瞬时弹性成像及血清HBsAg、HBV DNA联合评估乙型肝炎肝纤维化程度的价值

摘要/Abstract

摘要： 目的探讨瞬时弹性成像及血清乙型肝炎表面抗原(HBsAg)、乙型肝炎病毒DNA(HBV DNA)联合评估乙型肝炎肝纤维化程度的价值。方法 2019年2月-2023年4月淮南朝阳医院收治77例慢性乙型肝炎患者,患者均接受肝脏穿刺活检判定肝纤维化分期,其中S0期14例、S1期20例、S2期21例、S3期13例、S4期9例。采用Mindray Hepatus 5检测仪检测肝硬度值,检测血清HBsAg、HBV DNA水平。结果 S0~S1期、S2期、S3期、S4期肝硬度值分别为(6.02±1.41)、(9.11±1.46)、(11.26±1.38)、(13.05±1.59)kPa,S4期肝硬度值大于S3期,S3期肝硬度值大于S2期,S2期肝硬度值大于S0~S1期(P<0.05);S0~S1期、S2期、S3期、S4期HBsAg水平分别为(216.81±42.09)、(142.68±35.17)、(53.61±11.54)、(26.51±8.14)IU/mL,S0~S1期、S2期、S3期、S4期HBV DNA分别为(1.14×10⁶±1.79×10⁵)、(1.06×10⁶±1.54×10⁵)、(9.61×10⁵±1.39×10⁵)、(8.47×10⁵±1.33×10⁵)IU/mL,S0~S1期HBsAg水平高于S2期,S2期HBsAg水平高于S3期,S3期HBsAg水平高于S4期,S0~S1期HBV DNA水平高于S3期和S4期,S2期HBV DNA水平高于S4期(P<0.05);经ROC分析,肝硬度值与血清HBsAg、HBV DNA评估肝纤维化程度≥S2期的ROC曲线下面积分别为0.829(95%CI: 0.746~0.912)、0.747(95%CI: 0.678~0.816)、0.723(95%CI: 0.624~0.821),最佳截断值分别为7.362 kPa、148.306 IU/mL、1.092×10⁶ IU/mL,敏感度分别为0.774、0.648、0.679,特异度分别为0.920、0.837、0.863,三项指标联合诊断的曲线下面积为0.907(95%CI: 0.861~0.953),敏感度和特异性分别为0.910、0.958,P<0.05。结论瞬时弹性成像及血清HBsAg、HBV DNA单独评估肝纤维化程度≥S2期的慢性乙型肝炎患者均有较好的价值,联合评估时可进一步提高灵敏度和特异度。

关键词: 慢性乙型肝炎, 肝纤维化, 瞬时弹性成像, 乙型肝炎病毒表面抗原, 乙型肝炎病毒基因

Abstract: Objective To investigate the value of instantaneous elastic imaging combined with serum hepatitis B virus surface antigen (HBsAg) and hepatitis B virus gene (HBV DNA) in evaluating the degree of hepatitis B liver fibrosis. Methods From February 2019 to April 2023, 77 patients with chronic hepatitis B were admitted to Huainan Chaoyang Hospital. All patients received liver puncture biopsy to determine the stage of liver fibrosis, and the results showed that 14 cases were in stage S0, 20 cases were in stage S1, 21 cases were in stage S2, 13 cases were in stage S3, and 9 cases were in stage S4. The Mindray Hepatus 5 tester was used to determine the liver hardness value, and the serum HBsAg and HBV DNA levels were tested. Results The liver hardness values of S0-S1, S2, S3 and S4 stages were (6.02±1.41)kPa, (9.11±1.46)kPa, (11.26±1.38) kPa and (13.05±1.59) kPa, respectively. The liver hardness values of S4 stage were higher than those of S3 stage and S3 stage were higher than those of S2 stage. The liver hardness of S2 stage was higher than that of S0-S1 stage (P<0.05). HBsAg levels in stages S0-S1, S2, S3 and S4 were (216.81±42.09) IU/mL, (142.68±35.17) IU/mL, (53.61±11.54) IU/mL, and (26.51±8.14) IU/mL, respectively. HBV DNA in S0-S1, S2, S3 and S4 stages were (1.14×10⁶±1.79×10⁵)IU/mL,(1.06×10⁶±1.54×10⁵)IU/mL, (9.61×10⁵±1.39×10⁵) IU/mL, (8.47×10⁵±1.33×10⁵) IU/mL, respectively. HBsAg level in S0-S1 stage was higher than that in S2 stage, the level in S2 stage was higher than that in S3 stage, and the level in S3 stage was higher than that in S4 stage. HBV DNA level in S0-S1 stage was higher than that in S3 stage and S4 stage, and the level in S2 stage was higher than that in S4 stage (P<0.05). According to ROC analysis, the area under ROC curve of liver hardness value and serum HBsAg and HBV DNA in evaluating the degree of liver fibrosis ≥S2 stage were 0.829 (95%CI: 0.746~0.912), 0.747 (95%CI: 0.678~0.816) and 0.723 (95%CI: 0.778~0.816), respectively. The optimal cut-off values were 7.362 kPa, 148.306 IU/mL, 1.092×10⁶ IU/mL, the sensitivity were 0.774, 0.648, 0.679, and the specificity were 0.920, 0.837, 0.863, respectively. The area under the curve of the combined diagnosis was 0.907 (95%CI: 0.861~0.953), the sensitivity and specificity were 0.910 and 0.958, respectively, P<0.05. Conclusion Instantaneous elastic imaging and serum HBsAg and HBV DNA have good value in the evaluation of chronic hepatitis B patients with liver fibrosis degree ≥S2 stage, and the sensitivity and specificity can be further improved in the combined evaluation.

Key words: Chronic hepatitis B, Liver fibrosis, Instantaneous elastic imaging, Hepatitis B virus surface antigen, Hepatitis B virus gene

王大龙, 王涛, 王康娥. 瞬时弹性成像及血清HBsAg、HBV DNA联合评估乙型肝炎肝纤维化程度的价值[J]. 肝脏, 2024, 29(1): 56-59.

WANG Da-long, WANG Tao, WANG Kang-e. The value of instantaneous elastography combined with serum HBsAg and HBV DNA in evaluating the degree of hepatitis B related liver fibrosis[J]. Chinese Hepatolgy, 2024, 29(1): 56-59.

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