瞬时弹性成像技术对原发性胆汁性肝硬化、自身免疫性肝炎的鉴别及与肝脏纤维化程度、肝功能的相关性研究  

Correlation of Fibroscan parameter with degree of liver fibrosis and liver function and its value for differential diagnosis of primary biliary cirrhosis and autoimmune hepatitis

作　　者：张兆辉[1] 庄轶超 杨文宪 Zhao-Hui Zhang;Yi-Chao Zhuang;Wen-Xian Yang(Department of General Surgery,Jinhua Central Hospital,Jinhua 321099,Zhejiang Province,China;Department of Surgery,Lipu Town Central Health Center,Jindong District,Jinhua 321041,Zhejiang Province,China;Department of Surgery,The First People’s Hospital of Yongkang,Yongkang 321300,Zhejiang Province,China)

机构地区：[1]金华市中心医院普通外科,浙江省金华市321099 [2]金华市金东区澧浦镇中心卫生院外科,浙江省金华市321041 [3]永康市第一人民医院外一科,浙江省永康市321300

出　　处：《世界华人消化杂志》2023年第11期464-469,共6页World Chinese Journal of Digestology

摘　　要：背景目前瞬时弹性成像技术已逐渐应用非酒精性脂肪肝、慢性乙肝等鉴别诊断,但有关其同时鉴别原发性胆汁性肝硬化和自身免疫性肝炎(autoimmune hepatitis,AIH)鲜有研究.目的探讨瞬时弹性成像技术对原发性胆汁性肝硬化、AIH的鉴别及与肝脏纤维化程度、肝功能的相关性.方法选取2020-02/2022-02我院收治的89例原发性胆汁性肝硬化患者作为研究组,同期纳入89例AIH患者作为对照组.统计2组瞬时弹性成像技术参数[肝硬度(liver stiffness measurement,LSM)]、肝功能指标[丙氨酸氨基转移酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、B细胞激活因子(b cell activating factor,BAFF)、Klotho蛋白],Spearman分析LSM值与肝脏纤维化程度、肝功能指标相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析LSM值、肝功能指标对原发性胆汁性肝硬化、AIH鉴别诊断价值.结果研究组LSM值高于对照组(P<0.05);研究组Ⅲ-Ⅳ期所占比例及血清ALT、AST、BAFF水平高于对照组,Klotho蛋白水平低于对照组(P<0.05);LSM值与肝纤维化程度、ALT、AST、BAFF呈正相关,与Klotho蛋白呈负相关(P<0.05);ROC显示,LSM值诊断原发性胆汁性肝硬化价值的AUC为0.846(95%CI:0.785-0.896),高于ALT、AST、BAFF、Klotho蛋白.结论瞬时弹性成像技术参数与肝脏纤维化程度、肝功能密切相关,对准确鉴别原发性胆汁性肝硬化和AIH,尚需进一步研究,探索鉴别诊断参数值.BACKGROUND The use of transient elastography for the differential diagnosis of non-alcoholic fatty liver and chronic hepatitis B has been increasing,but little research has been done to differentiate primary biliary cirrhosis from autoimmune hepatitis(AIH)by using this technique.AIM To investigate the identification of primary biliary cirrhosis(PBC)and autoimmune hepatitis(AIH)by transient elastography(Fibroscan)and its correlation with the degree of liver fibrosis and liver function.METHODS A total of 89 patients with PBC admitted to our hospital from February 2020 to February 2022 were selected as a research group,and 89 patients with AIH treated during the same period were included as a control group.Fibroscan parameter[liver stiffness(LSM value)]and liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),B cell activating factor(BAFF),and Klotho protein]were calculated,and the correlation of LSM value with the degree of liver fibrosis and liver function indexes was assessed by Spearman correlation analysis.Receiver operating characteristic(ROC)curve analysis was performed to assess the value of LSM value and liver function indexes in the differential diagnosis of PBC and AIH.RESULTS The LSM value of the study group was significantly higher than that of the control group(P<0.05).The proportion of patients with stages III and IV liver fibrosis and the levels of serum ALT,AST,and BAFF in the study group were significantly higher than those of the control group,and the level of Klotho protein was significantly lower than that of the control group(P<0.05).LSM values were positively correlated with the degree of liver fibrosis,ALT,AST,and BAFF,and negatively correlated with Klotho protein(P<0.05).CONCLUSION LSM value is closely related to the degree of liver fibrosis and liver function,and further studies are needed to explore the value of transient elastography for the differential diagnosis of PBC and AIH.

关 键 词：原发性胆汁性肝硬化 自身免疫性肝炎 瞬时弹性成像技术 肝纤维化 肝功能 

分 类 号：R575[医药卫生—消化系统]