丙氨酸氨基转移酶水平对FibroTouch检测慢性乙型肝炎患者肝脏硬度值的影响研究  

Impact of Alanine Aminotransferase Level on Liver Stiffness Measured by Fibrotouch in Patients with Chronic Hepatitis B

作　　者：王文玲 张馨元 叶松 李荣宽[1] WANG Wenling;ZHANG Xinyuan;YE Song;LI Rongkuan(The Second Hospital of Dalian Medical University,Dalian 116023,China;The 91550th Hospital of Chinese People's Liberation Army,Dalian116023,China)

机构地区：[1]大连医科大学附属第二医院,辽宁省大连市116023 [2]中国人民解放军91550部队医院,辽宁省大连市116023

出　　处：《中国全科医学》2021年第30期3842-3847,共6页Chinese General Practice

基　　金：吴阶平医学基金会肝病医学部资助项目(LDWMF-FT-2016J001)——定量肝脏弹性测定系统FibroTouch在临床肝病中的相关研究。

摘　　要：背景多项研究表明丙氨酸氨基转移酶(ALT)水平升高可导致肝脏硬度值(LSM)升高,但少有研究探讨不同程度升高的ALT水平尤其是轻度升高的ALT水平对慢性乙型肝炎患者(CHB)LSM的影响。目的明确ALT水平对FibroTouch检测CHB患者LSM的影响。方法选取2016年5月至2019年3月就诊于大连医科大学附属第二医院感染科病房的CHB患者145例,根据ALT水平分为A组〔ALT<1×参考值上限(ULN)〕46例、B组(1×ULN≤ALT<2×ULN)64例、C组(2×ULN≤ALT<5×ULN)35例。所有患者接受肝脏穿刺活检和FibroTouch检查,参照METAVIR计分系统标准将肝脏穿刺活检结果分为轻微肝纤维化(F1)、明显肝纤维化(F2~F3)、肝硬化(F4)。比较不同ALT水平、肝纤维化程度CHB患者LSM;以肝脏穿刺活检结果为“金标准”,绘制受试者工作特征(ROC)曲线以分析FibroTouch对CHB肝纤维化程度的诊断效能。结果A组、B组患者总体LSM及F1、F2~F3、F4患者LSM均低于C组(P<0.05)。A组患者中16例为F1,22例为F2~F3,8例为F4;B组患者中14例为F1,44例为F2~F3,6例为F4;C组患者中6例为F1,22例为F2~F3,7例为F4。A组、B组、C组中F1患者LSM分别低于F2~F3、F4患者,F2~F3患者LSM分别低于F4患者(P<0.05)。Spearman秩相关分析结果显示,三组患者总体LSM均与肝纤维化程度呈正相关(rs值分别为0.81、0.71、0.73,P<0.001)。绘制ROC曲线发现,FibroTouch诊断总体、A组、B组、C组患者F2~F3的曲线下面积(AUC)分别为0.904、0.933、0.914、0.897,诊断总体、A组、B组、C组患者F4的AUC分别为0.942、0.954、0.989、0.949(P<0.001)。结论ALT<2×ULN时FibroTouch检测CHB患者LSM不受明显影响,而ALT≥2×ULN时FibroTouch检测CHB患者LSM可能被高估,不一定能反映真实肝纤维化程度。Background A number of studies have shown that elevated alanine aminotransferase(ALT)level may result in increase of liver stiffness measurements,but few studies have explored the association of liver stiffness measurements with elevated ALT,especially mildly elevated ALT,in patients with chronic hepatitis B(CHB).Objective To explore the impact of ALT level on liver stiffness measured by FibroTouch in patients with CHB.Methods A total of 145 CHB patients were recruited from Inpatient Ward of Infectious Disease Department,the Second Hospital of Dalian Medical University during May 2016 to March 2019.All of them performed ALT blood test,measured liver stiffness by FibroTouch,and assessed liver fibrosisby liver biopsy.Liver stiffness measured by FibroTouch was compared by ALT level〔ALT<1×ULN(upper limit of normal)(group A,n=46),1×ULN≤ALT<2×ULN(group B,n=64),2×ULN≤ALT<5×ULN(group C,n=35)〕and by liver fibrosis assessed by liver biopsy using the METAVIR scoring system〔score F1(mild liver fibrosis),score F2-F3(obvious liver fibrosis)and score F4(cirrhosis)〕.ROC analysis was used to assess the accuracy of FibroTouch in measuring liver stiffness,with the results of liver biopsy serving as the gold standard of reference.Results Groups A and B had lower mean liver stiffness measured by FibroTouch than group C(P<0.05).Patients with mild liver fibrosis(n=16)in group A had lower mean liver stiffness measured by FibroTouch than those(n=6)in group C,so did those(n=14)in group B(P<0.05).Patients with obvious liver fibrosis(n=22)in group A showed lower mean liver stiffness measured by FibroTouch than those(n=22)in group C,so did those(n=44)in group B(P<0.05).Patients with cirrhosis(n=8)in group A demonstrated lower mean liver stiffness measured by FibroTouch than those(n=7)in group C,so did those(n=6)in group B(P<0.05).In groups A,B and C,the mean liver stiffness measured by FibroTouch successively increased with the aggravation of liver fibrosis severity assessed by liver biopsy(P<0.05).Spearman rank correlation

关 键 词：丙氨酸转氨酶 乙型肝炎 肝纤维化 FibroTouch 肝脏硬度值 

分 类 号：R345.55[医药卫生—基础医学] R512.62