LSM、FIB-4与不同抗肝纤维化慢性乙型肝炎患者的肝脏Ishak评分相关性研究  

Study on the Correlation between LSM,FIB-4,and Liver Ishak Scores in Patients with Chronic Hepatitis B Undergoing Different Anti-hepatic Fibrosis Treatment

作　　者：王堃 揭方荣 潘金平 孙秀光 WANG Kun;JIE Fangrong;PAN Jinping;SUN Xiuguang(Department of Hepatology,Yichun People's Hospital,Yichun 336000,China;不详)

机构地区：[1]宜春市人民医院肝病科,江西宜春336000

出　　处：《中国医学创新》2025年第1期78-82,共5页Medical Innovation of China

基　　金：宜春市指导性科技计划项目(2022ZDJH6046)。

摘　　要：目的:比较不同抗肝纤维化治疗的慢性乙型肝炎患者(chronic hepatitis B,CHB)肝硬化程度(liver stiffness measurement,LSM)、4因子纤维化指数(fibrosis-4 index,FIB-4)与肝纤维化病理分期(肝脏Ishak评分)的相关性。方法:选取宜春市人民医院2022年1月—2023年6月收治的CHB患者137例进行回顾性研究,患者均行肝穿刺活检,通过Ishak评分系统将患者分为抗肝纤维化组(n=92)和未抗肝纤维化组(n=45),制定不同抗肝纤维化方案治疗半年,将抗纤维化组患者根据治疗方案不同分为鳖甲软肝片组(n=34)、大黄蛰虫片组(n=30)、扶正化瘀胶囊组(n=28)。对各组患者采用FibroTouch-B检测LSM,全自动血细胞分析仪检测血小板(platelets,PLT),全自动生化检测仪检测血清丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST),根据FIB-4=(年龄×AST)/(PLT×ALT1/2)计算FIB-4,并进行比较。采用Spearman分析不同抗纤维治疗的CHB患者中LSM、FIB-4与肝脏Ishak评分的相关性。结果:抗纤维组与未抗纤维化组性别、年龄、PLT、ALT、LSM比较差异均无统计学意义(P>0.05);抗纤维组AST、FIB-4均高于未抗纤维化组(P<0.05);治疗后,鳖甲软肝片组、大黄蛰虫片组、扶正化瘀胶囊组LSM、FIB-4及Ishak评分比较,差异均无统计学意义(P>0.05);在鳖甲软肝片组中LSM与肝脏Ishak评分呈正相关(P<0.05),在扶正化瘀胶囊组中FIB-4、LSM与肝脏Ishak评分呈正相关(P<0.05),在大黄蛰虫片组中LSM、FIB-4与肝脏Ishak评分无相关性(P>0.05)。结论:不同抗肝纤维化治疗方案对CHB患者的肝硬化评估存在差异。抗纤维化组的AST和FIB-4指数较未抗纤维化组显著升高。在鳖甲软肝片组中,LSM与肝脏Ishak评分呈正相关;扶正化瘀胶囊组则发现FIB-4和LSM与Ishak评分呈正相关,而大黄蛰虫片组未见相关性。不同治疗方案对肝硬化评估的影响不同。Objective:To compare the correlation between liver stiffness measurement(LSM),4-factor fibrosis index(FIB-4),and liver fibrosis histological staging(liver Ishak scores)in patients with chronic hepatitis B(CHB)undergoing different anti-fibrotic treatments.Method:A retrospective study was conducted on 137 CHB patients treated at Yichun People's Hospital from January 2022 to June 2023.All patients underwent liver biopsy,and were classified into the anti-fibrotic treatment group(n=92)and the non-anti-fibrotic treatment group(n=45)based on the Ishak scoring system.The anti-fibrotic group was further divided into three treatment subgroups:Biejia Ruangan Tablets group(n=34),Dahuang Zhechong Tablets group(n=30),and Fuzheng Huayu Capsules group(n=28).For all groups,the FibroTouch-B was used to measure LSM,an automatic blood cell analyzer to count platelets(PLT),and an automatic biochemical analyzer to test for serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST).The FIB-4 index was calculated as(age×AST)/(PLT×ALT1/2).The results were compared,and the Spearman test was used to analyze the correlation between LSM,FIB-4,and liver Ishak scores in CHB patients under different anti-fibrotic treatments.Result:There were no significant differences in gender,age,PLT,ALT,and LSM between the anti-fibrotic and non-anti-fibrotic groups(P>0.05).However,AST and FIB-4 were higher in the anti-fibrotic group compared to the non-anti-fibrotic group(P<0.05).After treatment,there were no significant differences in LSM,FIB-4,or Ishak scores among the three treatment subgroups(P>0.05).In the Biejia Ruangan Tablets group,LSM was positively correlated with the Ishak score(P<0.05).In the Fuzheng Huayu Capsules group,both FIB-4 and LSM showed a positive correlation with the Ishak score(P<0.05),while in the Dahuang Zhechong Tablets group,no significant correlation was found between LSM,FIB-4,and the Ishak score(P>0.05).Conclusion:Different anti-fibrotic therapies have varying effects on the assessment of liver cirrhosis in CHB pa

关 键 词：4因子纤维化指数 慢性乙型肝炎 肝纤维化 Ishak评分 

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