摘要
目的通过检测肝内胆汁淤积(IHC)患者治疗前后肝脏硬度值(LSM)变化,旨在评价瞬时弹性成像在IHC病情监测及治疗反应中的意义。方法纳入2017年4月—2019年6月期间我院收治的IHC患者56例,男性21例、女性35例,年龄(38.4±7.5)岁。IHC诊断符合ALP>1.5倍正常值上限且GGT>3倍正常值上限、影像学提示无胆管扩张。计量资料[M(P25,P75)]表示,Kruskal-Wallis H检验比较;计数资料(%)表示,卡方检验比较;受试者工作特征曲线(ROC曲线)评价诊断效能。结果 IHC病因包括自身免疫性肝炎22例(39.3%),原发性硬化性胆管炎12例(21.4%),药物源性因素8例(14.3%),原发性胆汁性胆管炎6例(10.7%)及其他原因(重叠综合征、肝豆状核变性、布加综合征、EB病毒感染、淋巴瘤)8例(14.3%)。按METAVIR评分,IHC患者治疗前F0、F1、F2、F3、F4各分期为5例(8.9%)、9例(16.1%)、15例(26.8%)、11例(19.6%)、16例(28.5%),治疗后为14例(25.0%)、11例(19.6%)、9例(16.1%)、6例(10.7%)及16例(28.5%),具有显著性差异(P<0.05)。瞬时弹性成像诊断IHC患者≥F2肝纤维化时的临界值、敏感性、特异性及ROC曲线下面积(AUC)分别为6.8kPa、98%、50%及0.77;≥F3肝纤维化时的临界值、敏感性、特异性及AUC分别为9.2 kPa、88%、83%及0.90;F4肝纤维化时的临界值、敏感性、特异性及AUC分别为13.5 kPa、91%、98%及0.93。IHC患者治疗前LSM值为[12.8(9.0,24.2)]kPa,治疗后[9.6(5.2,18.1)]kPa,具有统计学差异(P<0.05)。结论瞬时弹性成像是评估IHC患者肝纤维化程度、病情监测和治疗反应的有效方法,具有足够的诊断性能。
Objective To investigate the significance of transient elastography in disease monitoring and treatment evaluation of intrahepatic cholestasis(IHC).Methods A total of 56 IHC patients,who were admitted to our hospital from April 2017 to June 2019,including 21 males and 35 females,aged(38.4±7.5)years,were enrolled.IHC diagnosis conforms to alkaline phosphatase>1.5 times the upper limit of normal value,gamma-glutamyltranspeptidase>3 times the upper limit of normal value,and imaging showing no bile duct dilatation.Measurement data[median(25 th percentile,75 th percentile)]were analyzed by Kruskal-Wallis H test,and counting data(%)were analyzed by chi-square test.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency.Results IHC etiology includes 22 cases(39.3%)of autoimmune hepatitis,12 cases(21.4%)of primary sclerosing cholangitis,8 cases(14.3%)of drug induction,6 cases(10.7%)of primary biliary cirrhosis and 8 cases(14.3%)of other causes(overlap syndrome,hepatolenticular degeneration,Budd-Chiari syndrome,EB virus infection and lymphoma).According to METAVIR score,the numbers of IHC patients with fibrosis stage(F)0,F1,F2,F3 and F4 were 5 cases(8.9%),9 cases(16.1%),15 cases(26.8%),11 cases(19.6%)and 16 cases(28.5%)before treatment,respectively,14 cases(25.0%),11 cases(19.6%),9 cases(16.1%),6 cases(10.7%)and 16 cases(28.5%)after treatment,respectively(P<0.05).The cutoff value,sensitivity,specificity and area under the ROC curve(AUC)of liver stiffness measurement(LSM)for IHC patients with METAVIR≥F2 were 6.8 kPa,98%,50%and 0.77,respectively.The cut-off value,sensitivity,specificity and AUC for METAVIR≥F3 were 9.2 kPa,88%,83%and 0.90,respectively.The cut-off value,sensitivity,specificity and AUC for F4 were 13.5 kPa,91%,98%and 0.93,respectively.The LSM value of IHC patients was[12.8(9.0,24.2)]kPa before treatment and[9.6(5.2,18.1)]kPa after treatment,with statistical difference(P<0.05).Conclusion Transient elastography is an effective method to evaluate the degree of liver fibrosi
作者
严华
郑立敏
杨小红
YAN Hua;ZHENG Li-min;YANG Xiao-hong(Department of Ultrasound Imaging,Jianli People’s Hospital,Hospital,Hubei 433300,China)
出处
《肝脏》
2020年第9期943-945,共3页
Chinese Hepatology
基金
2018年武汉市卫计委科研立项青年项目(WZ18Q06)。
关键词
肝内胆汁淤积
瞬时弹性成像
肝脏硬度值
受试者工作特性曲线
Intrahepatic cholestasis
Transient elastography
Liver stiffness measurement
Receiver operator characteristic curve