摘要
目的 基于肝病理Scheuer评分比较肝硬度值(LSM)和血清学模型对获得持续病毒学应答(MVR)的慢性乙型肝炎(CHB)人群肝纤维化分期的诊断效能。方法 纳入86例符合MVR且丙氨酸转氨酶正常、Scheuer评分G<2的CHB患者,收集并计算患者LSM及天冬氨酸转氨酶/血小板计数、基于4因子的肝纤维化指数、天冬氨酸/丙氨酸转氨酶、γ-谷氨酰转移酶/血小板、S指数、AGAP评分、King's指数、Forns指数等。根据肝活检Scheuer评分分组:轻微纤维化组35例(1≤S<2)、显著纤维化组41例(2≤S≤3)、进展期纤维化组10例(3<S≤4),对3组患者进行Scheuer分期与LSM和血清学模型之间Spearman相关性研究;用受试者操作特征曲线下面积(AUC)比较LSM与各血清学模型对S≥2及S≥3的诊断效能,并进行亚组分析,探讨LSM和血清学模型对不同乙型肝炎e抗原状态的诊断效能。结果 3组患者无创纤维化指标基线数据差异有统计学意义(P<0.05)。除天冬氨酸/丙氨酸转氨酶外,LSM和血清学模型与Scheuer分期均呈正相关关系,LSM相关性最大(rs=0.615,P<0.001)。在Scheuer分期S≥2、S≥3时,LSM-AUC分别为0.818、0.887,均高于血清学模型,尤其S≥3时,差异有统计学意义(P<0.05);AGAP评分+Forns指数+LSM-AUC(0.905)较LSM-AUC(0.887)有所提高,但差异无统计学意义(P=0.313)。在Scheuer分期S≥2、S≥3时,LSM在乙型肝炎e抗原阴性组AUC均高于乙型肝炎e抗原阳性组。结论 LSM诊断CHB-MVR患者纤维化效能高于各血清模型,尤其对乙型肝炎e抗原阴性CHB-MVR患者评估作用更强。但LSM用于肝纤维化动态进展评估效能的稳定性需做更长期的队列研究验证。
Objective Based on the Scheuer score of liver pathology,to compare the diagnostic efficacy of liver stiffness measurement(LSM)and serological models for liver fibrosis stage in patients with chronic hepatitis B(CHB)who have maintained virologic response(MVR).Methods A total of 86 CHB patients with MVR,normal alanine aminotransferase and Scheuer score(G<2)were enrolled.LSM,aspartate aminotrans ferase to platelet ratio index,fibrosis index based on four factors,aspartate alanine aminotransferase ratio,gamma-glutamyl transpeptidase to platelet ratio,S index,AGAP score,King's index,and Forns index were collected and calculated.According to the Scheuer score of liver biopsy,35 cases had mild fibrosis:1≤S<2,41 cases had significant fibrosis:2≤S≤3,and 10 cases had advanced fibrosis:3<S≤4.Spearman correlation study was performed between the Scheuer stage and LSM and serological models.The area under the curve(AUC)of the receiver operating characteristic was used to compare the diagnostic efficacy of LSM and serological models for S≥2 and S≥3,and a subgroup analysis was performed to explore the diagnostic efficacy of LSM and serological models for different hepatitis B e antigen(HBeAg)states.Results The baseline data of noninvasive fibrosis indicators were of statistically significant differences between the three groups(P<0.05).Except for the aspartate alanine aminotransferase ratio,LSM and serological models were positively correlated with the Scheuer stage,and LSM had the largest correlation(rs=0.615,P<0.001).In Scheuer stage S≥2 and S≥3,LSM-AUC(0.818 and 0.887)were higher than the serological models,especially when S≥3,the difference was statistically significant(P<0.05).AGAP score and S index,and LSM combination-AUC(0.905)were higher than independent LSM AUC(0.887),but no statistical difference was shown(P=0.313).At the Scheuer stage S≥2 and S≥3,the AUC of LSM in HBeAg negative group was higher than the HBeAgpositive group.Conclusion The diagnosing efficacy of LSM in patients with CHB-MVR was hi
作者
张春霞
王亮
刘天府
李娟
刘元元
裴志燕
张岭漪
Zhang Chunxia;Wang Liang;Liu Tianfu;Li Juan;Liu Yuanyuan;Pei Zhiyan;Zhang Lingyi(The Second Clinical Medical School,Lanzhou University,Lanzhou 730030,China;Department of Infectious Diseases,The Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Hepatology,The Second Hospital of Lanzhou University,Lanzhou 730030,China)
出处
《兰州大学学报（医学版）》
2024年第3期35-43,共9页
Journal of Lanzhou University（Medical Sciences）
基金
甘肃省教育科技创新资助项目(2022B-047)
兰州大学第二医院“萃英科技创新”计划资助项目(CY2021-QN-A18)。
关键词
慢性乙型肝炎
持续病毒学应答
肝硬度值
肝纤维化
血清学指标
诊断
chronic hepatitis B
maintained virologic response
liver stiffness measurement
hepatic fibrosis
serological indicator
diagnosis
