瞬时弹性成像联合血清HBsAg水平对慢性HBV感染者肝纤维化的无创诊断价值

目的 探讨瞬时弹性成像联合血清乙型肝炎病毒表面抗原(HBsAg)水平对慢性乙型病毒性肝炎(CHB)感染者肝纤维化的无创诊断价值.方法 选取接受肝穿刺检查的195例CHB感染者,将其分为乙型肝炎病毒E抗原(HBeAg)阳性及阴性组.以肝穿刺病理结果为金标准,分析血清HBsAg水平、瞬时弹性成像两个指标单独和联合诊断的受试者工作曲线(ROC曲线),探索其对肝脏纤维化程度的无创诊断价值.结果 HBeAg阳性患者随着肝纤维化程度加重HBsAg水平逐渐降低,HBsAg与纤维化程度呈负相关性(rs=-0.377,P<0.05);经二分类Logistic回归分析显示在性别、年龄、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、血小板(PLT)、HBsAg、乙型肝炎病毒DNA(HBV DNA)、肝脏硬度测量值(LSM)等因素中,HBsAg为HBeAg阳性患者严重肝纤维化独立预测因素(P<0.05).ROC曲线分析HBsAg诊断严重肝纤维化的曲线下面积(AUC)为0.750,敏感度(SN)为89.50%,特异度(SP)为57.20%.瞬时弹性成像诊断严重肝纤维化的AUC为0.787,SN为83.6%,SP为68.3%,阳性预测值(PPV)为38.10%,阴性预测值(NPV)为94.91%.将瞬时弹性成像与血清HBsAg联合诊断严重肝纤维化较单独诊断相比,串联方法显示两者联合后SP提升为86.43%, PPV提升为56.27%;并联方法显示两者联合后SN提高至98.34%,NPV提高至99.03%.HBeAg阴性患者血清HBsAg与纤维化程度呈正相关性(rs=0.223,P<0.05),经二分类Logistic回归分析提示HBsAg不是HBeAg阴性组肝纤维化独立预测因素.结论 在HBeAg阳性的慢性HBV感染者中,HBsAg与瞬时弹性成像联合诊断可提高严重肝脏纤维化的诊断价值.

Noninvasive diagnosis value of transient elastography combined withHBsAg for liver fibrosis in patients with chronic hepatitis B

Objective To explore the non-invasive diagnostic value of transient elastography (TE)combined with serum hepatitis B virus antigen(HBsAg) level in patients with chronic HBV infection.Methods 195 patients were recruited and divided into two groups: HBeAg-positive group and HBeAg-negative group.ROC analysis was performed to determine the diagnosis value of TE combined with HBsAg for liver fibrosis compared with the gold standard of liver biopsy.Results The HBeAg-positive patients with significant liver fibrosis had a significantly lower HBsAg level, and Spearman rank correlation analysis showed that HBeAg positive patients with HBsAg had a negative correlation with the degree of fibrosis (rs=-0.377, P<0.05).Binary Logistic regression analysis showed that the level of HBsAg was an indepent prognostic factor of liver fibrosis, gender and age, alanine transaminase(ALT), aspartate aminotransferase(AST), albumin(ALB), platelet(PLT),HBsAg, liver stiffiness measurement(LSM), hepatitis B virus DNA(HBV DNA) (P<0.05).HBsAg could predict S3-S4 liver fibrosis and its area under curve(AUC) was 0.750, sensitivity(SN) was 89.5%, specificity(SP) was 57.2%.TE could predict S3-S4 liver fibrosis and its SN was 83.6%, SP was 68.3%,positive prective value(PPV) was 38.10%,negative prective value(NPV) was 94.91%.Significant increase of SP and PPV was observed in TE and HBsAg in series combined group for predicting S3-S4(SP=86.43%,PPV=56.27%).The parallel conection of TE and HBsAg for predicting S3-S4 was increased SN and NPV(SN=98.34%,NPV=99.03%).A positive correlation between HBsAg and liver fibrosis was revealed in HBeAg negative patients (rs=0.223, P<0.05).Binary Logistic regression analysis showed that HBsAg was not independent influence factor in HBeAg negative patients.Conclusion Combined use of HBsAg and transient elastography can improve the diagnostic value of HBeAg positive CHB sever liver fibrosis.