超声剪切波弹性成像联合AAR、APRI和FIB-4指数诊断慢性乙型肝炎患者肝纤维化程度效能研究*

doi:10.3969/j.issn.1672-5069.2025.01.009

摘要/Abstract

摘要： 目的分析超声剪切波弹性成像(SWE)联合天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)、天冬氨酸氨基转移酶/血小板比值指数(APRI)和基于4因子的肝纤维化指标(FIB-4)检测诊断慢性乙型肝炎(CHB)患者肝纤维化程度的价值。方法 2022年1月～2024年6月我院诊治的CHB患者121例,均接受肝穿刺活检和SWE检查并测量杨氏模量值,常规行血液和血清检测,计算AAR、APRI和FIB-4。应用多因素Logistic回归分析影响CHB患者发生显著性肝纤维化的因素,应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析指标诊断显著性肝纤维化的效能。结果在121例CHB患者中,经肝组织病理学检查诊断肝纤维化F0期11例,F1期36例(非显著性肝纤维化47例),F2期40例,F3期19例(显著性肝纤维化59例)和F4期15例;显著组杨氏模量值、AAR、APRI和FIB-4分别为(11.5±3.1)kPa、(1.4±0.5)、(1.1±0.5)和(2.2±0.8),均显著大于非显著组[分别为(6.8±2.8)kPa、(1.0±0.3)、(0.6±0.2)和(1.5±0.6),P<0.05];多因素Logistic回归分析显示,杨氏模量值(OR=4.389,95% CI:2.059～9.352)、AAR(OR=2.342,95% CI:1.355～4.046)、APRI(OR=3.916,95% CI:1.892～8.102)和FIB-4(OR=1.306,95% CI:1.042～1.636)均是影响CHB患者发生显著性肝纤维化的独立危险因素;ROC曲线分析显示,应用杨氏模量值联合AAR、APRI和FIB-4诊断CHB患者显著性肝纤维化的AUC为0.950(95% CI:0.916～0.984),其敏感度为90.5%,特异度为80.9%,显著优于任一单一指标(P<0.05)。结论应用SWE联合AAR、APRI和FIB-4可帮助临床初步判断CHB患者肝纤维化程度,为进一步采取干预措施提供了线索。

关键词: 慢性乙型肝炎, 肝纤维化, 超声剪切波弹性成像, 天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值, 天冬氨酸氨基转移酶/血小板比值指数, 基于4因子的肝纤维化指数, 诊断

Abstract: Objective The aim of this study was to investigate diagnosis of liver fibrosis by shear wave elastography (SWE) in combination with aspartate aminotransferase to alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI) and fibrosis index based on 4 factors (FIB-4) in patients with chronic hepatitis B (CHB). Methods 121 patients with CHB were enrolled in our hospital between January 2022 and June 2024, and all received liver biopsies and SWE examination for Young’ s modulus. AAR, APRI and FIB-4 were calculated, routinely. Multivariate Logistic regression analysis was applied to analyze factors affecting significant liver fibrosis (SLF) in patients with CHB. Receiver operating characteristic curve (ROC) with the area under the curve (AUC)was performed to assess diagnostic performance. Results Of the 121 patients with CHB, liver histo-pathological examination showed liver fibrosis F0 stage in 11 cases and F1 stage in 36 cases (non-SLF in 47 cases),F2 stage in 40 cases and F3 stage in 19 cases (SLF in 59 cases) and F4 stage in 15 cases; the Young’ s modulus, AAR, APRI and FIB-4 in patients with SLF were (11.5±3.1)kPa, (1.4±0.5),(1.1±0.5) and (2.2±0.8), all significantly greater than [(6.8±2.8)kPa, (1.0±0.3),(0.6±0.2) and (1.5±0.6), respectively, P<0.05] in those with non-SLF; multivariate Logistic regression analysis showed that Young’ s modulus(OR=4.389, 95% CI:2.059-9.352),AAR(OR=2.342, 95% CI:1.355-4.046),APRI(OR=3.916, 95% CI:1.892-8.102) and FIB-4(OR=1.306, 95% CI:1.042-1.636) were all the independent impacting factors for SLF in patients with CHB ; ROC analysis demonstrated that the AUC was 0.950(95% CI:0.916-0.984), with sensitivity of 90.5% and specificity of 80.9%, when combination of Young’ s modulus, AAR, APRI and FIB-4 were applied to predict SLF in patients with CHB, much superior to any one index did(P<0.05). Conclusion Application of SWE in combined with other non-invasive parameters could helpscreen and assessment liver fibrosis in patients with CHB, which needs further clinical investigation.

Key words: Hepatitis B, Liver fibrosis, Shear wave elastography, Aspartate aminotransferase to alanine aminotransferase ratio, Aspartate aminotransferase to platelet ratio index, Fibrosis index based on 4 factors, Diagnosis

王常鹤, 朱璇, 邓静, 张聪颖, 赵宇, 刘芳. 超声剪切波弹性成像联合AAR、APRI和FIB-4指数诊断慢性乙型肝炎患者肝纤维化程度效能研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 32-35.

Wang Changhe, Zhu Xuan, Deng Jing, et al. Preliminary diagnosis of liver fibrosis by shear wave elastography in combination with AAR, APRI and FIB-4 in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2025, 28(1): 32-35.

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超声剪切波弹性成像联合AAR、APRI和FIB-4指数诊断慢性乙型肝炎患者肝纤维化程度效能研究^*

Preliminary diagnosis of liver fibrosis by shear wave elastography in combination with AAR, APRI and FIB-4 in patients with chronic hepatitis B

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