肝脏瞬时弹性成像与血清学模型对乙型肝炎肝纤维化的诊断价值

肝脏 ›› 2025, Vol. 30 ›› Issue (6): 784-788.

肝脏瞬时弹性成像与血清学模型对乙型肝炎肝纤维化的诊断价值

梁阔鹏, 张磊, 李丽平, 张代辉, 王晓娟, 李金龙, 王文川, 苗杰

054000 河北河北医科大学附属邢台市人民医院超声科(梁阔鹏,张磊,李丽平),CT/MRI室(王晓娟),检验科(李金龙),中西医结合肝病科(王文川),病理科(苗杰);邢台市中心医院医学影像中心(张代辉)

收稿日期:2024-02-25 出版日期:2025-06-30 发布日期:2025-08-08
基金资助:
邢台市重点研发计划自筹项目(2021ZC131)

The diagnosis of liver fibrosis in chronic hepatitis B patients based on a transient elastography and serological model

LIANG Kuo-peng¹, ZHANG Lei¹, LI Li-ping¹, ZHANG Dai-hui², WANG Xiao-juan³, LI Jin-long⁴, WANG Wen-chuan⁵, MIAO Jie⁶

1. Department of Ultrasound, Xingtai People's Hospital Affiliated to Hebei Medical University, Hebei 054000,China;
2. Medical Imaging Center, Xingtai Central Hospital,Hebei 054000,China;
3. CT/MRI, Xingtai People's Hospital Affiliated to Hebei Medical University, Hebei 054000,China;
4. Department of Clinical Laboratory, Xingtai People's Hospital Affiliated to Hebei Medical University,Hebei 054000,China;
5. Department of Hepatology of Integrated Traditional and Western Medicine, Xingtai People's Hospital Affiliated to Hebei Medical University, Hebei 054000,China;
6. Department of Pathology, Xingtai People's Hospital Affiliated to Hebei Medical University, Hebei 054000,China

Received:2024-02-25 Online:2025-06-30 Published:2025-08-08

摘要/Abstract

摘要： 目的探讨肝脏瞬时弹性成像(transient elastograph,TE)的硬度值(liver siffness measurement, LSM)与血清学模型诊断乙型肝炎肝纤维化严重程度的可行性,为无创评估肝纤维程度提供可靠的方法。方法回顾性分析2019年1月至2021年12月期间在我院行肝穿刺活检的乙型肝炎患者,所有患者均进行超声瞬时弹性成像检测和血清学检查,计算APRI、AAR、FIB-4,采用Spearman相关系数分析瞬时弹性成像测量的硬度值、APRI、AAR、FIB-4与肝纤维分级之间的相关性,应用受试者工作特征曲线下面积(AUROC)评估各指标诊断乙型肝炎患者肝纤维化的效能。结果共153人纳入研究,经病理结果证实,S1、S2、S3、S4分别为32、35、10、76例,LSM、APRI、AAR、FIB-4与肝纤维化程度相关,相关系数分别为0.737、0.473、0.516、0.720,经 AUROC分析显示,APRI对S2诊断效能高于LSM、AAR、FIB-4,而LSM对S3、S4的诊断效能均高于其他血清学模型;LSM和FIB-4联合诊断≥S2肝纤维化的特异性高达96.8%。结论应用超声瞬时弹性成像对乙型肝炎患者肝纤维化的诊断有一定的临床价值,其与FIB-4联合可以免除部分肝病患者行肝穿刺活检。

关键词: 乙型肝炎, 肝纤维化, 瞬时弹性成像, 肝穿刺活检

Abstract: Objective To explore the feasibility of using liver stiffness measurement (LSM) based on transient elastography and serological model to diagnose the severity of liver fibrosis in chronic hepatitis B (CHB) patients, and to provide a reliable method for noninvasive assessment of liver fibrosis. Methods The study enrolled 153 hepatitis B patients who underwent liver biopsies between January 2019 to January 2021. All patients had data on transient elastography and serological tests. Serum aspartate aminotransferase and platelet ratio index (APRI), AST/ALT ratio (AAR), liver fibrosis factor 4 index (FIB-4) of all patients were calculated. The Correlation between liver stiffness based on transient elastography, APRT, AAR, FIB-4 factor and the degree of liver fibrosis was analyzed using Spearman correlation method. The area under the curve (AUROC) was used to evaluate the efficacy of each index to diagnose liver fibrosis in CHB patients. Results 153 participants were included in the study. As confirmed by the pathological findings, The numbers of patients with fibrosis stages S1, S2, S3, and S4 were 32, 35, 10, and 76, respectively. Patients with stages≥S2 had significant fibrosis. The LSM, APRI, AAR, and FIB-4 factors were associated with the degree of liver fibrosis. The correlation coefficients were 0.737, 0.473, 0.516, and 0.720, respectively. As shown by the AUROC analysis, APRI had higher diagnostic efficacy in S2 than LSM, AAR, and FIB-4 factors. The diagnostic efficacy of LSM for S3 and S4 was higher than those of the other serological models; The specificity of the combination of LSM and FIB-4 factors for diagnosing fibrosis stages ≥ S2 was up to 96.8%. Conclusion Transient elastography is of certain clinical value in the diagnosis of liver fibrosis in CHB patients, and its combination with FIB-4 factor can exempt some of the patients from the necessity of liver puncture biopsy.

Key words: Chronic hepatitis B, Liver fibrosis, Transient elastography, Liver puncture biopsy

梁阔鹏, 张磊, 李丽平, 张代辉, 王晓娟, 李金龙, 王文川, 苗杰. 肝脏瞬时弹性成像与血清学模型对乙型肝炎肝纤维化的诊断价值[J]. 肝脏, 2025, 30(6): 784-788.

LIANG Kuo-peng, ZHANG Lei, LI Li-ping, ZHANG Dai-hui, WANG Xiao-juan, LI Jin-long, WANG Wen-chuan, MIAO Jie. The diagnosis of liver fibrosis in chronic hepatitis B patients based on a transient elastography and serological model[J]. Chinese Hepatolgy, 2025, 30(6): 784-788.

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