关键词: 慢性乙型肝炎, 瞬时弹性成像, 肝脏硬度值, 门静脉血流动力学指标

Abstract: Objective The role of liver stiffness measurement combined with portal venous hemodynamic parameters in evaluting hepatic fibrosis states in patients with CHB. Methods 145 patients with CHB who were diagnosed and treated in Santai County People's Hospital between February 2020 and June 2024 were collected. According to the degree of liver fibrosis, patients with CHB were divided into a mild fibrosis group and a severe fibrosis group, and the differences in LSM and portal vein hemodynamics indexes between the two groups were compared, and the evaluation efficiency of LSM and portal vein hemodynamic indexes for severe liver fibrosis and cirrhosis was analyzed. Results Among 145 patients with CHB, 49 cases were mild and 96 cases were severe liver fibrosis. The values of LSM, PVD, PVVmean, PVQ, and CI in mild hepatic fibrosis were (6.3±1.1) kPa, (1.0±0.2) cm, (16.9±0.6) cm/s, 1 030.0 (895.6~1 233.5) mL/min, and (0.05±0.01), respectively. These parameters showed statistically significant differences compared to those in severe hepatic fibrosis [(13.0±1.8) kPa, (1.4±0.4) cm, (14.8±0.5) cm/s, 1 570.2 (1 382.4~1 687.5) mL/min, and (0.09±0.02), P<0.05]. Taking the above indexes as test variables and the severity of liver fibrosis as state variables, the evaluation efficiency of LSM and portal hemodynamics indexes in patients with severe liver fibrosis in CHB was analyzed. The results showed that the AUC, sensitivity and specificity of combined diagnosis of LSM, PVD, PVVmean, PVQ and CI were higher than those of single diagnosis (P<0.05). Thirty-seven patients with severe liver fibrosis can be diagnosed as cirrhosis. In non-cirrhotic patients, the values of LSM, PVD, PVVmean, PVQ, and CI were (11.0±1.4) kPa, (1.2±0.3) cm, (16.7±1.0) cm/s, 1 530.2 (1 382.4~1 577.2) mL/min, and (0.08±0.02), respectively. These parameters demonstrated statistically significant differences when compared to cirrhotic patients [(16.1±2.1) kPa, (1.7±0.4) cm, (11.8±0.4) cm/s, 1 611.4 (1 424.3~1 687.5) mL/min, and (0.11±0.02), P<0.05]. Taking the above indexes as test variables and cirrhosis status as the state variable, the evaluation efficiency of LSM and portal hemodynamics in patients with CHB was analyzed. The results showed that the AUC, sensitivity and specificity of combined diagnosis of LSM, PVD, PVVmean, PVQ and CI were higher than those of single diagnosis (P<0.05). Conclusion LSM combined with portal hemodynamics can effectively differentiate hepatic fibrosis state in CHB patients, which can be popularized in clinical practice.

Key words: Chronic hepatitis B, Transient elastography, Liver stiffness measurement, Portal vein hemodynamic index