实时超声剪切波成像技术联合血清学指标、APRI指数评估慢性乙型肝炎纤维化程度的价值  

The application of real-time shear wave elastography combined with serum HA and APRI index in the evaluation of fibrosis degree in patients with chronic hepatitis B

作　　者：韦玉亚 朱婷 唐文静 方静 WEI Yu-ya;ZHU Ting;TANG Wen-jing;FANG Jing(Department of Ultrasound,Huazhong University of Science and Technology Union,Shenzhen Hospital,Guangdong 518000,China)

机构地区：[1]华中科技大学协和深圳医院超声科,广东518000

出　　处：《肝脏》2021年第8期883-886,891,共5页Chinese Hepatology

摘　　要：目的研究实时超声剪切波成像技术(SWE)联合血清透明质酸(HA)、天冬氨酸转氨酶/血小板比值指数(APRI)在评估慢性乙肝患者肝纤维化程度中的应用价值。方法回顾性分析2018年6月至2020年6月华中科技大学协和深圳医院116例慢性乙肝患者的临床资料。所有患者均接受肝穿刺活检并行SWE检查,记录弹性模量值。采用放射免疫法检测血清透明质酸(HA),计算APRI指数。分析弹性模量值、血清HA及APRI评估肝纤维化的准确性。结果S0~S148例,S232例,S320例,S416例。4组不同肝纤维化程度患者弹性模量值分别为(7.2±2.4)kPa、(8.9±3.0)kPa、(13.6±5.3)、(18.7±6.5)kPa,血清HA分别为(139.1±72.8)μg/L,(337.6±115.2)μg/L,(416.2±136.5)μg/L,(584.2±162.6)μg/L,APRI分别为(0.4±0.2),(0.7±0.3),(0.9±0.4),(1.1±0.5),差异均有统计学意义(P<0.05)。受试者工作曲线(ROC)分析显示,弹性模量值(AUC=0.765,95%CI=0.642~0.889)、血清HA(AUC=0.797,95%CI=0.680~0.913)及APRI(AUC=0.732,95%CI=0.599~0.866)对判断肝纤维化≥S2期具有较高应用价值。多元逐步回归分析结果显示弹性模量值、血清HA及APRI与慢性乙肝患者肝纤维化程度密切相关(P<0.05)。弹性模量值+HA+APRI联合诊断预测肝纤维化≥S2期的敏感度和特异度分别为60.1%和90.5%,弹性模量值+HA+APRI联合诊断预测肝纤维化≥S2期的敏感度和特异度分别为92.5%和66.5%。结论SWE联合血清HA、APRI指数评估慢性乙肝患者肝纤维化程度具有较高准确性。Objective To study the application value of real-time shear wave elastography(SWE)combined with serum hyaluronic acid(HA)and aspartate aminotransferase and platelet ratio index(APRI)in the evaluation of fibrosis degree in patients with chronic hepatitis B.Methods There were 116 cases of clinical dataes with chronic hepatitis B from June 2018 to June 2020,all patients underwent liver biopsy,the grade of liver fibrosis was recorded.All patients were examined by SWE and the elastic modulus was recorded.The serum hyaluronic acid(HA)was detected by radioimmunoassay,the APRI index was calculated.The accuracy of elastic modulus,serum HA and APRI in evaluating liver fibrosis were analyzed.Results There were 48 cases of S0-S1,32 cases of S2,20 cases of S3 and 16 cases of S4.There were significant differences in four groups of patients with different degrees of liver fibrosis in elastic modulus[(7.2±2.4)kPa,(8.9±3.0)kPa,(13.6±5.3),(18.7±6.5)kPa,P<0.05],serum HA[(139.1±72.8)μg/L,(337.6±115.2)μg/L,(416.2±136.5)μg/L,(584.2±162.6)μg/L,P<0.05],APRI[(0.4±0.2),(0.7±0.3),(0.9±0.4),(1.1±0.5),P<0.05].The re-ceiver operative characteristic curve(ROC)analysis showed that modulus of elasticity(AUC=0.765,95%CI=0.642-0.889),serum HA(AUC=0.797,95%CI=0.680-0.913)and APRI(AUC=0.732,95%CI=0.599-0.866)had high application value in judging liver fibrosis≥S2 stage.The multiple stepwise regression analysis showed that the elastic modulus,serum HA and APRI were closely related to the degree of liver fibrosis in patients with chronic hepatitis B(P<0.05).The sensitivity and specificity of elastic modulus value+HA+APRI of combined diagnosis predicts liver fibrosis≥S2 stage were 60.1%and 90.5%respectively,the sensitivity and specificity of elastic modulus value+HA+APRI in predicting liver fibrosis≥S2 stage were 92.5%and 66.5%,respectively.Conclusion The SWE combined with serum HA and APRI index has high accuracy in evaluating the degree of liver fibrosis in patients with chronic hepatitis B.

关 键 词：超声剪切波成像 血清HA APRI指数 慢性乙肝 肝纤维化 

分 类 号：R512.62[医药卫生—内科学]