多种无创诊断指标评估原发性胆汁性胆管炎患者肝硬化价值研究*

doi:10.3969/j.issn.1672-5069.2025.06.022

实用肝脏病杂志 ›› 2025, Vol. 28 ›› Issue (6): 886-889.doi: 10.3969/j.issn.1672-5069.2025.06.022

多种无创诊断指标评估原发性胆汁性胆管炎患者肝硬化价值研究^*

陈杉杉, 司晓闯, 朱家宝, 谢淑慧, 吴静, 吴彬彬, 徐艳青, 梁燕楼, 王子弦, 孙亚楠

226000 江苏省南通市南通大学附属南通第三医院/南通市第三人民医院超声科(陈杉杉,朱家宝,谢淑慧,吴静,吴彬彬,徐艳青,梁燕楼,王子弦,孙亚楠);肝胆外科(司晓闯)

收稿日期:2025-05-13 出版日期:2025-11-10 发布日期:2025-11-13
通讯作者: 吴静,E-mail:ntsywj@163.com
作者简介:陈杉杉,女,32岁,硕士研究生,住院医师。主要从事超声医学研究。E-mail:1396689083@qq.com
基金资助:
^*江苏省南通市卫健委科研项目(编号:QNZ2023065)

Diagnostic performance of liver shear wave velocity and various noninvasive parameter combination in the assessment of liver cirrhosis in patients with primary biliary cholangitis

Chen Shanshan, Si Xiaochuang, Zhu Jiabao, et al

Department of Ultrasound, Third Hospital Affiliated to Nantong University, Nantong 226000, Jiangsu Province, China

Received:2025-05-13 Online:2025-11-10 Published:2025-11-13

摘要/Abstract

摘要： 目的探讨采用超声联合弹性成像技术评估原发性胆汁性胆管炎(PBC)患者发生肝硬化的价值。方法 2021年4月～2024年6月我院就诊的PBC患者83例,均接受肝活检和超声检查,记录肝脏剪切波速度(V_S)、肝纤维化指数(LFI)、纤维化相关指数(F Index)、炎症相关指数(A Index)和脂肪变衰减系数(ATT),常规临床检测,计算基于4因子的纤维化指数(FIB-4)和天冬氨酸氨基转移酶/血小板比值指数(APRI)。绘制受试者工作特征(ROC)曲线评估指标的诊断效能。结果在83例PBC患者中,发现肝硬化22例(26.5%),非肝硬化61例(73.5%);肝硬化患者PLT计数为117.5(99.3,139.5)×10⁹/L,显著低于非肝硬化患者【174.0(139.0,216.0)×10⁹/L,P＜0.05】,FIB-4、APRI、Vs、LFI和F Index水平分别为3.4(2.7,4.9)、1.2(0.9,1.4)、(2.7±0.4) m/s、(3.4±0.7)和(2.8±0.4), 均显著高于非肝硬化患者【分别为2.2(1.4,2.9)、0.8(0.5,1.2)、(1.7±0.4)m/s、(2.7±1.1)和(1.7±0.7),P＜0.05】;经ROC分析显示应用FIB-4、APRI、Vs、LFI和F Index评估PBC患者发生肝硬化的AUC分别为0.791、0.694、0.955、0.695和0.919,其中Vs的诊断效能最优;经变量筛选建立FIB-4与Vs的联合预测模型,其诊断的AUC为0.969,显著优于单一指标诊断。结论采用超声弹性成像联合FIB-4无创评估PBC患者肝硬化具有一定的应用价值,值得临床扩大验证。

关键词: 原发性胆汁性胆管炎, 肝硬化, 超声弹性成像, 肝纤维化模型, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of liver shear wave velocity (Vs) and various noninvasive parameter combination in the assessment of liver cirrhosis in patients with primary biliary cholangitis (PBC). Methods 83 patients with PBC were encountered in our hospital between April 2021 and June 2024, all underwent liver biopsy and ultrasound examination to record liver fibrosis index (LFI), fibrosis related index (F Index), inflammation activity index (A Index), and adiposity attenuation coefficient (ATT). Fibrosis index based on factor 4 (FIB-4) and aspartate aminotransferase/platelet ratio index (APRI) were calculated. Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy. Results Of the 83 patients with PBC, liver cirrhosis was proven by histo-pathological examination in 22 cases (26.5%), and PBC without liver cirrhosis were found in 61 cases (73.5%); blood PLT counts in cirrhosis patients was 117.5(99.3,139.5)×10⁹/L, significantly lower than that in patients without cirrhosis [174.0(139.0, 216.0)×10⁹/L,P＜0.05]; FIB-4 and APRI socres, Vs, LFI, and F index were 3.4 (2.7, 4.9), 1.2 (0.9, 1.4), (2.7±0.4) m/s, (3.4±0.7) and (2.8±0.4), all significantly higher than [2.2 (1.4, 2.9), 0.8 (0.5, 1.2), (1.7±0.4) m/s, (2.7±1.1) and (1.7±0.7), respectively, P＜0.05] in those without; ROC analysis showed that the AUCs were 0.791, 0.694, 0.955, 0.695 and 0.919, respectively, when FIB-4 score, APRI, Vs, LFI, and F index were applied to evaluate the occurrence of cirrhosis in PBC patients, with Vs having the highest diagnostic efficacy; the AUC was 0.969, when FIB-4 and Vs combination was established, much superior to an parameter did alone. Conclusion The noninvasive assessment of cirrhosis in patients with PBC by using elastography and liver fibrosis model is satisfactory, which needs further clinical investigation.

Key words: Primary biliary cholangitis, Liver cirrhosis, Ultrasound elastograph, Liver fibrosis index, Diagnosis

陈杉杉, 司晓闯, 朱家宝, 谢淑慧, 吴静, 吴彬彬, 徐艳青, 梁燕楼, 王子弦, 孙亚楠. 多种无创诊断指标评估原发性胆汁性胆管炎患者肝硬化价值研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 886-889.

Chen Shanshan, Si Xiaochuang, Zhu Jiabao, et al. Diagnostic performance of liver shear wave velocity and various noninvasive parameter combination in the assessment of liver cirrhosis in patients with primary biliary cholangitis[J]. Journal of Practical Hepatology, 2025, 28(6): 886-889.

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多种无创诊断指标评估原发性胆汁性胆管炎患者肝硬化价值研究^*

Diagnostic performance of liver shear wave velocity and various noninvasive parameter combination in the assessment of liver cirrhosis in patients with primary biliary cholangitis

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