超声点定量弹性成像技术对AIH和PBC患者肝纤维化诊断价值分析*

目的 探讨应用超声点定量弹性成像(ElastPQ)技术诊断自身免疫性肝病(AILD)患者肝纤维化的效能。方法 2010年1月～2018年12月我院收治的自身免疫性肝炎(AIH)患者58例,原发性胆汁性肝硬化(PBC)患者46例,使用Philips iU22彩色多普勒超声诊断仪行肝脏硬度检查,检测血清指标获得天冬氨酸氨基转移酶/血小板比值指数(APRI)和基于4因子(FIB-4)指数,绘制受试者工作特性曲线(ROC)下面积(AUC),并计算敏感性、特异性和准确性。结果 本组AIH与PBC患者血清ALT、AST、ALP和GGT水平存在统计学差异(P<0.05);AIH患者ElastPQ为(5.8±0.9)kPa,显著低于PBC患者【(7.1±1.2)kPa,P<0.05】,而两组APRI【1.6(1.1,2.3)对1.7(1.4,2.0)】和FIB-4【2.8(1.8,3.5)对2.6(1.9,3.2),P>0.05】无显著性差异;以ElastPQ大于/等于6.09 kPa诊断PBC患者存在≥F3肝纤维化的灵敏度、特异度和准确性分别为99.7%、80.9%和91.8%,而诊断AIH患者肝纤维化的效能则较低。结论 应用ElastPQ技术诊断显著肝纤维化在PBC患者有指导意义,而在AIH患者则需要进一步研究。

Verification of elastography point quantification by sonography in the diagnosis of hepatic fibrosis in patients with autoimmune liver diseases

Objective The aim of this study was to evaluate the diagnostic efficacy of spot quantitative elastography(ElastPQ)by sonography for hepatic fibrosis in patients with autoimmune liver disease(AILD).Methods 58 patients with autoimmune hepatitis(AIH)and 46 patients with primary biliary cirrhosis(PBC)were admitted to our hospital,and all of them received sonography for ElastPQ detection.Serum parameters were obtained for aspartate aminotransferase to platelet ratio index(APRI)and fibrosis factors-four(FIB-4)calculation.The receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)were calculated for diagnostic sensitivity(Se),specificity(Sp)and accuracy(Ac).Results There were significantly differences in serum ALT,AST,ALP and GGT levels between patients with AIH and PBC(P<0.05);the ElastPQ in patients with AIH was(5.8±0.9)kPa,significantly lower than[(7.1±1.2)kPa,P<0.05],while there were no significantly differences with respect to APRI[1.6(1.1,2.3)vs.1.7(1.4,2.0)]and FIB-4[2.8(1.8,3.5)vs.2.6(1.9,3.2),P>0.05]between the two groups;we set the ElastPQ equal to or greater than 6.09 kPa as the cut-off-value,the Se,Sp and Ac in predicting liver fibrosis≥F3 in patients with PBC were 99.7%,80.9%and 91.8%,while the diagnostic efficacy was relatively low in patients with AIH.Conclusions The application of ElastPQ is helpful in diagnosis of hepatic fibrosis in patients with PBC,which warrants further investigation.