management of patients with primary biliary cholangitis. Hepatol Int, 2022, 16(1): 1-23.
[6] Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med, 2001, 344(7): 495-500.
[7] Yamashita Y, Umemura T, Kimura T, et al. Prognostic utility of albumin-bilirubin grade in Japanese patients with primary biliary cholangitis. JHEP Rep, 2023, 5(4): 100662.
[8] Tu Z, Wang Y, Wang Y, et al. TR score: a noninvasive model to predict histological stages in patients with primary biliary cholangitis. Front Immunol, 2023, 14:1152294.
[9] Ludwig J, Dickson ER, Mcdonald GS. Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch A Pathol Anat Histol, 1978, 379(2): 103-112.
[10] Trivella J, John BV, Levy C. Primary biliary cholangitis: Epidemiology, prognosis, and treatment. Hepatol Commun, 2023, 7(6):325-328.
[11] Lindor KD, Bowlus CL, Boyer J, et al. Primary biliary cholangitis: 2018 practice guidance from the american association for the study of liver diseases. Hepatology, 2019, 69(1): 394-419.
[12] Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology, 2008, 134(4): 960-974.
[13] 瞬时弹性成像技术(TE)临床应用专家共识(2015年). 中国肝脏病杂志(电子版), 2015, 7(2): 12-18.
[14] Gómez-Dominguez E, Mendoza J, García-Buey L, et al. Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis. Aliment Pharmacol Ther, 2008, 27(5): 441-447.
[15] Corpechot C. Utility of noninvasive markers of fibrosis in cholestatic liver diseases. Clin Liver Dis, 2016, 20(1): 143-158.
[16] Patel K, Sebastiani G. Limitations of non-invasive tests for assessment of liver fibrosis. JHEP Rep, 2020, 2(2): 100067.
[17] Cristoferi L, Calvaruso V, Overi D, et al. Accuracy of transient elastography in assessing fibrosis at diagnosis in naïve patients with primary biliary cholangitis: a dual cut-off approach. Hepatology, 2021, 74(3): 1496-1508.
[18] Islam S, Antonsson L, Westin J, et al. Cirrhosis in hepatitis C virus-infected patients can be excluded using an index of standard biochemical serum markers. Scand J Gastroenterol, 2005, 40(7): 867-872.
[19] Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2): 518-526.
[20] Okdemir S, Cakmak E. A novel non-invasive score for the prediction of advanced fibrosis in patients with chronic hepatitis B. Ann Hepatol, 2022, 27(1): 100544.

瞬时弹性成像技术和无创诊断模型诊断原发性胆汁性胆管炎患者肝纤维化效能研究^*

Predictive performance of transient elastography and other common non-invasive diagnostic models in predicting histological fibrosis staging in patients with primary biliary cholangitis

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]	韦新焕, 柳雅立, 张晶, 贾继东. 代谢相关性脂肪性肝硬化诊疗进展^*[J]. 实用肝脏病杂志, 2024, 27(5): 641-645.
[2]	杨逸铭, 李晓环, 刘玉品, 欧金龙, 黎胜, 石美凤, 汪印强. FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 701-704.
[3]	谢爱萍, 赵景, 蒋祁明, 何秀波. 超声声衰减系数与受控衰减参数联合肝脏硬度检测诊断NAFLD患者NASH发生效能研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 705-708.
[4]	高怡, 沈小雪, 夏素芹, 张洁, 朱先兰. 自身免疫性肝炎和原发性胆汁性胆管炎患者血清胆汁酸成分变化及其对治疗应答的影响^*[J]. 实用肝脏病杂志, 2024, 27(5): 709-712.
[5]	王燕燕, 周桐桐, 卞兆连. 原发性胆汁性胆管炎和原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征患者临床与肝组织病理学特点分析^*[J]. 实用肝脏病杂志, 2024, 27(5): 721-724.
[6]	信亮亮, 温智. 2D-SWE技术联合FIB-4和血清VEGF水平评估乙型肝炎肝硬化患者食管静脉曲张价值研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 737-740.
[7]	连作勤, 王世明, 张甲, 李付平. 富马酸丙酚替诺福韦联合复方鳖甲软肝片治疗乙型肝炎肝硬化患者疗效和安全性评估^*[J]. 实用肝脏病杂志, 2024, 27(5): 753-756.
[8]	陈思彤, 卫小蝶, 韦新焕, 郭海清, 张晶. 代谢功能障碍相关脂肪性肝病诊疗进展^*[J]. 实用肝脏病杂志, 2024, 27(4): 481-483.
[9]	柳雅立, 张晶. 儿童和青少年代谢相关脂肪性肝病研究进展^*[J]. 实用肝脏病杂志, 2024, 27(4): 488-491.
[10]	中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 实用肝脏病杂志, 2024, 27(4): 494-510.
[11]	罗洪霞, 李静秋, 李媛媛, 冯国隽, 余霞. 超重/肥胖非酒精性脂肪性肝病儿童磁共振质子密度脂肪分数检测意义研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 527-530.
[12]	任浩, 熊清芳. 多种无创检测指标预测自身免疫性肝病患者肝硬化效能比较^*[J]. 实用肝脏病杂志, 2024, 27(4): 535-538.
[13]	柯海霞, 张娇珍, 蒙夏玲, 许政衡, 邓丕豪. 慢加急性乙型肝炎肝衰竭患者血清CRP和sTREM-1水平变化及其预测继发感染的价值研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 555-558.
[14]	汤泽宇, 顾菲, 周健文, 姜小兰, 毛雨婧, 樊琦. CT参数联合FIB-4和血清VEGF水平预测乙型肝炎肝硬化患者并发食管静脉曲张效能分析^*[J]. 实用肝脏病杂志, 2024, 27(4): 579-582.
[15]	夏礼鹏, 褚玉玄, 赵如盛. 增强MRI联合IVIM-DWI诊断小肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(4): 587-590.