ARFI联合血清学指标对慢性乙型肝炎患者肝纤维化和门静脉压力评估的临床研究

摘要/Abstract

摘要： 目的应用声脉冲辐射力成像技术(ARFI)测量肝脏剪切波速度(SWV)联合血清学指标评价慢性乙型肝炎(CHB)患者肝纤维化(HF)和门静脉压力(Ppv)。方法 2017年10月至2020年4月淮安市第四人民医院收治的CHB患者80例(男49例、女31例),年龄(41.3±6.6)岁。Spearman相关系数评价相关性;ROC曲线确定诊断显著肝纤维化的截断点,计算诊断效能。结果 80例CHB患者S0、S1、S2、S3及S4期为9、27、27、6及11例,PLT为(185.5±40.8)×10⁹/L,ALT为(44.7±9.2)IU/L,AST为(34.1±11.6)IU/L,SWV为(1.81±0.56)m/s。ARFI检测SWV值、APRI及FIB-4与HF分期呈显著正相关(r=0.78、0.53及0.47,P<0.05);ARFI检测SWV值诊断显著HF截断点、AUC(95%CI)、敏感度及特异度分别为1.59 m/s、0.86(0.79~0.92)、67%及88%;APRI诊断显著HF截断点、AUC(95%CI)、敏感度及特异度分别为0.33、0.77(0.69~0.84)、89%及56%;FIB-4诊断显著HF截断点、AUC(95%CI)、敏感度及特异度分别为1.33、0.75(0.67~0.83)、74%及69%;三者联合诊断显著肝纤维化时AUC(95%CI)、敏感度及特异度分别为0.91(0.85~0.96)、95%及90%。CHB患者Dpv、Vmean、Qpv及Ppv分别为(1.2±0.1)cm、(18.9±1.8)cm/s、(1 240.6±148.0)mL/min及(3.3±0.2)kPa。Ppv与HF分期呈显著正相关(r=0.66,P<0.05),同时ARFI检测SWV值、APRI及FIB-4与Ppv呈显著正相关(r=0.39、0.45及0.42,P<0.05)。结论 ARFI联合APRI、FIB-4可作为评价CHB患者HF、Ppv的参考指标。

关键词: 慢性乙型肝炎, 声脉冲辐射力成像技术, 肝脏剪切波速度, 肝纤维化, 门静脉压力

Abstract: Objective Serological indexes and hepatic shear wave velocity (SWV) measured by acoustic radiation force impulse (ARFI) were used to evaluate hepatic fibrosis (HF) and portal vein pressure (PVP) in patients with chronic hepatitis B (CHB).Methods From October 2017 to April 2020, there were 80 patients with CHB (49 males and 31 females). The Spearman correlation coefficient was used to evaluate the correlation, the receiver operating characteristic (ROC) curve was used to determine the cut-off point for the diagnosis of significant HF, and to calculate the diagnostic efficiency.Results Among the 80 patients with CHB, with an average age of (41.3 ± 6.6) years, there were 9, 27, 27, 6 and 11 patients in stage (S) 0, S1, S2, S3 and S4. And the average levels of platelet (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and SWV were (185.5 ± 40.8) × 10⁹/L, (44.7 ± 9.2) U/L, (34.1 ± 11.6) U/L and (1.81 ± 0.56) m/s, respectively. The SWV value detected by ARFI, AST to PLT ratio index (APRI) and fibrosis-4 score (FIB-4) were significantly positively correlated with HF staging (r=0.78, 0.53 and 0.47, P<0.05). The cutoff point of SWV value (detected by ARFI) for diagnosing significant HF, area under ROC (AUC) [95% confidence interval (CI)], sensitivity and specificity diagnosed by were 1.59m/s, 0.86 (0.79~0.92), 67% and 88%, respectively. The cutoff point of APRI for diagnosing significant HF, AUC (95%CI), sensitivity and specificity were 0.33, 0.77 (0.69~0.84), 89% and 56%, respectively. The cutoff point of FIB-4 for diagnosing significant HF, AUC (95%CI), sensitivity and specificity were 1.33, 0.75 (0.67-0.83), 74% and 69%, respectively. The AUC (95%CI), sensitivity and specificity of the combination of SWV value, APRI and FIB-4 for the diagnosis of significant HF were 0.91, 95% and 90%, respectively. In patients with CHB, the internal diameter of portal vein trunk (Dpv), mean flow velocity (Vmean), portal venous blood flow (Qpv) and PVP were (1.2 ± 0.1) cm, (18.9 ± 1.8) cm/s, (1 240.6 ± 148.0) ml/min and (3.3 ±0.2) kPa, respectively. PVP was significantly positively correlated with HF staging (r=0.66, P<0.05), so were SWV, APRI and FIB-4 (r=0.39, 0.45 and 0.42, all P<0.05).Conclusion ARFI combined with APRI and FIB-4 can be used as a reference index to evaluate HF and PVP in patients with CHB.

Key words: Chronic hepatitis B, Acoustic radiation force impulse, Shear wave velocity, Hepatic fibrosis, Portal vein pressure

叶晓航, 张荣荣, 陶晶. ARFI联合血清学指标对慢性乙型肝炎患者肝纤维化和门静脉压力评估的临床研究[J]. 肝脏, 2020, 25(12): 1300-1302.

YE Xiao-hang, ZHANG Rong-rong, TAO Jing. Clinical research on evaluation of hepatic fibrosis and portal vein pressure in patients with chronic hepatitis B by acoustic radiation force impulse combined with serological indexes[J]. Chinese Hepatolgy, 2020, 25(12): 1300-1302.

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