二维剪切波弹性成像测量肝脏硬度对慢性乙型肝炎患者肝脏相关事件的预测价值

摘要/Abstract

摘要： 目的评价二维剪切波弹性成像(2D-SWE)测量肝脏硬度值(LSM)对慢性乙型肝炎(CHB)患者肝脏相关事件(LREs)的预测价值。方法选取2014年5月至2020年10月期间476例CHB患者(男295例、女181例),年龄(50.4±9.7)岁。LREs定义为肝脏失代偿、肝细胞癌和(或)肝脏相关死亡。做单因素及多因素分析以确定CHB患者LREs发生相关独立预测因素;绘制ROC曲线,取约登指数最大时作为诊断截断值并计算诊断指标。结果 CHB患者出现LREs 68例(LREs组),未出现LREs 408例(非LREs组),比较两组资料可知,LREs组、非LREs组年龄分别为(57.6±7.4)岁、(49.3±9.2)岁,差异有统计学意义(P<0.05);LREs组Child-Pugh A、B及C分级为2例(2.9%)、20例(29.4%)及46例(67.6%),非LREs组Child-Pugh A、B及C分级为146例(35.8%)、221例(54.2%)及41例(10.0%),差异有统计学意义(P<0.05);LREs组ALT、AST、PLT、HBeAg为(68.5±79.6)IU/L、(56.1±63.6)IU/L、(112.8±48.0)×10⁹/L、49例(72.0%),与非LREs组[(144.1±126.0)IU/L、(132.8±130.5)IU/L、(165.4±56.4)×10⁹/L、208例(51.0%)]比,差异有统计学意义(P<0.05);LREs组LSM、APRI、FIB-4为(26.6±10.7)kPa、(1.0±0.4)、(2.1±1.3),与非LREs组[(16.4±11.8)kPa、(0.5±0.2)、(1.2±0.9)]比,差异有统计学意义(P<0.05)。将上述差异性资料纳入多因素分析,结果表明Child-Pugh分级、LSM、APRI及FIB-4为CHB患者LREs发生的独立预测因素(P<0.05)。2D-SWE检测LSM诊断CHB患者LREs发生时的AUC值(0.88)分别显著高于APRI(0.74)、FIB-4(0.78)(P<0.05),当三者联合诊断时诊断敏感度、特异度及准确度为89.7%(61/68)、94.8%(387/408)及94.1%(448/476)。结论 2D-SWE测量LSM能够有效诊断CHB患者LREs的发生,当与APRI、FIB-4联合诊断时诊断效能进一步提升,具有临床应用价值。

关键词: 慢性乙型肝炎, 二维剪切波弹性成像, 肝脏硬度值, 肝脏相关事件

Abstract: Objective To evaluate the predictive value of liver stiffness measurement (LSM) with two-dimensional shear wave elastography (2D-SWE) for liver related events (LREs) in chronic hepatitis B (CHB) patients. Methods A total of 476 CHB patients were selected from May 2014 to October 2020, They were divided into a LREs group (n=68) and a non-LREs group (n=408) according to whether the patient developed LREs. LREs are defined as liver decompensation, hepatocellular carcinoma and/or liver-related death. Univariate and multivariate analysis were performed to determine the independent predictive factors related to the occurrence of LREs in CHB patients, ROC curve was drawn and the diagnostic cutoff point was taken at the maximum Jordan index. The diagnostic index were calculated. Results The age of LREs group and non-LREs group was(57.6±7.4)and (49.3±9.2) years, respectively, and there was significant difference between these two groups (P<0.05). The numbers of patients of Child-Pugh A, B and C grades were 2 cases (2.9%), 20 cases (29.4%) and 46 cases (67.6%) in LREs group, and 146 cases (35.8%), 221 cases (54.2%) and 41 cases (10.0%) respectively in non-LREs group. The difference was statistically significant (P<0.05). The levels of ALT, AST, PLT and HBeAg in LREs group were(68.5±79.6)IU/L,(56.1±63.6)IU/L,(112.8±48.0)×10⁹/L,49 cases(72.0%),respectively, which were significantly higher than those in non-LREs group [(144.1±126.0) IU/L, (132.8±130.5) IU/L, (165.4±56.4)×10⁹/L, 208 cases (51.0%), respectively,all P<0.05]. LSM, APRI and FIB-4 in LREs group were (26.6±10.7) kPa, (1.0±0.4) and (2.1±1.3), respectively,which were significantly higher than those in non-LREs group [(16.4±11.8)kPa, (0.5±0.2) and (1.2±0.2), respectively, all P<0.05]. The above variants were included in multivariate analysis, and the results showed that Child-Pugh grade, LSM, APRI and FIB-4 were independent predictors of LREs in CHB patients. The AUC value of LSM (0.88) for the diagnosis of LREs in CHB patients by 2D-SWE was significantly higher than those of APRI (0.74) and FIB-4 (0.78) (P<0.05). When triply combined these parameters, the diagnostic sensitivity, specificity and accuracy were 89.7% (61/68), 94.8% (387/408) and 94.1% (448/476), respectively. Conclusion 2D-SWE measurement of LSM can effectively predict the occurrence of LREs in CHB patients. When combined with APRI and FIB-4, the diagnostic efficiency is further improved, which has value of clinical application.

Key words: Chronic hepatitis B, Two-dimensional shear wave elastography, Liver stiffness measurement, Liver-related events

朱冬明, 丁洁. 二维剪切波弹性成像测量肝脏硬度对慢性乙型肝炎患者肝脏相关事件的预测价值[J]. 肝脏, 2021, 26(9): 990-993.

ZHU Dong-ming, DING Jie. Predicting liver-related events in chronic hepatitis B patients by the measurement of liver stiffness with two-dimensional shear wave elastography[J]. Chinese Hepatolgy, 2021, 26(9): 990-993.

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