肝肌信号强度比及血清标志物对慢性乙型肝炎肝纤维化的诊断价值  

Value of liver-muscle signal intensity and serum markers in diagnosis of chronic hepatitis B liver fibrosis

作　　者：温雅 屈兆宇 鲁景楠 阴玮灵 黄晓旗 WEN Ya;QU Zhaoyu;LU Jingnan;YIN Weiling;HUANG Xiaoqi(Department of Medical Imaging,Affiliated Hospital of Yan’an University,Yan’an,Shaanxi 716000,China)

机构地区：[1]延安大学附属医院影像科,陕西延安716000

出　　处：《临床肝胆病杂志》2023年第3期573-579,共7页Journal of Clinical Hepatology

基　　金：延安市科学技术研究发展计划项目(2018KS-11)。

摘　　要：目的结合ALT和肝脏硬度值水平分组,探讨磁敏感加权成像(SWI)的肝肌信号强度比(LMR)及血清标志物诊断慢性乙型肝炎纤维化严重程度的价值。方法回顾性收集2018年10月—2021年9月就诊于延安大学附属医院的慢性乙型肝炎患者255例,将患者分为严重肝纤维化(SLF)组77例与非SLF组178例,SLF组定义为ALT水平在正常范围内且肝脏硬度大于9.0 kPa,或ALT水平高于正常值上限1~5倍且肝脏硬度大于12.0 kPa的患者。在SWI序列下测量肝脏的平均SWI值(SWIliver)及竖脊肌信号强度并计算LMR。正态分布的计量资料2组间比较采用t检验,非正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。利用二元Logistic回归分析SLF的影响因素。采用受试者工作特征(ROC)曲线分析LMR及其联合血清学的诊断效能,使用DeLong检验比较不同AUC的差异。结果SLF组较非SLF组的ALT(Z=-3.569,P<0.001)、AST(Z=-5.495,P<0.001)、透明质酸(HA)(Z=-6.746,P<0.001)、层粘连蛋白(LN)(Z=-5.459,P<0.001)、Ⅳ型胶原(Ⅳ-C)(Z=-8.470,P<0.001)、Ⅲ型前胶原(PCⅢ)(Z=-6.326,P<0.001)、APRI(Z=-9.004,P<0.001)、FIB-4(Z=-8.357,P<0.001)高,较非SLF组的PTA(t=10.088,P<0.001)、PLT(t=9.163,P<0.001)、SWIliver(t=2.347,P=0.02)、LMR×10(Z=-4.447,P<0.001)低。PTA、HA、Ⅳ-C、LMR×10为发生SLF的独立影响因素(P值均<0.05)。LMR×10诊断SLF的ROC曲线下面积(AUC)为0.675(95%CI:0.614~0.732),高于SWIliver的0.594(95%CI:0.531~0.655)(Z=3.984,P<0.001),PTA+HA+Ⅳ-C+LMR×10(AUC=0.937,95%CI:0.896~0.966)的诊断效能优于PTA+HA+Ⅳ-C(AUC=0.905,95%CI:0.858~0.941)(Z=2.228,P=0.026)。结论LMR及血清标志物可较准确区分SLF,LMR为一项定量、客观的影像学指标,优于SWIliver,并可提升血清学标志物对临床判定SLF的诊断效能。Objective To investigate the value of liver/muscle ratio(LMR)on susceptibility-weighted imaging(SWI)and serum markers in the diagnosis of the severity of chronic hepatitis B liver fibrosis after grouping based on alanine aminotransferase(ALT)level.Methods A retrospective analysis was performed for 255 patients with chronic hepatitis B who attended Affiliated Hospital of Yan’an University from October 2018 to September 2021,and the patients were divided into severe liver fibrosis group(SLF group)and non-severe liver fibrosis group(non-SLF group).The SLF group was defined as liver stiffness measurement(LSM)>9.0 kPa and ALT level within the normal range or LSM>12.0 kPa and ALT level greater than 1-5 times of the upper limit of normal.LMR was calculated by measuring the mean SWI value of the liver(SWIliver)and the signal intensity of the erector spinae.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two group;the chi-square test was used for comparison of categorical data between two groups.The binary logistic regression analysis was used to investigate the influencing factors for SLF.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of LMR and its combination with serum markers,and the DeLong test was used to compare the difference in the area under the ROC curve(AUC).Results Compared with the non-SLF group,the SLF group had significantly higher ALT(Z=-3.569,P<0.001),aspartate aminotransferase(AST)(Z=-5.495,P<0.001),hyaluronic acid(HA)(Z=-6.746,P<0.001),laminin(LN)(Z=-5.459,P<0.001),typeⅣcollagen(Ⅳ-C)(Z=-8.470,P<0.001),typeⅢprocollagen(PCⅢ)(Z=-6.326,P<0.001),aspartate aminotransferase-to-platelet ratio index(Z=-9.004,P<0.001),and FIB-4(Z=-8.357,P<0.001)and significantly lower prothrombin time activity(PTA)(t=10.088,P<0.001),platelet count(t=9.163,P<0.001),SWIliver(t=2.347,P=0.02),and LMR×10(Z=-4.447,P<0.001).PTA,H

关 键 词：乙型肝炎 慢性 肝硬化 磁共振成像 生物标记 肝肌比 诊断 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]