剪切波弹性成像和血清纤维化指标评估肝豆状核变性患者肝硬化发生的价值研究*

doi:10.3969/j.issn.1672-5069.2026.01.028

实用肝脏病杂志 ›› 2026, Vol. 29 ›› Issue (1): 109-112.doi: 10.3969/j.issn.1672-5069.2026.01.028

剪切波弹性成像和血清纤维化指标评估肝豆状核变性患者肝硬化发生的价值研究^*

朱泽文, 刘涛

225300 江苏省泰州市南京医科大学附属泰州人民医院超声科

收稿日期:2025-07-02 出版日期:2026-01-10 发布日期:2026-02-04
通讯作者: 刘涛,E-mail:liutao9026@163.com
作者简介:朱泽文,男,36岁,大学本科,主治医师。研究方向:超声诊断与介入治疗。E-mail:17315255953@163.com
基金资助:
^*江苏省卫生健康委科研项目(编号:Z2020030)

Prediction of liver cirrhosis by shear wave elastography and liver fibrosis index in patients with hepatolenticular degeneration

Zhu Zewen, Liu Tao

Department of Ultrasound, Taizhou People's Hospital, Affiliated to Nanjing Medical University, Taizhou 225300, Jiangsu Province, China

Received:2025-07-02 Online:2026-01-10 Published:2026-02-04

摘要/Abstract

摘要： 目的探讨应用超声剪切波弹性成像(SWE)与血清肝纤维化指标联合预测肝豆状核变性(HLD)患者发生肝硬化的价值。方法 2022年12月～2024年12月我院诊治的52例HLD患者,常规行肝活检和SWE检测肝脏杨氏模量值,计算天冬氨酸氨基转移酶／血小板比值指数(APRI和肝纤维化-4指数(FIB-4)评分。常规检测血清透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原氨基端肽(PIIINP)和IV型胶原(IV-C)。构建受试者工作特征曲线(ROC)分析预测效能。结果 9例肝硬化组APRI和FIB-4水平分别为(1.1±0.4)和(2.1±0.3),均显著高于43例非肝硬化组【分别为(0.5±0.2)和(1.2±0.2),P<0.05】; 肝硬化组血清HA水平为(313.4±54.7)ng/mL,杨氏模量值为(14.2±2.1)kPa,均显著高于或大于非肝硬化组【分别为(142.2±25.4)ng/mL和(7.9±0.9)kPa,P<0.05】;经ROC曲线分析表明,杨氏模量值联合任一肝纤维化指数或血清HA水平预测肝硬化存在的AUC为0.983(95%CI:0.955～1.000),其灵敏度为97.4%,特异度为98.1%。结论采用SWE检测联合肝纤维化指数预测HLD患者发生肝硬化有一定的临床价值。

关键词: 肝豆状核变性, 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指数, 诊断

Abstract: Objective The aim of this study was to investigate prediction of liver cirrhosis (LC) by shear wave elastography (SWE) and liver fibrosis index in patients with hepatolenticular degeneration (HLD). Methods 52 patients with HLD were encountered in our hospital between December 2022 and December 2024, and all underwent liver biopsies and SWE for Young’s modulus. Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (Fib-4) were calculated. Serum hyaluronic acid (HA), laminin (LN), type III procollagen amino-terminal peptide (PIIINP) and type IV collagen (IV-C) levels were analyzed. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy. Results APRI and FIB-4 scores in 9 patients with LC were (1.1±0.4) and (2.1±0.3), both significantly greater than [(0.5±0.2) and (1.2±0.2), respectively, P<0.05] in 43 patients with HLD; serum HA level was (313.4±54.7)ng/mL, and Young’s modulus was (14.2±2.1)kPa, both much higher or greater than [(142.2±25.4)ng/mL and (7.9±0.9)kPa, respectively, P<0.05] in those with HLD; ROC analysis showed that the AUC was 0.983(95%CI:0.955-1.000), with sensitivity of 97.4% and specificity of 98.1%, when combination of Young’s modulus with APRI or FIB-4 score and serum HA level in predicting LC in patients with HLD. Conclusion Shear wave elastography with combination of serum fibrosis markers or fibrosis index really have an excellent predictive performance in assessing LC in patients with HLD.

Key words: Hepatolenticular degeneration, Shear wave elastography, Aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 index, Diagnosis

朱泽文, 刘涛. 剪切波弹性成像和血清纤维化指标评估肝豆状核变性患者肝硬化发生的价值研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 109-112.

Zhu Zewen, Liu Tao. Prediction of liver cirrhosis by shear wave elastography and liver fibrosis index in patients with hepatolenticular degeneration[J]. Journal of Practical Hepatology, 2026, 29(1): 109-112.

参考文献

[1] Sun X, Zhang X, Yan H, et al. Protective effect of curcumin on hepatolenticular degeneration through copper excretion and inhibition of ferroptosis. Phytomedicine, 2023, 113: 154539.
[2] Ovchinnikova E V, Vaiman E E, Shnayder N A, et al. Classification and clinical heterogeneity of hepatolenticular degeneration. Pers Psychiatry Neurol, 2023, 3(2): 15-24.
[3] 徐旭,施漪雯,范建高. 肝豆状核变性治疗现状与展望. 实用肝脏病杂志,2024,27(3):477-480.
[4] Peng H, Li Z, Zhang W, et al. Changes in hepatic function after splenectomy for hepatolenticular degeneration, cirrhosis, and hypersplenism. Am Surg, 2023, 89(12): 5949-5956.
[5] Zhou J, Yan F, Xu J, et al. Diagnosis of steatohepatitis and fibrosis in biopsy-proven nonalcoholic fatty liver diseases: Including two-dimension real-time shear wave elastography and noninvasive fibrotic biomarker scores. Quant Imaging Med Surg, 2022, 12(3): 1800.
[6] Zhang X, Zheng R, Jin J, et al. US shear-wave elastography dispersion for characterization of chronic liver disease. Radiology, 2022, 305(3): 597-605.
[7] 中华医学会肝病学分会遗传代谢性肝病协作组. 肝豆状核变性诊疗指南(2022年版). 中华肝脏病杂志,2022,30(1):9-20.
[8] European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol, 2018, 69(2): 406-460.
[9] Zhang S, Cao S, Chen Y, et al. Discussion on the relationship between the distribution characteristics of TCM syndrome types and related objective indicators in hepatolenticular degeneration. Medicine, 2024, 103(38): e39747.
[10] Mariño Z, Schilsky ML. Wilson disease: Novel diagnostic and therapeutic Approaches. Semin Liver Dis, 2025,45(2):221-235.
[11] Trebicka J, Gu W, de Ledinghen V, et al. Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease. Gut, 2022, 71(2): 402-414.
[12] Losurdo G, Ditonno I, Novielli D, et al. Comparison of transient elastography and point shear wave elastography for analysis of liver stiffness: a prospective study. Diagnostics, 2024, 14(6): 604.
[13] 姜社甜,闫卫,赵磊,等. 声触诊组织量化技术联合血清肝纤维化指标诊断肝血吸虫病患者肝纤维化效能分析. 实用肝脏病杂志,2025,28(1):124-127.
[14] 程艳洁,王鹏飞,李峻. 水飞蓟素联合复方蛋氨酸胆碱治疗酒精性肝炎患者疗效及其对血清肝纤维化指标的影响. 实用肝脏病杂志,2024,27(3):349-352.
[15] 李尧,梁健,张春,等. 恩替卡韦联合聚乙二醇干扰素-α2b治疗代偿期乙型肝炎肝硬化患者疗效研究. 实用肝脏病杂志,2024,27(2):226-229.
[16] Maroto-García J, Moreno Álvarez A, Sanz de Pedro M P, et al. Serum biomarkers for liver fibrosis assessment. Adv Lab Med, 2024, 5(2): 115-130.
[17] Chen Z, Ma Y, Cai J, et al. Serum biomarkers for liver fibrosis. Clin Chim Acta, 2022, 537: 16-25.
[18] Chen Q, Mei L, Zhong R, et al. Serum liver fibrosis markers predict hepatic decompensation in compensated cirrhosis. BMC Gastroenterol, 2023, 23(1): 317.
[19] Cetinic I, de Lange C, Simrén Y, et al. Ultrasound shear wave elastography, shear wave dispersion and attenuation imaging of pediatric liver disease with histological correlation. Children, 2022, 9(5): 692.
[20] Luo Q T, Zhu Q, Zong X D, et al. Diagnostic performance of transient elastography versus two-dimensional shear wave elastography for liver fibrosis in chronic viral hepatitis: direct comparison and a meta-analysis. Biomed Res Int, 2022, 2022: 1960244.

剪切波弹性成像和血清纤维化指标评估肝豆状核变性患者肝硬化发生的价值研究^*

Prediction of liver cirrhosis by shear wave elastography and liver fibrosis index in patients with hepatolenticular degeneration

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