Clinical research on evaluation of hepatic fibrosis and portal vein pressure in patients with chronic hepatitis B by acoustic radiation force impulse combined with serological indexes
YE Xiao-hang, ZHANG Rong-rong, TAO Jing
2020, 25(12):
1300-1302.
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Objective Serological indexes and hepatic shear wave velocity (SWV) measured by acoustic radiation force impulse (ARFI) were used to evaluate hepatic fibrosis (HF) and portal vein pressure (PVP) in patients with chronic hepatitis B (CHB).Methods From October 2017 to April 2020, there were 80 patients with CHB (49 males and 31 females). The Spearman correlation coefficient was used to evaluate the correlation, the receiver operating characteristic (ROC) curve was used to determine the cut-off point for the diagnosis of significant HF, and to calculate the diagnostic efficiency.Results Among the 80 patients with CHB, with an average age of (41.3 ± 6.6) years, there were 9, 27, 27, 6 and 11 patients in stage (S) 0, S1, S2, S3 and S4. And the average levels of platelet (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and SWV were (185.5 ± 40.8) × 109/L, (44.7 ± 9.2) U/L, (34.1 ± 11.6) U/L and (1.81 ± 0.56) m/s, respectively. The SWV value detected by ARFI, AST to PLT ratio index (APRI) and fibrosis-4 score (FIB-4) were significantly positively correlated with HF staging (r=0.78, 0.53 and 0.47, P<0.05). The cutoff point of SWV value (detected by ARFI) for diagnosing significant HF, area under ROC (AUC) [95% confidence interval (CI)], sensitivity and specificity diagnosed by were 1.59m/s, 0.86 (0.79~0.92), 67% and 88%, respectively. The cutoff point of APRI for diagnosing significant HF, AUC (95%CI), sensitivity and specificity were 0.33, 0.77 (0.69~0.84), 89% and 56%, respectively. The cutoff point of FIB-4 for diagnosing significant HF, AUC (95%CI), sensitivity and specificity were 1.33, 0.75 (0.67-0.83), 74% and 69%, respectively. The AUC (95%CI), sensitivity and specificity of the combination of SWV value, APRI and FIB-4 for the diagnosis of significant HF were 0.91, 95% and 90%, respectively. In patients with CHB, the internal diameter of portal vein trunk (Dpv), mean flow velocity (Vmean), portal venous blood flow (Qpv) and PVP were (1.2 ± 0.1) cm, (18.9 ± 1.8) cm/s, (1 240.6 ± 148.0) ml/min and (3.3 ±0.2) kPa, respectively. PVP was significantly positively correlated with HF staging (r=0.66, P<0.05), so were SWV, APRI and FIB-4 (r=0.39, 0.45 and 0.42, all P<0.05).Conclusion ARFI combined with APRI and FIB-4 can be used as a reference index to evaluate HF and PVP in patients with CHB.
