声触诊弹性成像检测肝脾硬度联合APRI、FIB-4评估慢性乙型肝炎肝纤维化程度的价值

摘要/Abstract

摘要： 目的评估肝脾硬度值(LSM、SSM)联合常见肝纤维化指标APRI、FIB-4对慢性乙型肝炎(CHB)肝纤维化的诊断效能。方法选择2021年5月至2024年5月于我院诊治的117例CHB患者为研究对象,利用声触诊弹性成像(STE)检查LSM、SSM,通过检测血生化指标计算APRI、FIB-4,按照METAVIR评分系统进行肝纤维化评估,将CHB患者分为非显著组和显著肝纤维化组,并比较两组患者临床资料以及LSM、SSM、APRI及FIB-4;分析影响显著肝纤维化的危险因素,并采取ROC曲线评估各项指标诊断不同肝纤维化状态的效能。结果 117例CHB患者中F0至F4期分别为13例、32例、36例、24例及12例。进一步比较非显著组(≤F1期,n=45)、显著(≥F2期,n=72)肝纤维化组患者临床资料,显著肝纤维化组PLT、ALT、AST、LSM、SSM、APRI及FIB-4为(106.1±34.0)×10⁹/L、(66.1±10.4)U/L、(61.4±12.5)U/L、(13.1±1.7)kPa、(23.1±3.7)kPa、(2.3±0.5)、(1.8±0.4),与非显著肝纤维化组[(160.5±23.4)×10⁹/L、(51.4±9.8)U/L、(46.8±10.1)U/L、(9.2±1.5)kPa、(15.4±3.2)kPa、(1.1±0.3)、(1.0±0.3)]相比,差异具有统计学意义(P<0.05)。将上述差异性指标作为自变量进一步纳入多因素分析,以显著肝纤维化与否作为因变量,结果提示LSM、SSM、APRI及FIB-4可以显著影响CHB患者显著肝纤维化的发生(P<0.05)。LSM+SSM、LSM+SSM+APRI+FIB-4诊断AUC值分别显著高于LSM、SSM、APRI及FIB-4(P<0.05),且LSM+SSM+APRI+FIB-4诊断AUC值也显著高于LSM+SSM(P<0.05)。LSM+SSM诊断AUC、敏感度、特异度分别为0.85、88.9%、90.3%;LSM+SSM+APRI+FIB-4诊断AUC、敏感度、特异度分别为0.93、93.3%、91.7%。结论利用STE检测CHB患者LSM、SSM可有效评价肝纤维化状态,当与肝纤维化指标APRI、FIB-4结合诊断时,效能更为显著,作为无创诊断手段,值得进一步研究。

关键词: 慢性乙型肝炎, 声触诊弹性成像, 肝脏硬度值

Abstract: Objective To evaluate the diagnostic efficacy of liver and spleen stiffness measurement (LSM, SSM) combined with common liver fibrosis indexes APRI and FIB-4 in chronic hepatitis B (CHB). Methods 117 patients with CHB diagnosed and treated in our hospital between May 2021 and May 2024 were collected. LSM and SSM were examined by acoustic palpation elastography (STE), and serum aspartate aminotransferase and platelet ratio index (APRI) and liver fibrosis factor 4 index (FIB-4) were calculated through the detection of blood biochemical indexes. Liver fibrosis was evaluated according to METAVIR scoring system. The CHB patients were divided into a non-significant and a significant liver fibrosis groups, The clinical data, LSM, SSM, APRI and FIB-4 data of these two groups of patients were compared. The risk factors of significant liver fibrosis were analyzed, and the efficacy of each index in diagnosing different stages of liver fibrosis was evaluated by ROC curve analysis. Results Among 117 patients with CHB, there were 13 cases, 32 cases, 36 cases, 24 cases and 12 cases in F0 to F4 stages, respectively. The clinical data of patients with non-significant (≤F1 stage, N=45) and significant (≥F2 stage, N=72) liver fibrosis were compared. The PLT, ALT, AST, LSM, SSM, APRI and FIB-4 in the liver fibrosis group were (106.1±34.0) ×10⁹/L, (66.1±10.4) U/L, (61.4±12.5) U/L, (13.1±1.7) kPa, (23.1±3.7) kPa, (2.3±0.5), and (1.8±0.4), respectively, compared with those of (160.5±23.4) ×10⁹/L, (51.4±9.8) U/L, (46.8±10.1) U/L, (9.2±1.5) kPa, (15.4±3.2) kPa, (1.1±0.3), (1.0±0.3) in the non-significant hepatic fibrosis group, the difference was statistically significant (P<0.05). Taking these differences as independent variables and significant hepatic fibrosis as dependent variables, the results showed that LSM, SSM, APRI and FIB-4 were significantly associated with the occurrence of significant hepatic fibrosis in CHB patients (P<0.05). The diagnostic AUC values of LSM+SSM, LSM+SSM+APRI+FIB-4 were significantly higher than those of LSM, SSM, APRI and FIB-4 individually (P<0.05), and the diagnostic AUC value of LSM+SSM+APRI+FIB-4 was also significantly higher than that of LSM+SSM (P<0.05). The diagnostic AUC value, the sensitivity and specificity of LSM+SSM were 0.85, 88.9% and 90.3%, respectively. The diagnostic AUC value, the sensitivity and specificity of LSM+SSM+APRI+FIB-4 were 0.93, 93.3% and 91.7%, respectively. Conclusion Using STE to detect LSM and SSM in patients with CHB can effectively evaluate the status of liver fibrosis, and it is more effective when combined with APRI and FIB-4, which is worth of further study as a non-invasive diagnostic method.

Key words: Chronic hepatitis B, Sound touch elastography, Liver stiffness measurement

段良良, 白宝艳, 王胜利, 冯晓. 声触诊弹性成像检测肝脾硬度联合APRI、FIB-4评估慢性乙型肝炎肝纤维化程度的价值[J]. 肝脏, 2025, 30(6): 789-792.

DUAN Liang-liang, BAI Bao-yan, WANG Sheng-li, FENG Xiao. The efficacy of liver and spleen stiffness measurement combined with APRI and FIB-4 in the evaluation of liver fibrosis in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2025, 30(6): 789-792.

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参考文献

[1] Liu Q, Liu F, Duan W, et al. Predictive value of serum albumin, iron, ferritin, and hepcidin for antiviral efficacy of IFNα treatment in patients with chronic hepatitis B[J]. Ann Clin Lab Sci, 2024, 54(2):217-223.
[2] Hou J, Ning Q, Duan Z, et al. Five-year treatment with tenofovir alafenamide achieves high rates of viral suppression, alanine aminotransferase normalization, and favorable bone and renal safety in Chinese chronic hepatitis B patients[J]. J Clin Transl Hepatol. 2024, 12(5):469-480.
[3] Guller B Y, Gulumsek E, Sumbul H E, et al. RDW predicts fibrosis in patients with chronic hepatitis B having persistently normal ALT levels[J]. Ethiop J Health Sci, 2023, 33(4):591-600.
[4] Chen L, Tao X, Zeng M, et al. Noninvasive tests maintain high accuracy for advanced fibrosis in chronic hepatitis B patients with different nomenclatures of steatotic liver disease[J]. J Med Virol, 2024, 96(4):e29613.
[5] Tunçer G, Geyiktepe-Güçlü C, Bayramlar O F, et al. Predictors of significant histological hepatic abnormality in treatment-naive patients infected with HBeAg-negative chronic hepatitis B[J]. Infect Dis Clin Microbiol, 2024, 6(1):22-31.
[6] Kranidioti H, Zisimopoulos K, Oikonomou T, et al. Successful therapy with tenofovir disoproxil fumarate (TDF) in patients with chronic hepatitis B (CHB) does not guarantee amelioration of liver damage assessing by transient elastography. A retrospective-prospective multicenter study[J]. BMC Gastroenterol, 2024, 24(1):133.
[7] Con D, Tu S, Clayton-Chubb D, et al. Effect of concurrent metabolic dysfunction-associated steatotic liver disease on serial non-invasive fibrosis markers in chronic hepatitis B[J]. Dig Dis Sci, 2024, 69(4):1496-1506.
[8] Yang J R, La Q, Ding X M, et al. Application of real-time sound touch elastography for evaluating chronic kidney disease of transplanted Kidneys[J]. Transplant Proc, 2023, 55(9):2095-2101.
[9] Sushaal C R, Patil V M, Patil S. The role of sound touch elastography in assessment of liver fibrosis in chronic liver disease keeping APRI as the reference standard[J]. Abdom Radiol (NY), 2023, 48(11):3373-3381.
[10] Dajti E, Ravaioli F, Zykus R, et al. Accuracy of spleen stiffness measurement for the diagnosis of clinically significant portal hypertension in patients with compensated advanced chronic liver disease: a systematic review and individual patient data meta-analysis[J]. Lancet Gastroenterol Hepatol, 2023, 8(9):816-828.
[11] Fan R, Li G, Yu N, et al. aMAP score and its combination with liver stiffness measurement accurately assess liver fibrosis in chronic hepatitis B patients[J]. Clin Gastroenterol Hepatol, 2023, 21(12):3070-3079.e13.
[12] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30(12):1309-1331.
[13] Amernia B, Moosavy SH, Banookh F, et al. FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran[J]. BMC Gastroenterol, 2021, 21(1):453.
[14] Ho S Y, Wang L C, Hsu C Y, et al. Metavir fibrosis stage in hepatitis C-related hepatocellular carcinoma and association with noninvasive liver reserve models[J]. J Gastrointest Surg, 2020, 24(8):1860-1862.
[15] 李凯, 石波, 程序, 等. 应用STE/STQ技术评估慢性乙型肝炎患者肝纤维化程度效能研究[J]. 实用肝脏病杂志, 2024, 27(1):20-23.
[16] Dong B, Huang S, Chang J, et al. Comparison of sound touch elastography, sound touch quantify, and 4 serum fibrosis indexes for the diagnosis of liver fibrosis in patients with chronic hepatitis B[J]. Ultrasound Q, 2021, 37(2):123-128.
[17] Dong B T, Huang S, Lyu G R, et al. Assessment of liver fibrosis with liver and spleen stiffness measured by sound touch elastography, serum fibrosis markers in patients with chronic hepatitis B[J]. J Dig Dis, 2021, 22(6):342-350.
[18] Huang K, Li Q, Zeng W, et al. Ultrasound score combined with liver stiffness measurement by sound touch elastography for staging liver fibrosis in patients with chronic hepatitis B: a clinical prospective study[J]. Ann Transl Med, 2022, 10(6):271.
[19] 骆云凯, 鄢曹鑫, 张宣宣, 等. 声触诊弹性成像检测脾硬度对诊断慢性乙肝肝纤维化程度的应用价值[J]. 中华医学超声杂志(电子版), 2022, 19(11):1232-1237.
[20] Zhang W, Wang J, Linghu R, et al. Comparison between spleen and liver stiffness measurements by sound touch elastography for diagnosing cirrhosis at different aminotransferase levels: a prospective multicenter study[J]. Eur Radiol, 2022, 32(7):4980-4990.