瞬时弹性超声检测对蒙古族地区慢性乙型病毒性肝炎患者抗病毒治疗临床指导意义的研究
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摘要
目的探讨蒙古族地区慢乙肝患者瞬时弹性超声检测值与肝穿刺病理检查的相关性,及能否通过瞬时弹性超声检测正确评估肝纤维化并予以抗病毒治疗。方法收集该院2015年1月—2018年6月门诊及住院患者共63例,按着病理诊断分脂肪肝组和无脂肪肝组。对两组患者进行民族、性别、体重指数(BMI)、肝硬度值(LSM值)等分析,运用顺时弹性超声检测不同肝纤维化分期截断值及诊断不同纤维化分期的ROC曲线下面积。统计学分析采用t检验、χ~2检验、受试者工作特征曲线、曲线下面积(AUROC)。结果在63例患者中,脂肪肝组平均BMI(22.87±2.52)Kg/m~2、,LSM(16.39±8.31)Kpa、值高于无脂肪肝组BMI(19.75±2.92)Kg/m~2、LSM1(12.49±6.30)Kpa,差异有统计学意义(t=4.552、2.06,P<0.05)。两组在F1期肝纤维化LSM值差异无统计学意义(P>0.05),两组在F2、F3、F4各期LSM值[(12.75±2.26)kPa,(18.59±2.07)kPa,(31.82±2.46)kPa] vs [(8.28±0.66)kPa,(14.67±2.88)kPa,(23.8±1.18)kPa],差异有统计学意义(P<0.05)。绘制ROC曲线,两组结果显示F2、F3、F4期肝纤维化的ROC曲线下面积(AUROC)均>0.7,具有较高的准确性和灵敏度。瞬时弹性超声检测肝硬度值(LSM值)与不同肝纤维化分期在两组患者中均有相关性。部分患者LSM值符合指南要求,给予抗病毒治疗。但存在一定比率不符合指南要求者,未给予抗病毒治疗。结论蒙古族地区慢性乙型肝炎合并脂肪肝患者LSM值明显升高,用LSM评估肝纤维化程度的准确性降低,高估了肝纤维化程度,而非脂肪肝组患者应用LSM值评估肝纤维化指导抗病毒治疗又会漏诊部分患者。因此在蒙古族地区慢乙肝患者应用LSM值评估肝纤维化来指导进行抗病毒治疗,存在明显不足。
Objective To investigate the correlation between transient elastic ultrasound detection and liver biopsy in patients with chronic hepatitis B in Mongolian region, and whether liver fibrosis can be correctly assessed by transient elastic ultrasound and antiviral therapy. Methods A total of 63 outpatients and inpatients from January 2015 to June 2018 in our hospital were enrolled. According to the pathological diagnosis, the fatty liver group and the non-fatty liver group were divided. The two groups of patients were ana-lyzed for nationality, gender, body mass index(BMI) and liver stiffness value(LSM value). The time-dependent elastic ultrasound was used to detect the cutoff value of different liver fibrosis stages and to diagnose the area under the ROC curve of different fibrosis stages. Statistical analysis was performed using t test, χ~2 test, receiver operating characteristic curve, and area under the curve(AUROC). Results Among the 63 patients, the mean BMI(22.87±2.52 Kg/m~2, LSM16.39±8.31)KPa in the fatty liver group was higher than that in the non-fatty liver group(19.75±2.92)Kg/m~2, LSM(12.49± 6.30)kPa, respectively, with statistical significance(t=4.552,2.06,P<0.05). There was no statistically significant difference in the LSM value of F1 liver fibrosis between the two groups( P>0.05). The LSM values of F2, F3 and F4 in the two groups[(12.75±2.26)kPa,(18.59±2.07)kPa,(31.82±2.46)kPa] vs [(8.28±0.66)kPa,(14.67±2.88)kPa,(23.8±1.18)kPa] respectively, and the differences were statistically significant(t=5.71,3.17,6.76 P<0.05). The ROC curve was drawn.The results of the two groups showed that the area under the ROC curve(AUROC) of F2, F3, and F4 liver fibrosis was greater than0.7, which showed high accuracy and sensitivity. Transient elastic ultrasound detection of liver stiffness values(LSM values) and different liver fibrosis stages were associated in both groups of patients. Some patients have LSM values that meet the guidelines and are given antiviral therapy. However, there is a certain ratio that does not meet the guidelines, and no antiviral treatment is given. Conclusion The LSM value of patients with chronic hepatitis B and fatty liver in Mongolian area is significantly increased. The accuracy of liver fibrosis is estimated by LSM, and the degree of liver fibrosis is overestimated. The liver of the non-fatty liver group is evaluated by LSM. Fibrosis directs antiviral therapy and misses some patients. Therefore, in the Mongolian region, patients with chronic hepatitis B use LSM values to evaluate liver fibrosis to guide antiviral therapy, which is obviously insufficient.
Objective To investigate the correlation between transient elastic ultrasound detection and liver biopsy in patients with chronic hepatitis B in Mongolian region, and whether liver fibrosis can be correctly assessed by transient elastic ultrasound and antiviral therapy. Methods A total of 63 outpatients and inpatients from January 2015 to June 2018 in our hospital were enrolled. According to the pathological diagnosis, the fatty liver group and the non-fatty liver group were divided. The two groups of patients were ana-lyzed for nationality, gender, body mass index(BMI) and liver stiffness value(LSM value). The time-dependent elastic ultrasound was used to detect the cutoff value of different liver fibrosis stages and to diagnose the area under the ROC curve of different fibrosis stages. Statistical analysis was performed using t test, χ~2 test, receiver operating characteristic curve, and area under the curve(AUROC). Results Among the 63 patients, the mean BMI(22.87±2.52 Kg/m~2, LSM16.39±8.31)KPa in the fatty liver group was higher than that in the non-fatty liver group(19.75±2.92)Kg/m~2, LSM(12.49± 6.30)kPa, respectively, with statistical significance(t=4.552,2.06,P<0.05). There was no statistically significant difference in the LSM value of F1 liver fibrosis between the two groups( P>0.05). The LSM values of F2, F3 and F4 in the two groups[(12.75±2.26)kPa,(18.59±2.07)kPa,(31.82±2.46)kPa] vs [(8.28±0.66)kPa,(14.67±2.88)kPa,(23.8±1.18)kPa] respectively, and the differences were statistically significant(t=5.71,3.17,6.76 P<0.05). The ROC curve was drawn.The results of the two groups showed that the area under the ROC curve(AUROC) of F2, F3, and F4 liver fibrosis was greater than0.7, which showed high accuracy and sensitivity. Transient elastic ultrasound detection of liver stiffness values(LSM values) and different liver fibrosis stages were associated in both groups of patients. Some patients have LSM values that meet the guidelines and are given antiviral therapy. However, there is a certain ratio that does not meet the guidelines, and no antiviral treatment is given. Conclusion The LSM value of patients with chronic hepatitis B and fatty liver in Mongolian area is significantly increased. The accuracy of liver fibrosis is estimated by LSM, and the degree of liver fibrosis is overestimated. The liver of the non-fatty liver group is evaluated by LSM. Fibrosis directs antiviral therapy and misses some patients. Therefore, in the Mongolian region, patients with chronic hepatitis B use LSM values to evaluate liver fibrosis to guide antiviral therapy, which is obviously insufficient.
引文
[1]佚名.瞬时弹性扫描对慢性乙型肝炎抗病毒治疗后肝脏纤维化的评价应用研究[J].中国医学装备,2018,15(1):74-77.
[2]宁晓艳,程宁,黄鑫,等.瞬时弹性成像技术在慢性乙型肝炎抗病毒治疗中的应用价值[J].当代医学,2018,24(8):141-142.
[3]Chan HL,Wong GL,Choi PC,et al.Alanine aminotransferasebasedalgorithms of liver stiffness measrement by transiebt elastograhy(fibroscan)for liver fibrosis in chronic hepatitis B[J].J Viral Hepat,2009,16(1):36-44.
[4]武聚山,段斌炜,李娟,等.Fibroscan对慢性乙型肝炎患者肝纤维化临床分期的预测价值[J].中华传染病杂志,2017,35(8):498-500.
[5]林雪梅,梁必立,张立文,等.剪切波瞬间弹性成像技术定量评价脂肪肝纤维化程度[J].卫生职业教育,2016,34(9):151-152.
[6]佚名.肝脏瞬时弹性成像对慢性乙型肝炎肝纤维化的应用价值[J].影像研究与医学应用,2018,2(21):80.
[7]董菁菁,郭宏华.GGT与PLT比值指数对慢性乙型肝炎肝纤维化的诊断价值[J].临床肝胆病杂志,2017,33(3):548-552.
[8]曾静,孙婉璐,陈光榆.等.FibroTouch与FibroScan肝脏硬度和脂肪定量检测效能的比较[J].中华肝脏病杂志,2016,24(9):652-658.
[9]中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南[J].临床肝胆病杂志,2018,34(5):947-957.
[10]Fibro Touch瞬时弹性成像诊断慢性乙型肝炎合并肝癌患者肝纤维化程度应用研究[J].临床军医杂志,2017,45(9):930-933.
[2]宁晓艳,程宁,黄鑫,等.瞬时弹性成像技术在慢性乙型肝炎抗病毒治疗中的应用价值[J].当代医学,2018,24(8):141-142.
[3]Chan HL,Wong GL,Choi PC,et al.Alanine aminotransferasebasedalgorithms of liver stiffness measrement by transiebt elastograhy(fibroscan)for liver fibrosis in chronic hepatitis B[J].J Viral Hepat,2009,16(1):36-44.
[4]武聚山,段斌炜,李娟,等.Fibroscan对慢性乙型肝炎患者肝纤维化临床分期的预测价值[J].中华传染病杂志,2017,35(8):498-500.
[5]林雪梅,梁必立,张立文,等.剪切波瞬间弹性成像技术定量评价脂肪肝纤维化程度[J].卫生职业教育,2016,34(9):151-152.
[6]佚名.肝脏瞬时弹性成像对慢性乙型肝炎肝纤维化的应用价值[J].影像研究与医学应用,2018,2(21):80.
[7]董菁菁,郭宏华.GGT与PLT比值指数对慢性乙型肝炎肝纤维化的诊断价值[J].临床肝胆病杂志,2017,33(3):548-552.
[8]曾静,孙婉璐,陈光榆.等.FibroTouch与FibroScan肝脏硬度和脂肪定量检测效能的比较[J].中华肝脏病杂志,2016,24(9):652-658.
[9]中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.非酒精性脂肪性肝病防治指南[J].临床肝胆病杂志,2018,34(5):947-957.
[10]Fibro Touch瞬时弹性成像诊断慢性乙型肝炎合并肝癌患者肝纤维化程度应用研究[J].临床军医杂志,2017,45(9):930-933.