ALT<2倍ULN慢性乙型肝炎肝纤维化患者的肝穿刺病理及临床特征

摘要/Abstract

摘要： 目的研究ALT＜2 ULN慢性乙型肝炎肝纤维化患者的肝穿活检病理及临床特征;探讨瞬时弹性成像(FibroTouch)、FIB-4指数、APRI指数3种无创肝纤维化诊断指标对慢性乙型肝炎(CHB)进展性肝纤维化(≥S2)的诊断价值。方法纳入2015年1月至2019年12月就诊于新疆维吾尔自治区中医医院108例CHB患者,均采集患者的一般资料,进行血常规、肝功能、FibroTouch检测,计算FIB-4和APRI指数,并行肝脏组织学穿刺检查。结果慢性乙型肝炎不同肝纤维化程度患者在AST/ALT、AST/PLT、γ-GT、FibroTouch、FIB-4、APRI方面有统计学意义(P_AST/ALT=0.048,P_AST/PLT=0.032,P_GGT=0.041,P_FibroTouch=0.008,P_FIB-4=0.003,P_APRI=0.032);肝纤维化(≥S2)与＜S2患者在年龄、PLT、AST、AST/ALT、AST/PLT、HBV DNA、HBsAg定量、FibroTouch、FIB-4、APRI方面有统计学差异(P_年龄=0.005,P_PLT=0.040,P_AST=0.034,P_AST/ALT=0.002,P_AST/PLT=0.005,P_{HBV DNA}=0.002,P_表面抗原=0.012,P_FibroTouch=0.000,P_FIB-4=0.000,P_APRI=0.005)。不同肝功能水平慢性乙型肝炎的患者在AST、AST/PLT、FibroTouch、APRI方面有统计学比较有差异(P_AST=0.000,P_AST/ALT=0.001,P_FibroTouch=0.009,P_APRI=0.000);肝组织学穿刺活检表明:ALT＜1ULN慢性乙型肝炎患者中＜S2:33例(51.56%)、≥S2:31例(48.44%),1ULN≤ALT＜2ULN患者中＜S2:26例(54.17%)、≥S2:22例(45.83%)。3.运用受试者工作特征曲线下面积(AUC)比较,在CHB肝纤维化(≥S2)中FibroTouch的诊断价值均大于FIB-4、APRI指数;在≥S2中FibroTouch的AUC为0.73(0.63～0.82),截断值10.55 kpa,敏感度57%,特异度86%,阳性预测值79%,阴性预测值69%。结论 2 ULN＜ALT慢性乙型肝炎患者中≥S2比例较高,无创肝纤维化诊断FIB-4、APRI指数、FibroTouch有一定诊断价值,但仍然无法取代肝组织穿刺活检的地位。

关键词: 慢性乙型肝炎, 肝穿活检, 临床特征, 无创肝纤维化诊断

Abstract: Objective To investigate the pathological and clinical characteristics of liver biopsy in alanine transaminase (ALT) < 2 ULN patients with hepatitis B-related liver fibrosis.To analyze the clinical value of transient elastography (FibroTouch), fibrosis-4 index (FIB-4) and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) in diagnosing progressive liver fibrosis in patients with chronic hepatitis B (CHB).Methods A total of 108 CHB patients admitted to our hospital from January 2015 to December 2019 were enrolled. General data of patients were collected. blood routine examination, liver function test and FibroTouch were performed. The FIB-4 and APRI indexes were calculated and liver biopsy was performed.Results 1. There were significant differences in AST/ALT, AST/platelets (PLT), gamma-glutamyltransferase (GGT), FibroTouch, FIB-4, APRI (PAST/ALT = 0.048, PAST/PLT = 0.032, PGGT = 0.041, PFibroTouch = 0.008, PFIB-4 = 0.003, PAPRI = 0.032) among CHB patients with different liver fibrosis degree. There were significant differences in age, PLT, AST, AST/ALT, AST/PLT, HBV DNA, Hepatitis B surface antigen quantification, FibroTouch, FIB-4, APRI (Page = 0.005, PPLT = 0.040, PAST = 0.034, PAST/ALT = 0.002, PAST/PLT = 0.005, PHBV DNA = 0.002, Psurface antigen = 0.012, PFibroTouch = 0.000, PFIB-4 = 0.000, PAPRI = 0.005) between patients with progressive liver fibrosis and patients without advanced liver fibrosis. 2. There were significant differences in AST, AST/PLT, FibroTouch, APRI (PAST = 0.000, PAST/ALT = 0.001, PFibroTouch = 0.009, PAPRI = 0.000) among patients with different liver function levels. The liver biopsy shows that among the patients with ALT < 1ULN, 33(51.56%) without progressive liver fibrosis (S < 2) and 31(48.44%) with progressive liver fibrosis (S ≥ 2 ). And among patients with 1ULN ≤ ALT < 2ULN, 26 (54.17%) without progressive liver fibrosis (S < 2) and 22(45.83%) with progressive liver fibrosis (S ≥ 2). 3. Comparing the area under the receiver operating characteristic curve (AUC), the value of FibroTouch in diagnosing progressive liver fibrosis was greater than FIB-4 and APRI indexes. The AUC of FibroTouch in diagnosing progressive liver fibrosis (S ≥ 2) was 0.73(0.63～0.82), cut-off value was 10.55kpa, sensitivity was 57%, specificity was 86%, positive predictive value was 79% and negative predictive value was 69%.Conclusion Among CHB patients with ALT < 2ULN, the proportion of which with progressive liver fibrosis (S ≥ 2) is high. FIB-4, APRI, FibroTouch have certain diagnostic value, but still cannot replace liver biopsy.

Key words: Chronic hepatitis B, Liver biopsy, Clinical features, Non-invasive liver fibrosis diagnosis

郭峰, 窦婧, 王晓波, 马燕, 乐永红, 王晓忠. ALT<2倍ULN慢性乙型肝炎肝纤维化患者的肝穿刺病理及临床特征[J]. 肝脏, 2022, 27(4): 431-436.

GUO Feng, DOU Jing, WANG Xiao-bo, MA Yan, LE Yong-hong, WANG Xiao-zhong. Pathological and clinical features of liver biopsy in ALT < 2 ULNpatients with hepatitis B-related liver fibrosis[J]. Chinese Hepatolgy, 2022, 27(4): 431-436.

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