肝脏硬度值对HBeAg阳性慢性HBV感染者肝纤维化程度的诊断价值
|
摘要
目的评估肝脏硬度值(LSM)对HBeAg阳性慢性HBV感染者肝纤维化程度的诊断价值。方法采用回顾性研究方法,纳入2013年10月-2018年8月在延安大学附属医院住院行肝活组织检查的HBeAg阳性慢性HBV感染者330例,根据肝组织学病理结果,分为轻微肝纤维化(F0～F1)和明显肝纤维化(F2～F4)两组。计量资料两组间比较采用t检验或非参数Mann-Whitney U检验,计数资料两组间比较采用χ~2检验。通过logistic单因素及多因素分析筛选诊断明显肝纤维化的指标,然后对筛选后的指标绘制受试者工作特征(ROC)曲线评估其在诊断明显肝纤维化患者中的预测价值。结果 330例患者中轻微纤维化(F0～F1)有245例,明显肝纤维化(F2～F4)有85例。两组在临床指标HBV DNA、HBsAg、HBeAg、抗-HBc、ALT、AST、TBil和LSM水平上比较差异均有统计学意义(P值均<0. 05)。多因素分析显示,HBsAg与LSM是明显肝纤维化的独立危险因素(P值均<0. 05)。ROC曲线分析发现只有LSM有诊断价值,ROC曲线下面积为0. 744(95%可信区间:0. 680～0. 808)。以LSM≥6. 15 k Pa为界值,预测明显肝纤维化的敏感度为62. 4%,特异度为76. 3%,准确度为72. 1%,阳性预测值为72. 5%,阴性预测值为67. 0%。结论 LSM对明显肝纤维化的HBeAg阳性慢性HBV感染者有较好的预测价值。
To investigate the value of liver stiffness measurement(LSM) in the diagnosis of liver fibrosis degree in HBeAg-positive patients with chronic HBV infection. Methods A retrospective analysis was performed for the clinical data of 330 HBeAg-positive patients with chronic HBV infection who were hospitalized in Affiliated Hospital of Yan'an University from October 2013 to August 2018 and underwent liver biopsy,and according to liver pathological results,these patients were divided into mild liver fibrosis group(F0-F1) and significant liver fibrosis group(F2-F4). The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate analyses were performed to screen out the indices for the diagnosis of significant liver fibrosis,and the receiver operating characteristic(ROC) curve was plotted for these indices to evaluate their value in the diagnosis of significant liver fibrosis. Results Of all 330 patients,245 had mild liver fibrosis and 85 had significant liver fibrosis. There were significant differences between the two groups in HBV DNA,HBsAg,HBeAg,HBcAb,alanine aminotransferase,aspartate aminotransferase,total bilirubin,and LSM(all P < 0. 05). The multivariate analysis showed that HBsAg and LSM were independent risk factors for significant liver fibrosis(both P < 0. 05). The ROC curve analysis showed that only LSM had a diagnostic value,with an area under the ROC curve of 0. 744(95% confidence interval: 0. 680-0. 808). At the optimal cut-off value of6. 15 kPa,LSM had a sensitivity of 62. 4%,a specificity of 76. 3%,an accuracy of 72. 1%,a positive predictive value of 72. 5%,and a negative predictive value of 67. 0% in predicting significant liver fibrosis. Conclusion LSM has a good value in predicting significant liver fibrosis in HBeAg-positive patients with chronic HBV infection.
To investigate the value of liver stiffness measurement(LSM) in the diagnosis of liver fibrosis degree in HBeAg-positive patients with chronic HBV infection. Methods A retrospective analysis was performed for the clinical data of 330 HBeAg-positive patients with chronic HBV infection who were hospitalized in Affiliated Hospital of Yan'an University from October 2013 to August 2018 and underwent liver biopsy,and according to liver pathological results,these patients were divided into mild liver fibrosis group(F0-F1) and significant liver fibrosis group(F2-F4). The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate analyses were performed to screen out the indices for the diagnosis of significant liver fibrosis,and the receiver operating characteristic(ROC) curve was plotted for these indices to evaluate their value in the diagnosis of significant liver fibrosis. Results Of all 330 patients,245 had mild liver fibrosis and 85 had significant liver fibrosis. There were significant differences between the two groups in HBV DNA,HBsAg,HBeAg,HBcAb,alanine aminotransferase,aspartate aminotransferase,total bilirubin,and LSM(all P < 0. 05). The multivariate analysis showed that HBsAg and LSM were independent risk factors for significant liver fibrosis(both P < 0. 05). The ROC curve analysis showed that only LSM had a diagnostic value,with an area under the ROC curve of 0. 744(95% confidence interval: 0. 680-0. 808). At the optimal cut-off value of6. 15 kPa,LSM had a sensitivity of 62. 4%,a specificity of 76. 3%,an accuracy of 72. 1%,a positive predictive value of 72. 5%,and a negative predictive value of 67. 0% in predicting significant liver fibrosis. Conclusion LSM has a good value in predicting significant liver fibrosis in HBeAg-positive patients with chronic HBV infection.
引文
[1]SCHWEITZER A,HORN J,MIKOLAJCZYK RT,et al.Estimations of worldwide prevalence of chronic hepatitis B virus infection:A systematic review of data published between 1965 and2013[J].Lancet,2015,386(10003):1546-1555.
[2]European Association for the Study of the Liver.EASL clinical practice guidelines:Management of chronic hepatitis B virus infection[J].J Hepatol,2012,57(1):167-185.
[3]TERRAULT NA,LOK ASF,McMAHON BJ,et al.Update on prevention,diagnosis,and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology,2018,67(4):1560-1599.
[4]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[5]CAVIGLIA GP,ABATE ML,PELLICANO R,et al.Chronic hepatitis B therapy:Available drugs and treatment guidelines[J].Minerva Gastroenterol Dietol,2015,61(2):61-70.
[6]DENG GH,WANG ZL,WANG YM,et al.Dynamic determination and analysis of serum virus load in patients with chronic HBV infection[J].World Chin J Dig,2004,12(4):862-865.(in Chinese)邓国宏,王宗笠,王宇明,等.慢性HBV感染者血清病毒动力学的检测及分析[J].世界华人消化杂志,2004,12(4):862-865.
[7]SHARAIHA RZ,KUMTA NA,SAUMOY M,et al.Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients[J].Clin Gastroenterol Hepatol,2017,15(4):504-510.
[8]OU H,CAI S,LIU Y,et al.A noninvasive diagnostic model to assess nonalcoholic hepatic steatosis in patients with chronic hepatitis B[J].Therap Adv Gastroenterol,2017,10(2):207-217.
[9]PENG J,CAI S,YU T,et al.Aspartate aminotransferase to platelet ratio index-a reliable predictor of therapeutic efficacy and improvement of Ishak score in chronic hepatitis B patients treated with nucleoside analogues[J].Scand J Clin Lab Invest,2016,76(2):133-142.
[10]BRAVO AA,SHETH SG,CHOPRA S.Liver biopsy[J].N Engl J Med,2001,344(7):495-500.
[11]BEDOSSA P,POYNARD T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology,1996,24(2):289-293.
[12]CASTERA L,FORNS X,ALBERTI A.Non-invasive evaluation of liver fibrosis using transient elastography[J].J Hepatol,2008,48(5):835-847.
[13]European Association for Study of Liver,Asociacion Latinoamericana para el Estudio del Higado.EASL-ALEH clinical practice guidelines:Non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol,2015,63(1):237-264.
[14]CAO FM,ZHANG ZR,WANG X.The study correlation between liver stiffness and pathological staging of liver biopsy in patients with chronic hepatitis B by Fibroscan[J].Hebei Medicine,2018,24(7):1223-1226.(in Chinese)曹发明,张照如,王翔.Fibroscan测定慢性乙型肝炎患者肝硬度值与肝组织活检病理学分期的相关性研究[J].河北医学,2018,24(7):1223-1226.
[15]DUAN WJ,WANG XM,WANG Y,et al.Comparison of FibroTouch and FibroScan for the assessment of fibrosis in chronic hepatitis B patients[J].Chin J Exp Clin Virol,2018,32(4):399-402.(in Chinese)段维佳,王晓明,王宇,等.FibroTouch和FibroScan检测评估慢性乙型肝炎患者肝纤维化程度的诊断价值[J].中华实验和临床病毒学杂志,2018,32(4):399-402.
[16]TAN YW,ZHOU XB,YE Y,et al.Diagnostic value of FIB-4,aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase[J].World JGastroenterol,2017,23(31):5746-5754.
[17]ZHANG XY,QIAN J,HOU W,et al.Clinical value of diagnosing hepatic fibrosis by Mohamadnejad model and FibroScan in the HBe Ag negative chronic hepatitis B virus carriers[J].Chin J Exp Clin Virol,2018,32(1):70-74.(in Chinese)张孝盈,钱静,侯伟,等.利用Mohamadnejad模型和FibroScan诊断HBe Ag阴性慢性HBV携带者肝纤维化的临床价值[J].中华实验和临床病毒学杂志,2018,32(1):70-74.
[18]CHAN AO,YUEN MF,LAM CM,et al.Prevalence and characteristics of familial hepatocellular carcinoma caused by chronic hepatitis B infection in Hong Kong[J].Aliment Pharmacol Ther,2004,19(4):401-406.
[19]LIN CL,KAO JH.Review article:The prevention of hepatitis B-related hepatocellular carcinoma[J].Aliment Pharmacol T-her,2018,48(1):5-14.
[20]ZHOU JL,WU XN,SUN YM,et al.Progress in clinical studies of noninvasive early diagnosis of liver fibrosis and cirrhosis[J].JClin Hepatol,2018,34(8):1674-1677.(in Chinese)周家玲,吴晓宁,孙亚朦,等.ALT水平对乙型肝炎肝硬化患者肝脏硬度值的影响[J].临床肝胆病杂志,2018,34(8):1674-1677.
[2]European Association for the Study of the Liver.EASL clinical practice guidelines:Management of chronic hepatitis B virus infection[J].J Hepatol,2012,57(1):167-185.
[3]TERRAULT NA,LOK ASF,McMAHON BJ,et al.Update on prevention,diagnosis,and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology,2018,67(4):1560-1599.
[4]Chinese Society of Hepatology and Chinese Society of Infectious Diseases,Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.(in Chinese)中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.
[5]CAVIGLIA GP,ABATE ML,PELLICANO R,et al.Chronic hepatitis B therapy:Available drugs and treatment guidelines[J].Minerva Gastroenterol Dietol,2015,61(2):61-70.
[6]DENG GH,WANG ZL,WANG YM,et al.Dynamic determination and analysis of serum virus load in patients with chronic HBV infection[J].World Chin J Dig,2004,12(4):862-865.(in Chinese)邓国宏,王宗笠,王宇明,等.慢性HBV感染者血清病毒动力学的检测及分析[J].世界华人消化杂志,2004,12(4):862-865.
[7]SHARAIHA RZ,KUMTA NA,SAUMOY M,et al.Endoscopic sleeve gastroplasty significantly reduces body mass index and metabolic complications in obese patients[J].Clin Gastroenterol Hepatol,2017,15(4):504-510.
[8]OU H,CAI S,LIU Y,et al.A noninvasive diagnostic model to assess nonalcoholic hepatic steatosis in patients with chronic hepatitis B[J].Therap Adv Gastroenterol,2017,10(2):207-217.
[9]PENG J,CAI S,YU T,et al.Aspartate aminotransferase to platelet ratio index-a reliable predictor of therapeutic efficacy and improvement of Ishak score in chronic hepatitis B patients treated with nucleoside analogues[J].Scand J Clin Lab Invest,2016,76(2):133-142.
[10]BRAVO AA,SHETH SG,CHOPRA S.Liver biopsy[J].N Engl J Med,2001,344(7):495-500.
[11]BEDOSSA P,POYNARD T.An algorithm for the grading of activity in chronic hepatitis C.The METAVIR Cooperative Study Group[J].Hepatology,1996,24(2):289-293.
[12]CASTERA L,FORNS X,ALBERTI A.Non-invasive evaluation of liver fibrosis using transient elastography[J].J Hepatol,2008,48(5):835-847.
[13]European Association for Study of Liver,Asociacion Latinoamericana para el Estudio del Higado.EASL-ALEH clinical practice guidelines:Non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol,2015,63(1):237-264.
[14]CAO FM,ZHANG ZR,WANG X.The study correlation between liver stiffness and pathological staging of liver biopsy in patients with chronic hepatitis B by Fibroscan[J].Hebei Medicine,2018,24(7):1223-1226.(in Chinese)曹发明,张照如,王翔.Fibroscan测定慢性乙型肝炎患者肝硬度值与肝组织活检病理学分期的相关性研究[J].河北医学,2018,24(7):1223-1226.
[15]DUAN WJ,WANG XM,WANG Y,et al.Comparison of FibroTouch and FibroScan for the assessment of fibrosis in chronic hepatitis B patients[J].Chin J Exp Clin Virol,2018,32(4):399-402.(in Chinese)段维佳,王晓明,王宇,等.FibroTouch和FibroScan检测评估慢性乙型肝炎患者肝纤维化程度的诊断价值[J].中华实验和临床病毒学杂志,2018,32(4):399-402.
[16]TAN YW,ZHOU XB,YE Y,et al.Diagnostic value of FIB-4,aspartate aminotransferase-to-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase[J].World JGastroenterol,2017,23(31):5746-5754.
[17]ZHANG XY,QIAN J,HOU W,et al.Clinical value of diagnosing hepatic fibrosis by Mohamadnejad model and FibroScan in the HBe Ag negative chronic hepatitis B virus carriers[J].Chin J Exp Clin Virol,2018,32(1):70-74.(in Chinese)张孝盈,钱静,侯伟,等.利用Mohamadnejad模型和FibroScan诊断HBe Ag阴性慢性HBV携带者肝纤维化的临床价值[J].中华实验和临床病毒学杂志,2018,32(1):70-74.
[18]CHAN AO,YUEN MF,LAM CM,et al.Prevalence and characteristics of familial hepatocellular carcinoma caused by chronic hepatitis B infection in Hong Kong[J].Aliment Pharmacol Ther,2004,19(4):401-406.
[19]LIN CL,KAO JH.Review article:The prevention of hepatitis B-related hepatocellular carcinoma[J].Aliment Pharmacol T-her,2018,48(1):5-14.
[20]ZHOU JL,WU XN,SUN YM,et al.Progress in clinical studies of noninvasive early diagnosis of liver fibrosis and cirrhosis[J].JClin Hepatol,2018,34(8):1674-1677.(in Chinese)周家玲,吴晓宁,孙亚朦,等.ALT水平对乙型肝炎肝硬化患者肝脏硬度值的影响[J].临床肝胆病杂志,2018,34(8):1674-1677.