实时剪切波弹性成像联合血清IL-6/IL-22水平与自身免疫性肝病肝纤维化的相关性  

The association between the value of real-time shear wave elastography combined with serum IL-6/IL-22 levels and liver fibrosis in patients with autoimmune liver diseases

作　　者：于敏 仲跻凤 季瑜 YU Min;ZHONG Ji-feng;JI Yu(Department of Ultrasound,Hai’an Hospital of Traditional Chinese Medicine,Jiangsu 226600,China;Department of Spleen and Stomach Diseases,Hai’an Hospital of Traditional Chinese Medicine,Jiangsu 226600,China)

机构地区：[1]江苏省海安市中医院超声科,226600 [2]江苏省海安市中医院脾胃病科,226600

出　　处：《肝脏》2024年第8期919-923,共5页Chinese Hepatology

基　　金：南通市中医医疗联盟科研课题(TZYK202219)。

摘　　要：目的探讨实时剪切波弹性成像(SWE)联合血清白细胞介素-6(IL-6)/白细胞介素-22(IL-22)水平与自身免疫性肝病(AILD)患者肝纤维化(HF)的评估价值。方法选择海安市中医院2021年6月—2022年9月收治AILD患者130例作为研究对象,行SWE检查和测定血常规、肝生化指标、肝纤维化四项、IL-6、IL-22水平。根据肝活检和Metavir分级进行HF分期,在F1~4期的108例患者中,原发性胆汁性胆管炎(PBC)患者采用熊去氧胆酸联合泼尼松龙治疗,自身免疫性肝炎(AIH)采用泼尼松片联合硫唑嘌呤片口服,疗程6个月。比较HF各期的杨氏模量值和血清IL-6/IL-22水平,Pearson分析杨氏模量值和血清IL-6/IL-22水平与肝纤维化四项和FIB-4的相关性,绘制受试者工作特征曲线(ROC)分析杨氏模量值联合血清IL-6/IL-22水平的诊断效能;观察治疗6个月时不同疗效的的杨氏模量值和血清IL-6/IL-22水平。结果肝硬化组的杨氏模量值和IL-6/IL-22水平为(14.50±3.92)kPa和2.46±0.35,高于进展期HF组的(11.17±2.78)kPa和2.15±0.31,明显HF组的(7.29±1.56)kPa和1.92±0.28,无HF组的(4.93±0.71)kPa和1.67±0.24,差异有统计学意义(t=34.681,13.275,均P<0.05)。Pearson分析显示,AILD患者的杨氏模量值和血清IL-6/IL-22水平与层黏蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)等肝纤维化四项和FIB-4呈显著正相关(P<0.01)。AILD合并HF患者治疗后显效组的杨氏模量值和血清IL-6/IL-22水平为(6.90±1.48)kPa和1.78±0.23,低于有效组的(8.35±1.87)kPa和1.90±0.27,无效组的(9.51±2.24)kPa和2.04±0.29,差异有统计学意义(t=17.256,9.037,均P<0.05)。ROC曲线显示,杨氏模量值联合IL-6/IL-22水平诊断AILD患者HF分期的AUC、敏感度和特异度均高于任一单项效能(P<0.05)。结论SWE联合血清IL-6/IL-22水平与AILD患者的HF严重程度密切相关,能客观反映和动态观察治疗效果和疾病预后。Objective To investigate the value of real-time shear wave elastography(SWE)combined with serum interleukin-6(IL-6)/interleukin-22(IL-22)levels in evaluating hepatic fibrosis(HF)of patients with autoimmune liver diseases(AILD).Methods A total of 130 patients with AILD admitted to Haian Hospital of Traditional Chinese Medicine from June 2021 to September 2022 were selected as the study subjects.SWE examination was performed and blood routine,liver function,IL-6 and IL-22 levels were determined in all patients.HF staging was evaluated according to liver biopsy and Metavir staging system.Among 108 patients with fibrosis stage F1 to F4,patients with primary biliary cirrhosis(PBC)were treated with ursodeoxycholic acid in combination with prednisolone,and patients with autoimmune hepatitis(AIH)were treated with prednisolone tablets in combination with azathioprine tablets orally for 6 months.Young’s modulus and serum IL-6/IL-22 levels were compared at each stage of HF.The correlation between Young’s modulus and serum IL-6/IL-22 levels and the four items of liver fibrosis and FIB-4 were analyzed by Pearson method.The diagnostic efficiency of Young’s modulus combined with serum IL-6/IL-22 levels for the diagnosis of HF were analyzed by receiver operating characteristic curve(ROC)method.Young’s modulus and serum IL-6/IL-22 levels were observed after 6 months of treatment.Results The Young’s modulus and IL-6/IL-22 levels in the cirrhosis group were 14.50±3.92 kPa and 2.46±0.35,respectively,which were higher than those of 11.17±2.78 kPa and 2.15±0.31 in the advanced HF group,7.29±1.56 kPa and 1.92±0.28 in the HF group,as well as 4.93±0.71 kPa and 1.67±0.24 in the non-HF group(t=34.681,13.275,all P<0.05).Pearson analysis showed that Young’s modulus value and serum IL-6/IL-22 level in AILD patients were positively correlated with laminin(LN),hyaluronic acid(HA),type Ⅲ procollagen(PC-Ⅲ),type Ⅳ collagen(Ⅳ-C)and FIB-4 levels(P<0.01).After treatment,the Young’s modulus and serum IL-6/IL-22 levels in

关 键 词：自身免疫性肝病 肝纤维化 实时剪切波弹性成像 白细胞介素-6/白细胞介素-22 

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