FibroTouch检测肝脏硬度值联合门静脉血流动力学指标评估慢性乙型肝炎患者肝纤维化的临床价值  

Clinical value of liver stiffness value detected by FibroTouch combined with portal vein hemodynamics in evaluating liver fibrosis in patients with chronic hepatitis B

作　　者：党苗苗 杜苗苗 高艳梅 DANG Miao-miao;DU Miao-miao;GAO Yan-mei(Department of Ultrasound Medicine,Tongchuan People’s Hospital,Shaanxi 727000,China;Department of Ultrasound Medicine,the Second Affiliated Hospital of Xi’an Medical University,Shaanxi 710077;Department of Ultrasound Medicine,Sun Simmiao Hospital,Beijing University of Chinese Medicine,Tongchuan 727031,China)

机构地区：[1]铜川市人民医院超声医学科,陕西727000 [2]西安医学院第二附属医院超声医学科,陕西710077 [3]北京中医药大学孙思邈医院超声医学科,陕西727031

出　　处：《肝脏》2024年第10期1230-1234,共5页Chinese Hepatology

基　　金：陕西省重点研发计划项目(2020SF-177)。

摘　　要：目的探讨肝脏硬度值(LSM)联合多普勒超声检测门静脉血流动力学指标对慢性乙型肝炎(CHB)患者肝纤维化的评估价值。方法2020年8月—2023年7月我院收治的CHB患者99例,均进行肝活检、瞬时弹性成像技术和多普勒超声检查,记录其肝纤维化情况、LSM、门静脉主干内径(PVD)、静息状态下门静脉最大流速(Vmax)及平均流速(Vmean),根据患者Metavir纤维化评分系统将其分为无肝纤维化组(F0期)、轻度肝纤维化组(F1~F2期)和显著肝纤维组(≥F3期),对比三组LSM、PVD、Vmax及Vmean,采用Spearman相关性分析对LSM、PVD、Vmax及Vmean与Metavir评分的相关性进行分析,受试者工作曲线(ROC)分析LSM、PVD、Vmax及Vmean对CHB患者肝纤维化的评估价值。结果病理活检显示,本次99例患者中F0期16例,F1期30例,F2期24例,F3期20例,F4期9例。LSM、PVD:显著肝纤维化组[(13.67±1.95)kPa、(13.35±1.32)mm]>轻度肝纤维化组[(6.81±0.97)kPa、(11.77±1.15)mm]>无肝纤维化组[(5.12±0.84)kPa、(10.84±1.04)mm](P<0.05),Vmax、Vmean:显著肝纤维化组[(29.04±2.11)cm/s、(24.58±1.93)cm/s]<轻度肝纤维化组[(33.26±2.04)cm/s、(27.10±1.86)cm/s]<无肝纤维化组[(37.18±1.67)cm/s、(32.67±1.75)cm/s](P<0.05)。CHB患者LSM、PVD与Metavir评分均呈显著正相关性(r=0.649,r=0.477,P<0.05),Vmax、Vmean与Metavir评分均呈显著负相关性(r=-0.561,r=-0.538,P<0.05)。CHB患者LSM、PVD、Vmax、Vmean及其联合检测评估CHB患者显著肝纤维化的AUC值分别为0.938、0.886、0.800、0.867、0.983,敏感度分别为82.76%、89.66%、82.76%、79.31%、96.55%,特异度分别为91.43%、80.00%、64.29%、77.14%、90.00%,联合检测对CHB患者显著肝纤维化的评估效能优于各指标单独检测(P<0.05)。结论LSM及门静脉血流动力学指标与CHB患者肝纤维化有关,LSM联合多普勒超声检测门静脉血流动力学指标检测对CHB患者肝纤维化具有良好的评估效能。Objective To explore the evaluation value of liver stiffness value(LSM)combined with the portal vein hemodynamic indicators detected by Doppler ultrasound for liver fibrosis in patients with chronic hepatitis B(CHB).Methods Between August 2020 and July 2023,99 CHB patients admitted to our hospital underwent liver biopsy,instantaneous elastography,and Doppler ultrasound examination.Their liver fibrosis status,LSM,portal vein main diameter(PVD),resting portal vein maximum flow velocity(Vmax),and mean flow velocity(Vmean)were recorded.According to the Metavir fibrosis scoring system of patients,they were divided into three groups:without liver fibrosis(F0 stage),mild liver fibrosis group(F1-F2 stage)and significant liver fibrosis group(≥F3 stage).The LSM,PVD,Vmax,and Vmean of the three groups were compared.Spearman correlation analysis was used to analyze the correlation among the LSM,PVD,Vmax,Vmean and Metavir score.Receiver operating curve(ROC)analysis was used to evaluate the value of LSM,PVD,Vmax,and Vmean in evaluating liver fibrosis in CHB patients.Results Pathological biopsy showed that among the 99 patients,there were 16 cases in F0 stage,30 cases in F1 stage,24 cases in F2 stage,20 cases in F3 stage,and 9 cases in F4 stage.LSM and PVD:significant hepatic fibrosis group[(13.67±1.95)kPa,(13.35±1.32)mm]>mild hepatic fibrosis group[(6.81±0.97)kPa,(11.77±1.15)mm]>no hepatic fibrosis group[(5.12±0.84)kPa、(10.84±1.04)mm].Vmax,Vmean:significant hepatic fibrosis group[(29.04±2.11)cm/s,(24.58±1.93)cm/s]<mild hepatic fibrosis group[(33.26±2.04)cm/s,(27.10±1.86)cm/s].LSM,PVD and Metavir score in CHB patients were significantly positively correlated(r=0.649,r=0.477,P<0.05),while Vmax and Vmean were significantly negatively correlated with Metavir score(r=-0.561,r=-0.538,P<0.05).The area under the curve(AUC)of LSM,PVD,Vmax,Vmean,and their combined detection for evaluating significant liver fibrosis in CHB patients were 0.938,0.886,0.800,0.867,and 0.983,respectively,with sensitivities of 82.76%,89.66%,82.76%

关 键 词：慢性乙型肝炎 多普勒超声 门静脉血流动力学 肝脏硬度值 肝纤维化 

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