高频超声肝实质纹理特征定量联合血清AFP-L3水平评估乙型肝炎肝硬化患者肝功能分级价值研究  

Diagnostic performance of liver parenchymal texture feature quantification by high-frequency ultrasonography and serum AFP-L3 levels in the evaluation of liver function classification in patients with hepatitis B cirrhosis

作　　者：李芳[1] 王衍森 翁璐昕 Li Fang;Wang Yansen;Weng Luxin(Department of Ultrasound,Fifth People's Hospital,Anyang 455000,Henan Province,China)

机构地区：[1]河南省安阳市第五人民医院超声科,455000 [2]河南科技大学第四附属医院超声科

出　　处：《实用肝脏病杂志》2022年第4期542-545,共4页Journal of Practical Hepatology

基　　金：河南省医学科技攻关计划项目(编号:201900716)。

摘　　要：目的探讨应用高频超声肝实质纹理特征定量联合血清甲胎蛋白-L3(AFP-L3)水平评估乙型肝炎肝硬化患者肝功能分级的价值。方法2019年6月~2021年5月我院诊治的乙型肝炎肝硬化患者87例和在本院进行体检的健康志愿者80例,将肝硬化患者依据肝功能分级分为A级、B级和C级。使用高频超声检查,获取肝实质纹理特征定量指标,包括缺陷图单位面积局部最大值(x D)、缺陷图均值(mean D)和缺陷图的熵(εD)。采用ELISA法检测血清AFP-L3水平。应用MedCalc15.1统计学软件绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评价指标的评估价值。结果肝硬化患者高频超声肝实质纹理特征定量指标x D、mean D、εD和血清AFP-L3水平分别为(6.1±1.8)、(4.8±1.2)、(3.2±1.1)和(7.5±2.1)%,显著高于健康人【分别为(2.5±0.9)、(1.9±0.6)、(1.3±0.4)和(5.6±1.3)%,P<0.05】;24例Child C级患者x D、mean D、εD和血清AFP-L3水平分别为(6.9±2.2)、(7.0±2.2)、(4.3±1.3)和(9.0±2.4)%,显著高于29例Child B级患者【分别为(6.5±1.7)、(5.4±1.5)、(3.8±1.1)和(7.9±2.1)%,P<0.05】或34例A级患者【分别为(5.3±1.3)、(3.2±1.0)、(2.1±0.6)和(6.1±1.5)%,P<0.05】;联合应用mean D、εD和血清AFP-L3水平评估乙型肝炎肝硬化患者肝功能Child B级的AUC为0.910,其诊断的特异度为91.4%,显著高于各指标单独诊断(其特异度分别为70.7%、77.6%和75.9%,P<0.05)。结论应用高频超声肝实质纹理特征定量联合血清AFP-L3水平评估乙型肝炎肝硬化患者肝功能分级有一定的价值,可为临床早期发现肝功能Child B级患者提供参考指标。Objective The aim of this study was to explore the diagnostic performance of liver parenchymal texture feature quantification by high-frequency ultrasonography(HFU)and serum alpha-fetoprotein-L3(AFP-L3)levels in the evaluation of liver function classification in patients with hepatitis B cirrhosis.Methods 87 patients with liver cirrhosis induced by hepatitis B viral infection and 80 healthy volunteers who underwent physical examination were enrolled in our hospital between June 2019 and May 2021.According to the liver function class,the patients with liver cirrhosis were divided into Child-Pugh class A(n=34),Child-Pugh class B(n=29)and Child-Pugh class C(n=24).All the individuals underwent HFU check-up to obtain automatically x D,mean D andεD by software.Serum AFP-L3 was assayed by ELISA.The area under receiver operating characteristic curve(AUC)was applied to predict liver function class.Results The x D,mean D,εD and serum AFP-L3 levels in patients with liver cirrhosis were(6.1±1.8),(4.8±1.2),(3.2±1.1)and(7.5±2.1)%,significantly higher than[(2.5±0.9),(1.9±0.6),(1.3±0.4)and(5.6±1.3)%,respectively,P<0.05]in healthy persons;the x D,mean D,εD and serum AFP-L3 levels in patients with liver cirrhosis class C were(6.9±2.2),(7.0±2.2),(4.3±1.3)and(9.0±2.4)%,significantly higher than[(6.5±1.7),(5.4±1.5),(3.8±1.1)and(7.9±2.1)%,respectively,P<0.05]in patients with class B or[(5.3±1.3),(3.2±1.0),(2.1±0.6)and(6.1±1.5)%,respectively,P<0.05]in patients with class A;the AUC was 0.910,with the specificity of 91.4%in predicting liver function class B when the mean D,εD and serum AFP-L3 levels were combined,significantly higher than 70.7%,77.6%and 75.9%(P<0.05)by any one alone.Conclusion The diagnostic efficacy of liver parenchymal texture feature quantification by high-frequency ultrasonography and serum AFP-L3 level combination in predicting liver function class B is promising,and warrants further clinical investigation.

关 键 词：肝硬化 高频超声 肝实质纹理特征 甲胎蛋白-L3 CHILD分级 诊断 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]