肝脏炎症及胆红素对FibroScan诊断慢乙肝肝纤维化的影响

【摘要】 目的 探讨血清学指标及肝组织病理炎症分级对肝脏瞬时弹性探测仪(FS)诊断慢乙肝肝纤维化的影响。方法 选择行FS检查的慢乙肝患者70例,记录所检测到的肝硬度值(LSM)。所有受试者均于同期行肝脏穿刺活组织检查。并留取患者血清检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)、直接胆红素(DBIL)、总胆汁酸(TBA)、白蛋白(ALB)、白蛋白/球蛋白(A/G)、胆碱酯酶(CHE)。分析血清学指标及肝组织病理炎症分级对LSM的影响。结果 相关分析显示,LSM与年龄、肝组织病理炎症分级、纤维化分期、ALT、AST、GGT、ALP、TBIL、DBIL、TBA呈正相关,与ALB、A/G、CHE呈负相关。LSM与各指标的关系经多元回归分析,仅有TBA和年龄入选。S01期,LSM主要受ALT影响,且当ALT≥400U/L时对LSM的影响较大(P<0.01);S234期,LSM与肝病理炎症分级呈正相关(r=0.439,P=0.013),且LSM受不同TBIL水平影响,TBIL异常引起LSM升高。结论 在临床应用FS诊断慢乙肝肝纤维化时应考虑到肝脏炎症及胆红素水平,必要时结合肝脏穿刺活组织检查。

The Influence of Liver Inflammation and Bilirubin on the LSM in Patients with CHB

[Abstract] Objective To investigate the influence of serum indexes and the liver inflammation at histology on the diagnostic value of FibroScan for liver fibrosis in patients with CHB. Methods A total of 70 cases of patients with CHB were enrolled in this study. These patients were admitted to the Tianjin Second People’s Hospital, from January 2011 to November 2011.All of the patients underwent liver biopsy and liver stiffness measurement (LSM) by FibroScan at the same time. Meanwhile, the serums of the patients were collected to detect alanine aminotransferase(ALT), aspartate aminotransferas(AST), γ-glutamyl piptidase(GGT), alkaline phosphatase(ALP), total bilirubin(TBIL), direct bilirubin(DBIL), total bile acid(TBA), albumin(ALB), albumin /globular protein (A/G), and cholinesterase(CHE). The influence of serum indexes, the liver inflammation at histology on the LSM was analyzed. Results LSM was positively correlated with age, the grade of liver inflammation at histology, the stage of liver fibrosis at histology, ALT, AST, GGT, ALP, TBIL, DBIL and TBA while it was negatively correlated with ALB, A/G, and CHE when taken by correlation analysis. LSM was only correlated with TBA and age when taken by multiple regression analysis. During the period of S01, LSM was mainly affected by ALT, especially when ALT≥400u/L (P<0.01). During the period of S234, there was a positive correlation between LSM and the grade of liver inflammation at histology (r=0.439，P=0.013). And LSM were affected by the levels of TBIL, the abnormal of TBIL could lead to the rise of LSM. Conclusion In order to properly illustrate the liver fibrosis taken by FibroScan in CHB patients, the degree of liver inflammation and TBIL should be taken into consideration and it is also suggested to be combined with liver biopsy when necessary.