剪切波弹性成像联合APRI诊断酒精性肝病患者肝纤维化程度的价值

摘要/Abstract

摘要： 目的探讨剪切波弹性成像(SWE)联合天冬氨酸氨基转移酶(AST)和血小板(PLT)比率指数(APRI)在酒精性肝病(ALD)患者显著肝纤维化(≥F2期)诊断中的应用价值,并比较其在不同病因性肝病中的诊断效能差异。方法选取ALD患者104例,慢性乙型肝炎(CHB)患者70例、代谢相关脂肪性肝病(MAFLD)患者60例及健康对照50名。比较四组一般资料、肝功能、PLT、APRI及SWE水平差异。比较不同肝纤维化分期ALD患者APRI与SWE变化。采用ROC曲线分析APRI、SWE及二者联合预测显著肝纤维化的诊断效能,并比较不同病因下的诊断表现。进一步采用Pearson相关性分析及二元logistic回归分析,评估CHB、MAFLD及ALD中,APRI与SWE的相关性及其对显著肝纤维化的诊断贡献度。结果 ALD、CHB、MAFLD组ALT为(65.4±20.5)U/L、(90.4±35.0)U/L、(78.4±25.0)U/L,AST为(72.6±25.6)U/L、(78.4±30.2)U/L、(65.3±18.2)U/L,GGT为(128.5±40.8)U/L、(45.1±18.1)U/L、(60.2±22.2)U/L,APRI为(0.78±0.30)、(1.02±0.40)、(0.55±0.20),SWE为(9.6±3.2)kPa、(8.4±2.5)kPa、(7.1±2.0)kPa,均显著高于正常对照(均P<0.05)。在预测显著肝纤维化方面,SWE的AUC均高于APRI,而二者联合AUC最高,分别为ALD 0.96、CHB 0.92、MAFLD 0.88,灵敏度分别达到90.2%、86.0%、82.6%,特异度为92.2%、85.2%、80.8%。相关性分析显示,ALD中,SWE与APRI相关性最强(r=0.78),且SWE诊断贡献度最高(60.6%);CHB中,两者贡献度接近(SWE 51.5%,APRI 48.5%);MAFLD中,SWE贡献度(65.7%)明显高于APRI(34.3%)。结论 SWE联合APRI在诊断显著肝纤维化方面具有更高的准确性,优于单纯使用血清指标或弹性测量,尤其在ALD中表现最为突出。不同病因背景下,SWE与APRI的协同及贡献度存在明显差异,提示评估肝纤维化时应结合病因选择最优的无创指标组合。

关键词: 酒精性肝病, 慢性乙型肝炎, 代谢相关脂肪性肝病, 剪切波弹性成像

Abstract: Objective To evaluate the diagnostic value of shear wave elastography (SWE) combined with the aspartate aminotransferase-to-platelet ratio index (APRI) for identifying significant liver fibrosis (≥F2) in patients with alcohol-related liver disease (ALD), and to compare its diagnostic performance among different etiologies of chronic liver disease. Methods A total of 104 patients with ALD, 70 patients with chronic hepatitis B (CHB), 60 patients with metabolic dysfunction-associated fatty liver disease (MAFLD), and 50 healthy controls were enrolled. General characteristics, liver function parameters, PLT, APRI, and SWE levels were compared among the groups. APRI and SWE changes across different fibrosis stages in ALD were analyzed. ROC curves were used to assess the ability of APRI, SWE, and their combined model to predict significant fibrosis. Diagnostic performance was further compared across different etiologies. Pearson correlation analysis and binary logistic regression were applied to evaluate the correlation between APRI and SWE and their respective contributions to diagnosing significant fibrosis in ALD, CHB, and MAFLD. Results The ALT levels in the ALD, CHB, and MAFLD groups were (65.4±20.5) U/L, (90.4±35.0) U/L, and (78.4±25.0) U/L, respectively. AST levels were (72.6±25.6) U/L, (78.4±30.2) U/L, and (65.3±18.2) U/L, respectively. GGT levels were (128.5±40.8) U/L, (45.1±18.1) U/L, and (60.2±22.2) U/L, respectively. APRI scores were (0.78±0.30), (1.02±0.40), and (0.55±0.20), respectively, and SWE values were (9.6±3.2) kPa, (8.4±2.5) kPa, and (7.1±2.0) kPa, respectively. All these values were significantly higher than those of the normal control group (all P<0.05). In predicting significant liver fibrosis, SWE demonstrated higher AUC values than APRI, while the combination of both achieved the highest AUC (0.96 for ALD, 0.92 for CHB, and 0.88 for MAFLD), with sensitivities of 90.2%, 86.0%, and 82.6%, and specificities of 92.2%, 85.2%, and 80.8%, respectively. Correlation analysis revealed that SWE and APRI showed the strongest correlation in ALD (r=0.78), with SWE contributing the most to diagnosis (60.6%). In CHB, their contributions were similar (SWE 51.5%, APRI 48.5%), while in MAFLD, SWE contributed significantly more (65.7%) compared to APRI (34.3%). Conclusion SWE combined with APRI provides superior accuracy for diagnosing significant fibrosis in ALD compared with either serum-based markers or elastography alone, showing particularly strong performance in alcohol-related liver injury. The correlation and diagnostic contribution of SWE and APRI differ markedly across disease etiologies, indicating that etiology-based optimization of non-invasive fibrosis assessment strategies is necessary.

Key words: Alcohol-related liver disease, Chronic hepatitis B, Metabolic associated fatty liver disease, Shear wave elastography

赵英超, 罗朵朵, 武湘华, 任育慧, 王艳, 强晓辉, 杜海峰. 剪切波弹性成像联合APRI诊断酒精性肝病患者肝纤维化程度的价值[J]. 肝脏, 2026, 31(6): 847-850.

Zhao Yingchao, Luo Duoduo, Wu Xianghua, Ren Yuhui, Wang Yan, Qiang Xiaohui, Du Haifeng. Value of shear wave elastography combined with APRI in assessing liver fibrosis in patients with alcohol-related liver disease[J]. Chinese Hepatolgy, 2026, 31(6): 847-850.

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