声触诊组织量化技术联合FIB-4指数和AST/ALT比值诊断慢性乙型肝炎患者肝纤维化价值研究*

doi:10.3969/j.issn.1672-5069.2025.01.010

摘要/Abstract

摘要： 目的探讨应用声触诊组织量化(SPTQ)技术联合FIB-4指数和天门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶(ALT)比值评估慢性乙型肝炎(CHB)患者肝纤维化的价值。方法 2019年3月～2024年3月我院诊治的82例慢性乙型肝炎(CHB)患者,行肝活检进行肝纤维化分期,均接受肝脏超声、血清和血液检测,计算FIB-4指数和AST/ALT比值。多因素Logistic回归分析和应用受试者工作特征曲线(ROC)及曲线下面积(AUC)评估指标诊断CHB患者肝纤维化的效能。结果本组组织学检查发现S1期7例,S2期47例【即显著性肝纤维化(SF)47例】,S3期23例和S4期5例【即进展期肝纤维化(AF)28例】;AF组SWV、FIB-4和AST/ALT比值分别为(1.5±0.2)m/s、(2.0±0.3)和(1.5±0.3),均显著高于SF组【分别为(0.9±0.2)m/s、(1.0±0.1)和(0.8±0.2),P＜0.05】;AF组合并高血压和有乙型肝炎家族史占比分别为32.1%和75.0%,均显著高于SF组(分别为17.0%和19.2%,P＜0.05),血清总胆红素、GGT和HBV DNA分别为(24.6±5.3)μmol/L、(78.4±6.3)U/L和(5.8±1.1)lg U/ml,均显著高于SF组【分别为(15.5±3.2)μmol/L、(45.7±14.0)U/L和(3.7±1.0)lg U/ml,P＜0.05】;多因素Logistic回归分析结果显示SWV、FIB-4和AST/ALT比值是影响CHB患者发生AF的独立危险因素(P均＜0.05);ROC分析显示,SWV联合FIB-4和AST/ALT比值诊断AF的AUC为0.938(95%CI:0.862～0.979),其灵敏度为92.4%,特异度为86.2%,显著优于单个指标评估。结论应用SWV联合FIB-4和AST/ALT比值诊断CHB患者AF具有很大的临床价值,值得深入研究。

关键词: 慢性乙型肝炎, 肝纤维化, 声触诊组织量化技术, FIB-4指数, 天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值, 诊断

Abstract: Objective The purpose of this study was to investigate diagnostic performance of combination of sound palpation tissue quantification (SPTQ) and FIB-4 index and AST/ALT ratio in evaluation of liver fibrosis in patients with hepatitis B (CHB). Methods 82 naïve patients with CHB were encountered in our hospital between March 2019 and March 2024, and all underwent liver biopsy for liver fibrosis staging. Shear wave velocity (SWV) was obtained by SPTQ, and FIB-4 index and AST/ALT ratio were calculated routinely. Multivariate Logistic regression analysis was conducted and receiver operating characteristic curve (ROC) and its area under curve (AUC) were applied to evaluate liver fibrosis in patients with CHB. Results Liver histo-pathological examination showed S1 in 7 cases, S2, e.g., significant fibrosis (SF) in 47 cases, S3 in 23 cases and S4 in 5 cases, e.g., advanced fibrosis (AF) in 28 cases; SWV, FIB-4 and ratio of AST/ALT in patients with AF were (1.5±0.2)m/s, (2.0±0.3) and (1.5±0.3), all significantly higher than [(0.9±0.2)m/s, (1.0±0.1) and (0.8±0.2), respectively, P＜0.05] in those with SF; percentages of hypertension and family history of hepatitis B were 32.1% and 75.0%, both much higher than 17.0% and 19.2% (P＜0.05), total serum bilirubin, serum GGT levels and HBV DNA loads were (24.6±5.3)μmol/L, (78.4±6.3)U/L and (5.8±1.1)lg U/ml, all much higher than [(15.5±3.2)μmol/L, (45.7±14.0)U/L and (3.7±1.0)lg U/ml, respectively, P＜0.05] in patients with SF; multivariate Logistic regression analysis showed that SWV, FIB-4 and ratio of AST/ALT were independent risk factors for occurrence of AF in patients with CHB(all P＜0.05); ROC analysis demonstrated that the AUC was 0.938(95%CI:0.862-0.979), with sensitivity of 92.4% and specificity of 86.2%, when combination of SWV, FIB-4 and ratio of AST/ALT was applied to predict AF. Conclusion Combination of SWV, FIB-4 and AST/ALT ratio could predict AF existence in nave patients with CHB, which is worthy of further study.

Key words: Hepatitis B, Liver fibrosis, Sound palpation tissue quantification, FIB-4 index, Aspartate aminotransferase/alanine aminotransferase ratio, Diagnosis

胡雨, 王静晖, 王瑶. 声触诊组织量化技术联合FIB-4指数和AST/ALT比值诊断慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 36-39.

Hu Yu, Wang Jinghui, Wang Yao. Combination of sound palpation tissue quantification and FIB-4 index and AST/ALT ratio in evaluation of liver fibrosis in patients with hepatitis[J]. Journal of Practical Hepatology, 2025, 28(1): 36-39.

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声触诊组织量化技术联合FIB-4指数和AST/ALT比值诊断慢性乙型肝炎患者肝纤维化价值研究^*

Combination of sound palpation tissue quantification and FIB-4 index and AST/ALT ratio in evaluation of liver fibrosis in patients with hepatitis

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