超声剪切波弹性成像结合血浆NRG4水平评估慢性乙型肝炎肝纤维化程度的价值

摘要/Abstract

摘要： 目的探究超声剪切波弹性成像(SWE)联合血浆神经调节蛋白4(NRG4)水平评估慢性乙型肝炎(CHB)肝纤维化程度的价值。方法 2020年6月—2022年6月雅安市人民医院接诊的CHB肝纤维化患者116例,均进行肝脏穿刺病理活检,采用超声SWE检测肝脏杨氏模量值,Elisa法检测血浆NRG4水平。分析肝脏杨氏模量值及血浆NRG4水平与肝纤维化程度的相关性。绘制受试者工作特征曲线(ROC),并采用曲线下面积(AUC)评估杨氏模量值联合血浆NRG4水平对CHB肝纤维化程度的诊断效能。结果 116例CHB肝纤维化患者中F1期33例(28.4%)、F2期38例(32.8%)、F3期26例(22.4%)、F4期19例(16.4%)。F1期、F2期、F3期、F4期患者的杨氏模量值分别为[(5.2±1.3)kPa、(6.3±1.2)kPa、(8.7±1.4)kPa、(11.9±1.6)kPa, P<0.05];F1期、F2期、F3期、F4期患者的血浆NRG4水平分别为(6.7±1.2)、(4.9±1.0)、(3.3±0.9)、(1.9±0.5)pg/mL(P<0.05)。Spearman相关性分析结果显示,杨氏模量值与肝纤维化程度呈正相关(r=0.673, P<0.05);血浆NRG4水平与肝纤维化程度呈负相关(r=-0.702, P<0.05)。ROC分析结果显示,杨氏模量值对CHB肝纤维化患者F1期、F2期、F3期及F4期诊断的AUC分别为0.85(95%CI: 0.75～0.94)、0.83(95%CI: 0.75～0.92)、0.86(95%CI: 0.76～0.95)、0.92(95%CI: 0.82～1.00)。血浆NRG4水平对CHB肝纤维化患者F1期、F2期、F3期及F4期诊断的AUC分别为0.86(95%CI: 0.76～0.95)、0.82(95%CI:0.74～0.91)、0.88(95%CI: 0.80～0.97)、0.92(95%CI: 0.82～1.00)。杨氏模量值联合血浆NRG4水平对CHB肝纤维化患者F1期、F2期、F3期及F4期诊断的AUC分别为0.92(95%CI: 0.84～0.99)、0.92(95%CI: 0.85～0.98)、0.94(95%CI: 0.88～1.00)、0.97(95%CI: 0.91～1.00),杨氏模量值联合血浆NRG4诊断肝纤维化不同分期的AUC高于二者单一诊断(P<0.05)。结论杨氏模量值和血浆NRG4水平对CHB肝纤维化程度的诊断效果良好,且联合诊断价值更高。

关键词: 慢性乙型肝炎, 肝纤维化分期, 剪切波弹性成像, 杨氏模量值, 神经调节蛋白4

Abstract: Objective To explore the value of combining ultrasonic shear wave elastography (SWE) with plasma neuregulin 4 (Nrg4) levels in assessing the degree of liver fibrosis in patients with chronic hepatitis B (CHB). Methods Between June 2020 and June 2022, 116 patients with CHB-related liver fibrosis admitted to our hospital underwent liver biopsy. The liver's Young's modulus value was measured using ultrasound SWE, and the plasma Nrg4 levels were measured using the Elisa method. We analyzes the correlation between liver Young's modulus value and plasma Nrg4 levels with the degree of liver fibrosis. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was used to evaluate the diagnostic efficacy of combining Young's modulus and plasma Nrg4 levels for assessing the degree of liver fibrosis in CHB patients. Results Among the 116 patients with CHB liver fibrosis, there were 33 cases in the F1 phase (28.4%), 38 cases in the F2 phase (32.8%), 26 cases in the F3 phase (22.4%), and 19 cases in the F4 phase (16.4%). The Young's modulus values for patients in the F1, F2, F3, and F4 stages were [(5.2 ± 1.3) kPa, (6.3 ± 1.2) kPa, (8.7 ± 1.4) kPa, and (11.9 ± 1.6) kPa, respectively, P<0.05]. The plasma Nrg4 levels for patients in the F1, F2, F3, and F4 stages were [(6.7 ± 1.2) pg/mL, (4.9 ± 1.0) pg/mL, (3.3 ± 0.9) pg/mL, and (1.9 ± 0.5) pg/mL, respectively(P<0.05)]. Spearman correlation analysis showed that the Young's modulus value was positively correlated with the degree of liver fibrosis (r=0.673, P<0.05), while the plasma Nrg4 level was negatively correlated with the degree of liver fibrosis (r=-0.702, P<0.05). ROC analysis revealed the AUC values of Young's modulus for diagnosing F1, F2, F3, and F4 stages of CHB liver fibrosis were 0.85 (95% CI: 0.75-0.94), 0.83 (95% CI: 0.75-0.92), 0.86 (95% CI: 0.76-0.95), and 0.92 (95% CI: 0.82-1.00), respectively. The AUC values for plasma Nrg4 levels in diagnosing F1, F2, F3, and F4 stages were 0.86 (95% CI: 0.76-0.95), 0.82 (95% CI: 0.74-0.91), 0.88 (95% CI: 0.80-0.97), and 0.92 (95% CI: 0.82-1.00), respectively. The AUC values for diagnosing F1, F2, F3, and F4 stages using the combination of Young's modulus and plasma Nrg4 were 0.92 (95% CI: 0.84-0.99), 0.92 (95% CI: 0.85-0.98), 0.94 (95% CI: 0.88-1.00), and 0.97 (95% CI: 0.91-1.00), respectively. These combined AUC values were significantly higher than those of either Yang's modulus or plasma Nrg4 levels alone (P<0.05). Conclusion The effectiveness of Young's modulus value and plasma Nrg4 levels in diagnosing the degree of liver fibrosis in CHB is significant with the combined diagnostic value being even higher.

Key words: Chronic hepatitis B, Staging of liver fibrosis, Shear wave elastic imaging, Young's modulus value, Neuregulin 4

刘艳午, 田丹, 宋晶晶. 超声剪切波弹性成像结合血浆NRG4水平评估慢性乙型肝炎肝纤维化程度的价值[J]. 肝脏, 2024, 29(7): 825-829.

LIU Yan-wu, TIAN Dan, SONG Jing-jing. The combined value of ultrasounic shear wave elastography and plasma Nrg4 levels in assessing liver fibrosis severity in chronic hepatitis B[J]. Chinese Hepatolgy, 2024, 29(7): 825-829.

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