肝内胆汁淤积对肝脏硬度值测定的影响

摘要/Abstract

摘要： 目的通过检测肝内胆汁淤积(IHC)患者治疗前后肝脏硬度值(LSM)变化,旨在评价瞬时弹性成像在IHC病情监测及治疗反应中的意义。方法纳入2017年4月—2019年6月期间我院收治的IHC患者56例,男性21例、女性35例,年龄(38.4±7.5)岁。IHC诊断符合ALP>1.5倍正常值上限且GGT>3倍正常值上限、影像学提示无胆管扩张。计量资料[M(P25,P75)]表示,Kruskal-Wallis H检验比较;计数资料(%)表示,卡方检验比较;受试者工作特征曲线(ROC曲线)评价诊断效能。结果 IHC病因包括自身免疫性肝炎 22例(39.3%),原发性硬化性胆管炎 12例(21.4%),药物源性因素8例(14.3%),原发性胆汁性胆管炎 6例(10.7%)及其他原因(重叠综合征、肝豆状核变性、布加综合征、EB病毒感染、淋巴瘤)8例(14.3%)。按METAVIR评分,IHC患者治疗前F0、F1、F2、F3、F4各分期为5例(8.9%)、9例(16.1%)、15例(26.8%)、11例(19.6%)、16例(28.5%),治疗后为14例(25.0%)、11例(19.6%)、9例(16.1%)、6例(10.7%)及16例(28.5%),具有显著性差异(P<0.05)。瞬时弹性成像诊断IHC患者≥F2肝纤维化时的临界值、敏感性、特异性及ROC曲线下面积(AUC)分别为6.8kPa、98%、50%及0.77;≥F3肝纤维化时的临界值、敏感性、特异性及AUC分别为9.2 kPa、88%、83%及0.90;F4肝纤维化时的临界值、敏感性、特异性及AUC分别为13.5 kPa、91%、98%及0.93。IHC患者治疗前LSM值为[12.8(9.0,24.2)]kPa,治疗后[9.6(5.2,18.1)]kPa,具有统计学差异(P<0.05)。结论瞬时弹性成像是评估IHC患者肝纤维化程度、病情监测和治疗反应的有效方法,具有足够的诊断性能。

关键词: 肝内胆汁淤积, 瞬时弹性成像, 肝脏硬度值, 受试者工作特性曲线

Abstract: Objective To investigate the significance of transient elastography in disease monitoring and treatment evaluation of intrahepatic cholestasis (IHC). Methods A total of 56 IHC patients, who were admitted to our hospital from April 2017 to June 2019, including 21 males and 35 females, aged (38.4±7.5) years, were enrolled. IHC diagnosis conforms to alkaline phosphatase >1.5 times the upper limit of normal value, gamma-glutamyltranspeptidase >3 times the upper limit of normal value, and imaging showing no bile duct dilatation. Measurement data [median (25th percentile, 75th percentile)] were analyzed by Kruskal-Wallis H test, and counting data (%) were analyzed by chi-square test. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency. Results IHC etiology includes 22 cases (39.3%) of autoimmune hepatitis, 12 cases (21.4%) of primary sclerosing cholangitis, 8 cases (14.3%) of drug induction, 6 cases (10.7%) of primary biliary cirrhosis and 8 cases (14.3%) of other causes (overlap syndrome, hepatolenticular degeneration, Budd-Chiari syndrome, EB virus infection and lymphoma). According to METAVIR score, the numbers of IHC patients with fibrosis stage (F) 0, F1, F2, F3 and F4 were 5 cases (8.9%), 9 cases (16.1%), 15 cases (26.8%), 11 cases (19.6%) and 16 cases (28.5%) before treatment, respectively, 14 cases (25.0%), 11 cases (19.6%), 9 cases (16.1%), 6 cases (10.7%) and 16 cases (28.5%) after treatment, respectively (P<0.05). The cut-off value, sensitivity, specificity and area under the ROC curve (AUC) of liver stiffness measurement (LSM) for IHC patients with METAVIR ≥F2 were 6.8 kPa, 98%, 50% and 0.77, respectively. The cut-off value, sensitivity, specificity and AUC for METAVIR ≥F3 were 9.2 kPa, 88%, 83% and 0.90, respectively. The cut-off value, sensitivity, specificity and AUC for F4 were 13.5 kPa, 91%, 98% and 0.93, respectively. The LSM value of IHC patients was [12.8 (9.0, 24.2)] kPa before treatment and [9.6 (5.2, 18.1)] kPa after treatment, with statistical difference (P<0.05). Conclusion Transient elastography is an effective method to evaluate the degree of liver fibrosis, disease severity and therapeutic response in patients with IHC, which has sufficient diagnostic value.

Key words: Intrahepatic cholestasis, Transient elastography, Liver stiffness measurement, Receiver operator characteristic curve

严华, 郑立敏, 杨小红. 肝内胆汁淤积对肝脏硬度值测定的影响[J]. 肝脏, 2020, 25(9): 943-945.

YAN Hua, ZHENG Li-min, YANG Xiao-hong. Influence of intrahepatic cholestasis on liver stiffness measurement value[J]. Chinese Hepatolgy, 2020, 25(9): 943-945.

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