关键词: 慢性丙型肝炎, 肝纤维化, 瞬时弹性成像, 肝脏硬度, 脾脏硬度, 门静脉内径

Abstract: Objective To investigate the clinical value of liver hardness (LSM) and spleen hardness (SSM) measured by transient elastography (TE) combined with portal vein diameter (PVD) measured by color Doppler ultrasound (CDUS) to detect the liver fibrosis in chronic hepatitis C (CHC). Methods Ninety-four patients with CHC admitted to the Ultrasound Department of Haian People′s Hospital from June 2021 to October 2023 were included in the observation group, and 70 healthy physical examination personnel were included in the control group during the same period. LSM and SSM values were detected by TE and PVD values were detected by CDUS in both groups. Fasting blood samples were collected to calculate the ratio of red blood cell distribution width to platelet count (RPR), liver fibrosis-4 factor index (FIB-4) and serum albumin-bilirubin (ALBI) levels. Patients in observation group underwent liver biospy under the guidance of CDUS, and liver fibrosis staging was performed according to Scheuer method. The levels of LSM, SSM and PVD in the observation group and the control group at different stages of liver fibrosis were compared. Pearson analysis was used to analyze the correlation between LSM, SSM and PVD and the levels of RPR, FIB-4 and ALBI in CHC patients. Receiver operating characteristic (ROC) curve were used to analyze the diagnostic efficacy of LSM, SSM, and PVD indicators alone and in combination for liver fibrosis staging in CHC patients. Results LSM, SSM and PVD in observation group were (10.28±2.09) kPa, (16.62±2.78) kPa and (12.85±2.03) mm, which were higher than those in control group (4.35±0.76) kPa, (7.47±1.26) kPa, (10.64±1.59) mm. The differences were statistically significant (t=8.215, 8.672, 6.538, all P<0.05). The LSM, SSM and PVD of CHC patients in S4 group were (17.95±2.26) kPa, (20.63±3.75) kPa and (14.27±2.63) mm, which were higher than those in S3 group (14.07±2.51) kPa, (18.50±3.06) kPa and (13.49±2.37) mm. They were (10.38±2.16) kPa, (14.59±2.67) kPa, (12.57±2.18) mm in S2 group and (6.72±1.34) kPa, (10.47±2.31) kPa, (11.36±1.84) mm in S1 group. In S0 group, there were (4.93±0.82) kPa, (8.26±1.45) kPa, (10.85±1.62) mm, and the differences were statistically significant (F=25.694, 18.357, 11.462, all P<0.05). Pearson analysis showed that LSM, SSM and PVD in CHC patients were positively correlated with APRI and FIB-4, and negatively correlated with ALBI (P<0.01). ROC curve showed that the AUC of LSM, SSM and PVD alone or in combination for diagnosing of liver fibrosis stage in CHC patients were 0.758, 0.769, 0.652 and 0.846, respectively, and the sensitivity and specificity of combined diagnosis were higher than that of any single efficacy (P<0.01). Conclusion The combined detection of LSM, SSM and PVD by TE and CDUS can reliably diagnose and evaluate the degree of liver fibrosis in CHC patients, which has high clinical application value.    

Key words: CHC, Hepatic fibrosis, TE, LSM, SSM, PVD