摘要
目的:探讨肝脏硬度值(LSM)对乙型肝炎e抗原(HBeAg)阳性的慢性乙型肝炎(CHB)患者肝组织纤维化的评估价值。方法:回顾性分析2016年12月至2019年12月76例HBeAg阳性CHB患者的临床及病理资料。根据肝纤维化程度,分为S0-1组(n=30)和S2-3组(n=46),比较两组患者超声图像评分、临床相关指标的差异,分析HBeAg阳性CHB患者肝纤维化的危险因素,采用ROC曲线分析各指标预测肝纤维化的价值。结果:S0-1组肝纤维化患者超声图像中肝实质、被膜、边缘形态、静脉清晰度及总评分均显著低于S2-3期(P<0.05)。与S0-1组肝纤维化患者比较,S2-3组患者CHB病程明显增加,ALT、AST、LSM明显升高,PLT、HBsAg、HBV DNA明显降低(P<0.05)。Logistic回归分析显示,LSM是HBeAg阳性CHB患者肝纤维化的独立危险因素,而HBsAg则是保护性因素(P<0.05)。HBsAg、LSM、超声图像评分联合预测HBeAg阳性的CHB患者肝纤维化的AUC为0.939(95%CI:0.890~0.979),灵敏度为93.1%,特异度为96.9%,均显著高于HBeAg、超声图像评分的预测结果,LSM的灵敏度高于HBeAg、超声图像评分(P<0.05)。结论:LSM对肝组织纤维化程度具有较好的诊断价值,与HBsAg、超声图像评分联合可为HBeAg阳性CHB患者肝纤维化程度评估提供更可靠的依据。
Objective:To explore the evaluation value of liver stiffness measurement(LSM)for liver fibrosis in patients with HBeAg-positive chronic hepatitis B(CHB).Methods:Clinical and pathological data of 76 HBeAg-positive CHB patients from December 2016 to December 2019 were retrospectively analyzed.According to the degree of liver fibrosis,all the patients was divided into the S0-1 group(n=30)and the S2-3 group(n=46).The ultrasonic image scores and clinically relevant indicators were compared between the two groups.Risk factors for liver fibrosis in patients with HBeAg-positive CHB were analyzed,ROC curve was used to analyze the value of each index in predicting liver fibrosis.Results:Ultrasound images of liver parenchyma,capsule,border morphology,venous definition and total score of patients with S0-1 liver fibrosis were significantly lower than those of patients with S2-3(P<0.05).Compared with patients with stage S0-1 liver fibrosis,the course of CHB in patients with stage S2-3 was significantly increased,ALT,AST and LSM were significantly increased,and PLT,HBsAg and HBV DNA were significantly decreased(P<0.05).Logistic regression analysis showed that LSM was an independent risk factor for liver fibrosis in patients of HBsAg-positive CHB,while HBsAg was a protective factor(P<0.05).The AUC of the combination prediction of HBsAg,LSM and ultrasound score for liver fibrosis in HBeAg-positive CHB patients was 0.939(95%CI:0.890~0.979),the sensitivity was 93.1%,and the specificity was 96.9%,all of which were significantly higher than the predicted results of HBeAg and ultrasound score,and the sensitivity of LSM was higher than that of HBeAg and ultrasound score(P<0.05).Conclusion:LSM has a good diagnostic value for the degree of liver fibrosis, combined with HBsAg and ultrasound score can provide a more reliable basis for the assessment of liver fibrosis degree in patients of HBeAg-positive CHB.
作者
刘坤
王敏燕
凌琪华
郭绍文
LIU Kun;WANG Min-yan;LING Qi-hua;GUO Shao-wen(Department of Pathology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,201203,China;不详)
出处
《中西医结合肝病杂志》
CAS
2021年第6期552-554,557,共4页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
