超声弹性成像评估自身免疫性肝炎患者肝纤维化分期价值分析*

doi:10.3969/j.issn.1672-5069.2023.03.015

摘要/Abstract

摘要： 目的探讨采用超声弹性成像(UE)检测评估自身免疫性肝炎(AIH)患者肝纤维化分期的价值。方法 2017年3月～2022年3月我院诊治的AIH患者58例,均接受肝穿刺组织病理学检查,采用METAVIR标准评估肝纤维化分期。使用超声诊断仪进行肝脏硬度检查,获得病灶处剪切波速度(SWV)。常规检测血清和血液学指标,计算天冬氨酸氨基转移酶与血小板计数比值指数(APRI)。应用受试者工作特征曲线下面积(AUC)评估各指标诊断肝纤维化的效能。结果经肝组织病理学检查,在AIH患者中发现F0期肝纤维化7例(12.1%)、F1期15例(25.9%),即无显著性肝纤维化22例(37.9%),F2期17例(29.3%)、F3期13例(22.4%)和F4期6例(10.3%),即显著性纤维化36例(62.1%);显著性肝纤维化组外周血血小板(PLT)计数为(119.7±26.4)×10⁹/L,显著低于无肝纤维化组【(180.9±31.2)×10⁹/L,P<0.05】,APRI为(3.6±1.1),显著高于无肝纤维化组【(2.7±0.8),P<0.05】,SWV为(1.7±0.3)m/s,显著高于无肝纤维化组【(1.2±0.2)m/s,P<0.05】;分别以PLT计数<120.0×10⁹/L、APRI≥3.0和SWV≥1.6 m/s为截断点,诊断AIH患者显著性肝纤维化的AUC分别为0.74、0.75和0.95,敏感度分别为66.7%、75.0%和91.7%,特异度分别为77.3%、68.2%和86.4%,其中以SWV的诊断效能最高(P<0.05)。结论采用UE检测SWV评估AIH患者肝纤维化分期有一定的应用价值,有望成为无创性定量诊断肝纤维化程度的重要指标,值得进一步研究。

关键词: 自身免疫性肝炎, 肝纤维化, 超声弹性成像, 剪切波速度, 诊断

Abstract: Objective The aim of this study was to explore the diagnostic performance of ultrasound elastography (UE) in evaluation of liver fibrosis in patients with autoimmune hepatitis (AIH). Methods 58 patients with AIH were encountered in our hospital between March 2017 and March 2022, and all patients received liver biopsy and UE scan for detection of the shear wave velocity (SWV). The aspartate aminotransferase to platelet ratio index (APRI) was obtained. The diagnostic efficacy was evaluated by the area under the receiver operating characteristic curve (AUC). Results The liver histopathological examination showed that out of the 58 patients with AIH, there were 7 cases in liver fibrosis stage F0 (12.1%), 15 cases in F1 (25.9%), 17 cases in F2 (29.3%), 13 cases in F3 (22.4%) and 6 cases in F4 (10.3%), e.g., 22 cases (37.9%) without or with mild liver fibrosis, and 36 cases (62.1%) with significant liver fibrosis (SLF); the platelet count in patients with SLF was (119.7±26.4)×10⁹/L, significantly lower than [(180.9±31.2)×10⁹/L, P<0.05], the APRI was (3.6±1.1), significantly higher than [(2.7±0.8), P<0.05] and the SWV was (1.7±0.3)m/s, significantly higher than [(1.2±0.2)m/s, P<0.05] in patients without or with mild liver fibrosis; the AUCs were 0.74, 0.75 and 0.95, respectively, with the sensitivities of 66.7%, 75.0% and 91.7%, and the specificities of 77.3%, 68.2% and 86.4%, when the PLT count <120.0×10⁹/L, the APRI≥3.0 and the SWV≥1.6 m/s were set as the cut-off-value, in predicting SLF in patients with AIH, superior by SWV among them (P<0.05).Conclusion The application of UE scan for SWV detection is helpful for liver fibrosis staging in patients with AIH, and is expected to become an important non-invasive quantitative diagnostic parameter for liver fibrosis determination.

Key words: Autoimmune hepatitis, Liver fibrosis, Ultrasound elastography, Shear wave velocity, Diagnosis

朱琳, 陈洋, 杨青, 刘俊启. 超声弹性成像评估自身免疫性肝炎患者肝纤维化分期价值分析^*[J]. 实用肝脏病杂志, 2023, 26(3): 360-363.

Zhu Lin, Chen Yang, Yang Qing, et al.. Diagnostic performance of ultrasound elastography in evaluation of liver fibrosis in patients with autoimmune hepatitis[J]. Journal of Practical Hepatology, 2023, 26(3): 360-363.

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超声弹性成像评估自身免疫性肝炎患者肝纤维化分期价值分析^*

Diagnostic performance of ultrasound elastography in evaluation of liver fibrosis in patients with autoimmune hepatitis

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