实时二维剪切波弹性成像诊断自身免疫性肝病患者肝纤维化程度

目的评估实时二维剪切波弹性成像(2D-SWE)诊断自身免疫性肝病(AILD)患者肝纤维化程度的效能。方法回顾性分析102例AILD的临床2D-SWE资料。采用Kendall’s tau-b检验分析肝硬度测值(LSM)与肝纤维化分期、炎症分级的相关性;绘制受试者工作特征(ROC)曲线,以肝活体组织检查(LB)作为金标准,评估2D-SWE诊断各期肝纤维化的效能;以Logistic回归分析观察影响其诊断准确率的因素。结果LSM与纤维化分期呈正相关(r=0.58,P<0.01),与炎症分级无显著相关(r=0.29,P<0.01)。2D-SWE诊断≥F2期、≥F3期和F4期肝纤维化的ROC曲线下面积分别为0.93、0.86及0.86;截断值为8.10 kPa、10.20 kPa及13.50 kPa时,敏感度分别为89.16%、80.00%及88.46%,特异度分别为84.21%、76.60%及82.89%。对F4期肝纤维化,白蛋白是影响2D-SWE诊断准确率的独立影响因素(OR=1.10,P=0.01)。结论2D-SWE可评估AILD肝纤维化程度,对≥F2期诊断效能更优,且干扰因素较少。

Real-time two-dimensional shear wave elastography for diagnosis of liver fibrosis in patients with autoimmune liver diseases

Objective To assess the performances of real-time two-dimensional shear wave elastography(2D-SWE)on the degree of hepatic fibrosis in patients with autoimmune liver disease(AILD).Methods The clinical and 2D-SWE data of 102 patients with AILD were retrospectively analyzed.Taken liver biopsy(LB)as the gold standards,Kendall’s tau-b test was used to explore the correlations of liver stiffness measurement(LSM)and fibrosis stage and inflammatory activity score.Receiver operating characteristic(ROC)curves were constructed to assess the efficacy of 2D-SWE in diagnosing liver fibrosis in each stage,and Logistic regression analysis was carried out to analyze the impact factors of the diagnostic accuracy.Results LSM positively correlated with fibrosis stage(r=0.58,P<0.01),but not significantly correlated with inflammatory activity grade(r=0.29,P<0.01).The area under the ROC curve of 2D-SWE for diagnosing liver fibrosis≥F2 stage,≥F3 stage and F4 stage was 0.93,0.86 and 0.86,respectively.Taken 8.10 kPa,10.20 kPa and 13.50 kPa the cut-off values,the sensitivity was 89.16%,80.00%and 88.46%,the specificity was 84.21%,76.60%and 82.89%,respectively.For F4stage of liver fibrosis,albumin was the independent impact factor of the diagnostic accuracy of 2D-SWE(OR=1.10,P=0.01).Conclusion 2D-SWE could evaluate liver fibrosis stage in AILD patients,being more effective with fewer interfering factors for≥F2 stages liver fibrosis.