瞬时弹性成像检测肝硬度联合脾硬度对慢性乙型肝炎肝纤维化诊断的价值

肝脏 ›› 2023, Vol. 28 ›› Issue (3): 325-329.

瞬时弹性成像检测肝硬度联合脾硬度对慢性乙型肝炎肝纤维化诊断的价值

卢秋燕, 卢燕辉, 徐成润

漳州 363000 联勤保障部队第九○九医院厦门大学附属东南医院感染科

收稿日期:2022-04-23 出版日期:2023-03-31 发布日期:2023-08-28
通讯作者: 徐成润,Email: zhili909@163.com
基金资助:
第九○九医院院级科研项目(20YQ011);福建省医学创新课题项目(2018-CX-42)

Diagnostic value of liver stiffness combined with spleen stiffness detected by transient elastography for pathological stage of liver fibrosis in chronic hepatitis B patients

LU Qiu-yan, LU Yan-hui, XU Cheng-run

Department of Infection, No. 909 Hospital of Joint Logistics Support Force, Southeast Hospital Affiliated to Xiamen University, Zhangzhou 363000, China

Received:2022-04-23 Online:2023-03-31 Published:2023-08-28
Contact: XU Cheng-run,Email: zhili909@163.com

摘要/Abstract

摘要： 目的评价以FibroScan为代表的瞬时弹性成像所检测的肝硬度联合脾硬度对慢性乙型肝炎患者肝纤维化病理分期诊断的价值。方法回顾性分析2018年1月—2021年12月于联勤保障部队第九〇九医院收治的317例接受肝脏活检的慢性乙型肝炎患者临床资料。利用ROC曲线分析FibroScan所测量的肝脏硬度值(liver stiffness measurement, LSM)、脾脏硬度值(spleen stiffness measurement, SSM)与肝脏病理所诊断纤维化关系。采用logistic回归构建基于LSM和SSM的纤维化分级阶段模型。结果纳入患者的肝脏病理S0-S1为79例(24.92%),S2为102例(32.18%),S3为87例(27.44%),S4为49例(15.46%)。炎症情况G1为31(9.78%)例,G2为109例(34.38%),G3为128例(40.34%);G4为49例(15.46%)。LSM对显著纤维化(≥S2)、严重纤维化(≥S3)和肝硬化(S4)的最佳诊断LSM值为7.4 kPa(AUC = 0.861)、9.8 kPa(AUC = 0.909)和16.6 kPa (AUC = 0.915),SSM值依次为36.2 kPa(AUC = 0.817)、42.4 kPa(AUC = 0.913)和分别为49.1kPa (AUC = 0.930)。根据logistic回归构建基于LSM和SSM的预测肝脏病理诊断模型,并优化后得到R=LSM+SSM。所构建的诊断模型预测,较单独使用LSM或SSM与病理诊断一致性更高(P<0.001)。对显著纤维化、严重纤维化和肝硬化预测诊断AUC依次为0.913、0.962和0.991。结论基于瞬时弹性成像技术检测LSM联合SSM可提高对慢性乙型肝炎患者肝脏纤维化分级诊断效能。

关键词: 慢性乙型肝炎, 肝纤维化, 瞬时弹性成像技术, 无创诊断

Abstract: Objective To evaluate the diagnostic value of liver and spleen stiffness measured by transient elastography (FibroScan)regarding pathological stages of liver fibrosis in patients with chronic hepatitis B. Methods The clinical data of 317 patients with chronic hepatitis B who received liver biopsy from January 2018 to December 2021 in the No.909 Hospital of the joint logistics support unit were retrospectively analyzed. ROC curve was used to analyze the relationship between liver stiffness measurement (LSM)and spleen stiffness measurement (SSM)measured by FibroScan and fibrosis diagnosed by liver pathology. Logistic regression was used to construct a fibrosis grading stage model based on LSM and SSM. Results There were 79 (24.92%)cases of S0-S1, 102 (32.18%)cases of S2, 87 (27.44%)cases of S3 and 49 (15.46%)cases of S4. There were 31 (9.78%)cases of G1, 109 (34.38%)cases of G2 and 128 (40.34%)cases of G3; G4 was 49 (15.46%). The best LSM values for the diagnosis of significant fibrosis (≥ S2), severe fibrosis (≥ S3)and liver cirrhosis (S4)were 7.4 kPa (AUC = 0.861), 9.8 kPa (AUC = 0.909)and 16.6 kPa (AUC = 0.915), and the SSM values were 36.2 kPa (AUC = 0.817), 42.4 kPa (AUC = 0.913)and 49.1 kPa (AUC = 0.930), respectively. The predictive liver pathological diagnosis model based on LSM and SSM was constructed according to logistic regression, and R = LSM + SSM was obtained after optimization. The diagnostic model was more consistent with the pathological diagnosis than LSM or SSM alone (P<0.001). The AUCs of significant fibrosis, severe fibrosis and liver cirrhosis were 0.913, 0.962 and 0.991, respectively. Conclusion The detection of LSM combined with SSM based on transient elastography can improve the diagnostic efficiency of liver fibrosis in patients with chronic hepatitis B.

Key words: Chronic hepatitis B, Hepatic fibrosis, Transient elastography, Noninvasive diagnosis

卢秋燕, 卢燕辉, 徐成润. 瞬时弹性成像检测肝硬度联合脾硬度对慢性乙型肝炎肝纤维化诊断的价值[J]. 肝脏, 2023, 28(3): 325-329.

LU Qiu-yan, LU Yan-hui, XU Cheng-run. Diagnostic value of liver stiffness combined with spleen stiffness detected by transient elastography for pathological stage of liver fibrosis in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2023, 28(3): 325-329.

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