超声剪切波弹性成像检查联合APRI和FIB-4诊断血清HBeAg阳性慢性乙型肝炎患者肝纤维化程度价值研究*

doi:10.3969/j.issn.1672-5069.2025.05.006

摘要/Abstract

摘要： 目的探讨超声剪切波弹性成像(SWE)联合天冬氨酸氨基转移酶(AST)/血小板(PLT)比值指数(APRI)和肝纤维化4因子指数(FIB-4)诊断血清HBeAg阳性的慢性乙型肝炎(CHB)患者肝纤维化程度的价值。方法 2019年9月～2023年9月我院诊治的血清HBeAg阳性CHB患者98例,均接受血液、血清、超声SWE和肝活检检查,计算APRI和FIB-4,绘制受试者工作特征曲线(ROC)评估指标联合诊断肝纤维化的效能。结果在98例血清HBeAg阳性CHB患者中,组织病理学检查诊断肝纤维分期≤S1期20例,S2期38例,S3期26例和S4期14例;≤S1期患者血清AST和ALT水平分别为(39.8±6.0)U/L和(42.8±8.2)U/L,而S2期、S3期和S4期患者血清AST和ALT水平均显著升高(P＜0.05);S3期患者APRI、FIB-4和杨氏模量值分别为(0.6±0.3)、(1.7±0.5)和(10.1±0.7)kPa,S2期患者分别为(0.4±0.2)、(1.2±0.4)和(7.1±0.5)kPa,均显著大于≤S1期【分别为(0.3±0.2)、(0.8±0.3)和(6.3±0.7)kPa,P＜0.05】;ROC分析发现,杨氏模量值联合APRI和FIB-4诊断CHB患者显著性肝纤维化的曲线下面积(AUC)为0.84,灵敏度(Se)和特异度(Sp)分别为91%和67%,其Se显著高于单个指标诊断(P＜0.05),诊断进展性肝纤维化的AUC为0.92,Se和Sp分别为93%和74%,其Se也显著高于单个指标诊断(P＜0.05)。结论采用SWE联合APRI和FIB-4可帮助临床初步筛查CHB患者肝纤维分期,对进一步处置决策提供指导方向。

关键词: 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/血小板比值指数, 肝纤维化4因子指数, 诊断

Abstract: Objective The aim of this study was to investigate shear wave elastography(SWE) combined with aspartate aminotransferase (AST)/platelet (PLT) ratio index (APRI) and fibrosis factor 4 index (FIB-4) in predicting liver fibrosis (LF) in patients with serum HBeAg positive chronic hepatitis B (CHB). Methods 98 patients with serum HBeAg positive CHB were encountered inour hospital between September 2019 and September 2023, all underwent blood, serum, SWE and liver biopsies, and APRI and FIB-4 were calculated. Receiver operating characteristic curve (ROC) was applied to assess diagnostic efficacy. Results Of the 98 patients with serum HBeAgCHB, liver histo-pathological examination showed≤S1LF in 20 cases, S2 in 38 cases, S3 in 26 cases and S4 in 14 cases; serum AST and ALT levels in patients with ≤S1 were (39.8±6.0)U/L and (42.8±8.2)U/L, while they were much elevated in those with S2, S3 and S4(P＜0.05);APRI, FIB-4and Yang’s model in patients with S3 were (0.6±0.3),(1.7±0.5)and (10.1±0.7)kPa, in with S2 were (0.4±0.2),(1.2±0.4)and (7.1±0.5)kPa, all significantly greater than [(0.3±0.2),(0.8±0.3)and (6.3±0.7)kPa, respectively, P＜0.05]in patients with ≤S1; ROCanalysis demonstrated that the AUC was 0.84, with sensitivity (Se)and specificity(Sp)of 91% (P＜0.05)and 67%, in predicting significant LF, and theAUC was 0.92, with Se and Sp of 93%(P＜0.05)and 74%, in predicting advanced LF when combination of Yang’s model, APRI and FIB-4was used. Conclusion SWE and APRI plus FIB-4 would help clinicians preliminarily screen LF in patients with CHB.

Key words: Hepatitis B, Liver fibrosis, Shear wave elastography, Aspartate aminotransferase /platelet ratio index, Fibrosis factor 4 index, Diagnosis

汤洁, 姜正伟, 周冰清, 蒋蓓莉, 张睿. 超声剪切波弹性成像检查联合APRI和FIB-4诊断血清HBeAg阳性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, 2025, 28(5): 663-666.

Tang Jie, Jiang Zhengwei, Zhou Bingqing, et al. Diagnostic performance of shear wave elastography combined with APRI and FIB-4 in predicting liver fibrosis in patients with serum HBeAg positive chronic hepatitis B[J]. Journal of Practical Hepatology, 2025, 28(5): 663-666.

参考文献

[1] Yao L, Hu X, Dai K, et al. Mesenchymal stromal cells: promising treatment for liver cirrhosis. Stem Cell Res Ther,2022,13(1):308.
[2] Pei Q, Yi Q, Tang L. Liver fibrosis resolution: from molecular mechanisms to therapeutic opportunities. Int J Mol Sci,2023,24(11):9671.
[3] Zhang D, Zhang Y, Sun B. Themolecular mechanisms of liver fibrosis and its potential therapy in application. Int J Mol Sci,2022,23(20):12572.
[4] Horn P, Tacke F. Metabolic reprogramming in liver fibrosis. Cell Metab,2024,36(7):1439-1455.
[5] Li L, Huang Q, Yang L, et al. Theassociation between non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis with serological vitamin B12 markers: results from the NHANES 1999-2004. Nutrients,2022,14(6):1224.
[6] Kjaergaard M, Lindvig K P, Thorhauge K H, et al. Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. J Hepatol,2023,79(2):277-286.
[7] Ozturk A, Olson M C, Samir A E, et al. Liver fibrosis assessment: MR and US elastography.Abdom Radiol (NY),2022,47(9):3037-3050.
[8] 中华医学会感染病学分会,中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版). 实用肝脏病杂志,2020,23(1):9-32.
[9] Duseja A, Singh S P, De A, et al. Indiannational association for study of the liver (INASL) guidance paper on nomenclature, diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD). J Clin Exp Hepatol,2023,13(2):273-302.
[10] Graupera I, Thiele M, Serra-Burriel M, et al. Lowaccuracy of FIB-4 and NAFLD fibrosis scores for screening for liver fibrosis in the population. Clin Gastroenterol Hepatol,2022,20(11):2567-2576.
[11] Liu H, Fu Y, Guo D, et al. TMM:a comprehensive CAD system for hepatic fibrosis 5-grade METAVIR staging based on liver MRI. Med Phys,2024,51(3):2032-2043.
[12] Cheng F, Yang F, Wang Y, et al. Mesenchymal stem cell-derived exosomal miR-27b-3p alleviates liver fibrosis via downregulating YAP/LOXL2 pathway. J Nanobiotechnology,2023,21(1):195.
[13] Tapper E B, Parikh N D. Diagnosis andmanagement of cirrhosis and its complications: areview. JAMA,2023,329(18):1589-1602.
[14] Friedman S L, Pinzani M. Hepatic fibrosis 2022:unmet needs and a blueprint for the future. Hepatology,2022,75(2):473-488.
[15] Mabire M, Hegde P, Hammoutene A, et al. MAIT cell inhibition promotes liver fibrosis regression via macrophage phenotype reprogramming. Nat Commun,2023,14(1):1830.
[16] Terrault N A, Francoz C, Berenguer M, et al. Liver transplantation 2023: status report, current and future challenges. Clin Gastroenterol Hepatol,2023,21(8):2150-2166.
[17] Tadokoro T, Murata S, Kato M, et al. Human iPSC-liver organoid transplantation reduces fibrosis through immunomodulation. Sci Transl Med,2024,16(757):g338.
[18] Abu-Freha N, Mathew J B, Elhoashla A, et al. Chronic hepatitis C:diagnosis and treatment made easy. Eur J Gen Pract,2022,28(1):102-108.
[19] Yang R, Gui X, Ke H, et al. Accuracy of FIB-4 and APRI scores compared to transient elastography for liver fibrosis in patients with HIV and HBV co-infection. Int J STD AIDS,2023,34(1):18-24.
[20] Kumar A. Comparison ofnovel fibrosis index (NFI) with aspartate aminotransferase to platelet ratio index (APRI) in type II diabetes mellitus patients with nonalcoholic fatty liver disease and fibrosis (NAFLD). J Assoc Physicians India,2022,70(4):11-12.
[21] Sapmaz F P, Buyukturan G, Sakin Y S, et al. How effective are APRI, FIB-4, FIB-5 scores in predicting liver fibrosis in chronic hepatitis B patients. Medicine (Baltimore),2022,101(36):e30488.
[22] Raposeiras-Roubin S, Parada B J, Lizancos C A, et al. Liver fibrosis and outcomes of atrial fibrillation: the FIB-4 index. Clin Res Cardiol,2024,113(2):313-323.
[23] Ding Y, Wang Z, Niu H, et al. FIB-4 is closer to Fibroscan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning. Medicine (Baltimore),2023,102(34):e34957.
[24] Fraser D A, Wang X, Lund J, et al. A structurally engineered fatty acid,icosabutate, suppresses liver inflammation and fibrosis in NASH. J Hepatol,2022,76(4):800-811.
[25] Xu X L, Jiang L S, Wu C S, et al. The role of fibrosis index FIB-4 in predicting liver fibrosis stage and clinical prognosis:a diagnostic or screening tool. J Formos Med Assoc,2022,121(2):454-466.
[26] Sanyal A J, Foucquier J, Younossi Z M, et al. Enhanced diagnosis of advanced fibrosis and cirrhosis in individuals with NAFLD using FibroScan-based Agile scores. J Hepatol,2023,78(2):247-259.
[27] Philips C A, Kedarisetty C K. Palliative care for patients with end-stage liver disease. J Clin Exp Hepatol,2023,13(2):319-328.

超声剪切波弹性成像检查联合APRI和FIB-4诊断血清HBeAg阳性慢性乙型肝炎患者肝纤维化程度价值研究^*

Diagnostic performance of shear wave elastography combined with APRI and FIB-4 in predicting liver fibrosis in patients with serum HBeAg positive chronic hepatitis B

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]	中华医学会肝病学分会重型肝病与人工肝学组, 中华医学会肝病学分会终末期肝病营养与再生学组. 慢加急性肝衰竭诊治指南(2025 年版)[J]. 实用肝脏病杂志, 2025, 28(5): 641-647.
[2]	丛东威, 刘丽娜, 高文娟, 黄超群. 干扰素α-2b联合恩替卡韦与干扰素α-2b联合替诺福韦治疗HBeAg阳性慢性乙型肝炎患者疗效比较研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 655-658.
[3]	陈文哲, 王清园, 陈天, 许宇文. ApoB基因多态性对接受聚乙二醇干扰素α治疗的HBeAg阳性慢性乙型肝炎患者疗效的影响^*[J]. 实用肝脏病杂志, 2025, 28(5): 659-662.
[4]	袁铃, 姜霞, 孙美杰, 岳冬黎, 张晓玲. 艾米替诺福韦与丙酚替诺福韦挽救治疗低病毒血症的慢性乙型肝炎患者临床研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 667-670.
[5]	汤勤, 华忠, 苏麒麟, 陈小林. 艾米替诺福韦联合鳖甲煎丸治疗慢性乙型肝炎患者疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 671-674.
[6]	王凌云, 梅英, 陈梦雪, 程洪锋, 应修泉, 余萍萍. 定量CT诊断体检人群非酒精性脂肪性肝病效能研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 687-690.
[7]	程中华, 唐楠, 谷硕, 李晨露. 非酒精性脂肪性肝病患者血清miR-122、miR-140-5p和miR-34a水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(5): 695-698.
[8]	葛天明, 吴启源, 于小伟, 李冠武. 磁共振成像质子密度脂肪分数评估非酒精性脂肪性肝病患者肝脏脂肪变性临床价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 703-706.
[9]	陈洁, 杨才敏, 彭彩玲, 徐辉. 基于北京PIR分型标准评价恩替卡韦治疗乙型肝炎肝硬化患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 735-738.
[10]	汪闯, 周林, 高焕焕, 陈敬锋, 王彬阶. 脾切除术后乙型肝炎肝硬化患者血栓弹力图参数和凝血功能指标预测门静脉血栓形成的价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 739-742.
[11]	李嘉亮, 段艳, 申健, 王煜. 多普勒组织成像联合超声心动图检查诊断乙型肝炎肝硬化并发肝硬化性心肌病价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 743-746.
[12]	李新, 梅文娟, 张昊月. CEUS与增强CT/MRI LI-RADS分类诊断小肝细胞癌应用研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 755-758.
[13]	叶琴, 叶莉, 骆馨, 单勤星, 沈亦亮. CT检查指标联合血清甲胎蛋白水平诊断良恶性肝脏结节价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 767-770.
[14]	刘静芳, 张苏波, 丁军明, 杨卫健. 定量动态增强MRI诊断肝脏局灶性病变价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 776-779.
[15]	呙冬慧, 陈婷, 茅明. 富马酸替诺福韦二吡呋酯联合当飞利肝宁胶囊治疗慢性乙型肝炎患者临床研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 509-512.