瞬时弹性成像联合门静脉血流动力学指标诊断慢性乙型肝炎患者肝纤维化意义探讨*

目的 探讨瞬时弹性成像联合门静脉血流动力学指标诊断慢性乙型肝炎(CHB)患者肝纤维化的临床价值。方法 2016年2月～2019年9月我院收治的经肝组织活检诊断的CHB患者98例,使用FibroScan 502型诊断仪行肝脏硬度测定(LSM),使用超声检测门静脉主干内径(PVD)、平静呼吸时门静脉最大流速(Vmax)和平静呼吸时门静脉平均流速(Vmean)。采用多因素分析影响肝纤维化的因素,应用受试者工作特征(ROC)曲线评价诊断效能。结果 98例CHB患者经肝穿组织病理学检查,诊断为肝纤维化F0期6例,F1期22例,F2期34例,F3期28,F4期8例;F4期患者LSM、PVD、Vmax和Vmean分别为(28.6±7.8)kPa、(1.4±0.4)cm、(27.4±2.5)cm/s和(22.8±3.1)cm/s,与F1期比,差异显著[分别为(6.1±0.4)kPa、(1.0±0.2)cm、(33.8±1.4)cm/s和(28.5±1.4)cm/s,P<0.05];以F0和F1期划归为非显著性肝纤维化,将>F2期划归为显著肝纤维化。70例显著肝纤维化患者LSM、PVD、Vmax和Vmean分别为(14.2±3.8)kPa、(1.4±0.4)cm、(29.1±2.1)cm/s和(24.1±2.1)cm/s,与28例非显著肝纤维化患者比,差异显著[分别为(5.9±0.4)kPa、(1.0±0.2)cm、(36.8±1.5)cm/s和(30.5±1.4)cm/s,P<0.05];二分类Logistic回归分析结果提示LSM和PVD是肝纤维化发生的独立预测指标(P<0.05),以LSM等于8.4 kPa为截断点,其诊断显著肝纤维化的AUC为0.84(95%CI :0.80～0.89),敏感性为82%(95%CI:76%～85%),特异性为89%(95%CI:81%～93%),而PVD诊断的截断点为1.4 cm,其AUC为0.83(95%CI :0.78～0.89),敏感性为81%(95%CI:75%～86%),特异性为90%(95%CI:85%～94%)。结论 采用LSM和超声检测的PVD诊断CHB患者显著肝纤维化具有很高的诊断效能,值得临床扩大验证。

Application of transient elastography and portal hemodynamic parameters in the diagnosis of liver fibrosis in patients with chronic hepatitis B

Objective The aim of this study was to investigate the clinical application of transient elastography (TE) and portal hemodynamic parameters in the diagnosis of liver fibrosis (LF) in patients with chronic hepatitis B (CHB). Methods 98 patients with CHB were admitted to our hospital between February 2016 and September 2019, and liver biopsies were performed in all the patients. The liver stiffness measurement (LSM) was detected by TE, and the diameter of portal vein (PVD), the maximum velocity of portal vein (Vmax) and mean velocity of portal vein (Vmean) were obtained by sonography. The multivariate Logistic analysis was conducted for the influencing factors of LF, and the diagnostic efficacy was evaluated by AUROC. Results Out of 98 patients with CHB, the liver histopathological examination showed that LF F0 in 6, F1 in 22, F2 in 34, F3 in 28 and F4 in 8 patients; the LSM, PVD, Vmax and Vmean in patients with liver cirrhosis were (28.6±7.8)kPa, (1.4±0.4)cm, (27.4±2.5)cm/s and (22.8±3.1)cm/s, significantly different as compared to[(6.1±0.4)kPa, (1.0±0.2)cm, (33.8±1.4)cm/s and (28.5±1.4)cm/s, respectively, P<0.05] in patients with F1; the LSM, PVD, Vmax and Vmean in 70 patients with significant LF (>F2 stage) were (14.2±3.8)kPa, (1.4±0.4)cm, (29.1±2.1)cm/s and (24.1±2.1)cm/s, significantly different as compared to [(5.9±0.4)kPa, (1.0±0.2)cm, (36.8±1.5)cm/s and (30.5±1.4)cm/s, respectively, P<0.05] in 28 patients without significant LF (less than or equal to F1 stage); the Logistic regression analysis demonstrated that the LSM and PVD were the independent predicting factors for significant LF(P<0.05), and when LSM equal to 8.4 kPa was set as the cut-off-value, its diagnostic AUC was 0.84(95%CI :0.80-0.89), the sensitivity (Se) was 82%(95%CI:76%-85%) and the specificity (Sp) was 89%(95%CI:81%-93%), and as the PVD equal to 1.4 cm was set as the cut-off-value, its AUC was 0.83(95%CI :0.78-0.89), the Se was 81%(95%CI:75%-86%) and the Sp was 90%(95%CI:85%-94%). Conclusion The usefulness of LSM and PVD in non-invasively diagnosing LF in patients with CHB is feasible and efficacious, which warrants further clinical investigation.