剪切波弹性成像在评估自身免疫性肝炎患者肝纤维化和治疗反应中的作用  

The role of shear wave elastography in evaluating hepatic fibrosis and therapeutic response in patients with autoimmune hepatitis

作　　者：施霞[1,2] 倪雪君 马鑫[2] 武豆[2] 黄晨 SHI Xia;NI Xue-jun;MA Xin;WU Dou;HUANG Chen(Medical School of Nantong University Nantong City,Jiangsu Province 226007;Department of Ultrasound Medicine,shanghai Public Health Clinical Center,Fudan University Shanghai 201508;Department of Ultrasound Medicine,Nantong University Affiliated Hospital Nantong City,Jiangsu Province 226006;Department of Vascular surgery,Nantong University Affiliated Hospital Nantong City,Jiangsu Province 226006)

机构地区：[1]南通大学医学院,江苏226007 [2]上海市公共卫生临床中心超声科,201508 [3]南通大学附属医院超声科,226006 [4]南通大学附属医院血管外科,226006

出　　处：《肝脏》2023年第7期772-774,805,共4页Chinese Hepatology

基　　金：上海市公共卫生临床中心科研基金(KY-GW-2020-25)。

摘　　要：目的确定剪切波弹性成像(SWE)在评估自身免疫性肝炎(AIH)患者的肝脏硬度值(LSM)和治疗反应中的有效性。方法收集2017年6月至2022年10月期间入院诊治的AIH患者65例。根据METAVIR分类对AIH肝纤维化状态进行分期。对AIH患者进行标准化治疗,其中类固醇治疗为泼尼松联合或不联合硫唑嘌呤。比较治疗前后不同肝纤维化分期AIH临床资料,采用受试者工作特征(ROC)曲线分析LSM对AIH肝纤维化分期的预测价值。结果65例AIH患者中F1、F2、F3及F4期分别为16例、21例、15例及13例。F1期AIH患者PLT、Alb为238(193,420)×10^(9)/L、41.2(38.0,43.3)g/L,F2期为194(130,253)×10^(9)/L、37.4(36.2,40.4)g/L、F3期为167(92,233)×10^(9)/L、37.0(35.1,39.0)g/L、F4期为118(74,170)×10^(9)/L、34.4(32.2,37.1)g/L,差异有统计学意义(P<0.05)。F1期AIH患者APRI、FIB-4及LSM为2.6(1.7,4.1)、3.0(2.0,4.5)、7.2(5.0,9.7)kPa,F2期为4.4(2.8,6.8)、6.4(3.4,8.3)及12.7(7.7,15.3)kPa、F3期为5.7(3.0,7.2)、9.3(5.8,13.2)、13.0(9.2,18.7)kPa、F4期为2.3(1.4,3.8)、8.7(6.4,12.9)、15.4(13.3,21.5)kPa,差异有统计学意义(P<0.05)。LSM对≥F2期AIH肝纤维化诊断截断点、AUC分别为8.7 kPa、0.90(0.81~0.96);对F4期AIH肝纤维化诊断截断点、AUC分别为13.6 kPa、0.85(0.75~0.93),高于APRI、FIB-4(P<0.05)。65例AIH患者中接受、未接受类固醇治疗分别为43例、22例。与基线时比,接受、未接受类固醇治疗AIH患者随访时ALT、AST均显著降低(P<0.05);与基线时[4.7(3.4,7.2)、8.2(6.5,13.2)及13.3(9.7,21.5)kPa]比,接受类固醇治疗AIH患者随访时APRI、FIB-4及LSM均显著下降[0.6(0.4,0.8)、3.3(1.4,4.9)及7.5(3.2,9.4)kPa,P<0.05],而未接受类固醇治疗AIH患者基线、随访时APRI、FIB-4及LSM差异无统计学意义(P>0.05)。结论SWE是评估AIH患者肝纤维化的有效方法。在随访过程中LSM可作为评估AIH治疗反应的参数。Objective To determine the effectiveness of shear wave elastography(SWE)in evaluating liver stiffness measurement(LSM)to assess liver fibrosis and treatment response in patients with autoimmune hepatitis(AIH).Methods A total of 65 patients with AIH between June 2017 and October 2022 were enrolled,including 7 males and 58 females,averagely aged 57(41,73)years.The diagnosis of AIH met the requirements.According to METAVIR classification,AIH liver fibrosis was classified into stages.Standardized treatment was prednisone combined with or without azathioprine.The clinical data of AIH before and after treatment was compared,and the predictive value of LSM for AIH liver fibrosis staging was analyzed using the ROC curve.Results Among the 65 patients with AIH,there were 16 cases in F1,21 cases in F2,15 cases in F3 and 13 cases in F4 stages,respectively.The PLT and Alb of patients with stage F1 AIH were 238(193,420)×10^(9)/L and 41.2(38.0,43.3)g/L,compared with F2[194(130,253)×10^(9)/L,37.4(36.2,40.4)g/L],F3[167(92,233)×10^(9)/L,37.0(35.1,39.0)g/L]and F4[118(74,170)×10^(9)/L,34.4(32.2,37.1)g/L],F3[167(92,233)×10^(9)/L,37.0(35.1,39.0)g/L],with statistically significant difference(P<0.05).The APRI,FIB-4 and LSM of patients with F1 AIH were 2.6(1.7,4.1),3.0(2.0,4.5)and 7.2(5.0,9.7)kPa,compared with F2[4.4(2.8,6.8),6.4(3.4,8.3)and 12.7(7.7,15.3)kPa],F3[5.7(3.0,7.2),9.3(5.8,13.2)and 13.0(9.2,18.7)kPa]and F4[2.3(1.4,3.8),8.7(6.4,12.9)and 15.4(13.3,21.5)kPa],with statistically significant difference was(P<0.05).The AUC value of LSM in diagnosis of hepatic fibrosis of AIH in stage≥F2 and F4 was significantly higher than that of APRI and FIB-4(P<0.05).The cut-off point and AUC value of LSM in diagnosis of AIH liver fibrosis in stage≥F2 were 8.7 kPa and 0.90(0.81-0.96),respectively.The cut-off point and AUC value of diagnosis of liver fibrosis in F4 AIH were 13.6kPa and 0.85(0.75-0.93),respectively.Among 65 patients with AIH,43 patients received steroid therapy and 22 patients did not.Compared with the baseline,both the ste

关 键 词：自身免疫性肝炎 剪切波弹性成像 肝脏硬度值 泼尼松 受试者工作特征曲线 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.1[医药卫生—诊断学]