慢性乙型肝炎和肝硬化患者肝脏硬度检测值的变化及其影响因素分析
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摘要
目的探讨西藏地区慢性乙型肝炎(CHB)和乙型肝炎肝硬化(LC)患者肝脏硬度检测(LSM)值的变化与其影响因素。方法 2017年1月～2018年3月在西藏自治区藏医院门诊就诊的CHB患者70例,LC患者30例,使用肝脏瞬时弹性探测仪检测LSM,常规行彩超检查和血生化指标检测,采用Spearman相关性分析,建立多元逐步回归方程行多因素分析影响LSM的因素。结果 CHB患者LSM为(7.17±12.19) kPa,显著低于LC患者【(14.92±14.01)kPa,P<0.05】,CAP值为(210.70±66.22)db/m,与LC患者的(212.00±69.20)db/m比,无显著性差异(P>0.05);APTT、AST、ALP、GGT、GLOB、TBIL和TBA与LSM呈正相关(P<0.05),WBC、PLT、HGB、PTA、FIB、ALB、GFR和LDL-C与LSM呈负相关(P<0.05),而体质量、ALT、UREA、CREA、UA、TG、HDL-C、GLU、AMY和CAP值与LSM无显著性相关(P>0.05);肝脏表面光滑情况、肝脏实质回声情况、肝脏血管走形清晰情况、脾脏大小情况等因素与LSM显著相关(P<0.05),多元线性回归分析显示年龄(P=0.003)、肝脏回声增强(P=0.020)、肝脏回声结节(P=0.000)、凝血酶原时间(P=0.007)和总胆汁酸(P=0.004)是影响LSM值的独立因素。结论了解影响慢性HBV感染患者接受Fibroscan检测的LSM值的因素将有助于帮助临床医生尽早对病情作出正确的判断,给予合适的处理。
Objective To analyze the factors influencing liver stiffness measurement(LSM) in patients with chronic hepatitits B(CHB) and liver cirrhosis(LC) in Tibet. Methods 70 patients with CHB and 30 with LC were recruied in Traditional Tibetan Medicine Hospital between January 2017 and March 2018,and FibroScan was used to detect LSM in all the patients. Serum markers of liver function,renal function,blood lipids,blood glucose,blood coagulation function and blood routine examination,and ultrasonic examination were evaluated. Result The LSM was(7.17±12.19) kPa in patients with CHB,significantly lower than 【(14.92±14.01)kPa,P<0.05】 in patients with LC,and the CAP was(210.70±66.22) db/m,not significantly different as compared to(212.00±69.20) db/m in patients with LC(P >0.05);the APTT,AST,ALP,GGT,GLOB,TBIL and TBA were positively correlated,and WBC,PLT,HGB,PTA,FIB,ALB,GFR and LDL-C were negatively correlated to LSM(P<0.05),while body mass,ALT,UREA,CREA,UA,TG,HDL-C,GLU,AMY and controlled attenuation parameter were not statistically significantly correlated to LSM(P>0.05);multivariate regression analysis showed that age(P=0.003),hepatic echo enhancement(P =0.020),hepatic echo nodule(P =0.000),PT(P =0.007)and TBA(P =0.004) were the independent factors influencing the LSM in patients with hepatitis B viral infection. Conclusion Clinicians should take the influencing factors of LSM into consideration in clinical practice in order to deal with the patients properly in time.
Objective To analyze the factors influencing liver stiffness measurement(LSM) in patients with chronic hepatitits B(CHB) and liver cirrhosis(LC) in Tibet. Methods 70 patients with CHB and 30 with LC were recruied in Traditional Tibetan Medicine Hospital between January 2017 and March 2018,and FibroScan was used to detect LSM in all the patients. Serum markers of liver function,renal function,blood lipids,blood glucose,blood coagulation function and blood routine examination,and ultrasonic examination were evaluated. Result The LSM was(7.17±12.19) kPa in patients with CHB,significantly lower than 【(14.92±14.01)kPa,P<0.05】 in patients with LC,and the CAP was(210.70±66.22) db/m,not significantly different as compared to(212.00±69.20) db/m in patients with LC(P >0.05);the APTT,AST,ALP,GGT,GLOB,TBIL and TBA were positively correlated,and WBC,PLT,HGB,PTA,FIB,ALB,GFR and LDL-C were negatively correlated to LSM(P<0.05),while body mass,ALT,UREA,CREA,UA,TG,HDL-C,GLU,AMY and controlled attenuation parameter were not statistically significantly correlated to LSM(P>0.05);multivariate regression analysis showed that age(P=0.003),hepatic echo enhancement(P =0.020),hepatic echo nodule(P =0.000),PT(P =0.007)and TBA(P =0.004) were the independent factors influencing the LSM in patients with hepatitis B viral infection. Conclusion Clinicians should take the influencing factors of LSM into consideration in clinical practice in order to deal with the patients properly in time.
引文
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[4]陈高峰,平键,顾宏图,等.慢性乙型肝炎患者FibroTouch和FibroScan检测肝脏硬度与肝组织学Ishak纤维化评分的相关性分析.中华肝脏病杂志,2017,25(2):145-150.
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[8]Kim SU,Kim DY,Ahn SH,et al.The impact of steatosis on liver stiffness measurement in patients with chronic hepatitis B.Hepatogastroenterology,2010,57(101):832-838.
[9]Sebastiani G,Halfon P,Castera L,et al.SafeE biopsy:a validated method for large-scale s taging of liver fibrosis in chronic hepatitis C.Hepatology,2009,49(6):1821-1827.
[10]李建成,刘友德,范璐,等.瞬时弹性测定的影响因素研究进展.国际消化病杂志,2012,32(3):153-156.
[11]宋乐,江晓静.瞬时弹性检测技术在肝脏疾病诊断中的应用.实用肝脏病杂志,2016,19(1):105-108.
[12]中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[13]Coco B,Oliveri F,Maina AM,et al.Transient elastography:a new surrogate marker of liver fibrosis influenced by major changes of transaminases.J Viral Hepat,2007,14(5):360-369.
[14]Colletta C,Smirne C,Fabris C,et al.Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferases.Hepatology,2005,42(4):838-845.
[15]Oliveri F,Coco B,Ciccorossi P,et al.Liver stiffness in the hepatitis B virus carrier:a non-invasive marker of liver disease influenced by the pattern of transaminases.World J Gastroenterol,2008,14(40):6154-6162.
[16]Ding H,Wu T,Ma K,et al.Noninvasive measurement of liver fibrosis by transient elastography and influencing factors in patients with chronic hepatitis B:A single center retrospective study of 466 patients.J Huazhong Univ Sci Technolog Med Sci,2012,32(1):69-74.
[17]钤培国,廉晓晓,郭晓霞.无创诊断模型诊断乙型肝炎和肝硬化患者肝纤维化价值评价.实用肝脏病杂志,2016,19(5):578-582.
[18]谢琴秀,徐楠,江晓平,等.Fibro Scan对慢性乙型肝炎病毒感染者肝纤维化评估的影响因素分析.中华肝脏病杂志,2016,24(9):659-664.
[19]Foucher J,Castera L,Bernard PH,et al.Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations.Eur JGastroenterol Hepatol,2006,18(4):411-412.
[20]程小飞,梁雄波,熊晓青,等.多普勒超声测定乙型肝炎肝硬化患者肾动脉血流参数与Fibroscan测值的相关性分析.中国肝脏病杂志(电子版),2016,8(2):107-109.
[21]Piscaglia F,Salvatore V,Mulazzani L,et al.Corrigendum to“Differences in liver stiffness values obtained with new ultrasound elastography machines and fibroscan:A comparative study”.Dig Liver Dis,2018,50(6):633-640.
[22]Harata M,Hashimoto S,Kawabe N,et al.Liver stiffness in extrahepatic cholestasis correlates positively with bilirubin and negatively with alanine aminotransferase.Hepatol Res,2011,41(5):423-429.
[23]Millonig G,Reimann FM,Friedrich S,et al.Extrahepatic cholestasis increases liver stiffness(FibroScan)irrespective of fibrosis.Hepatology,2008,48(5):1718-1723.
[2]Foucher J,Chanteloup E,Vergniol J,et al.Diagnosis of cirrhosis by transient elastography(FibroScan):a prospective study.Gut,2006,55(3):403-408.
[3]陈永鹏.瞬时弹性扫描检测慢性乙型肝炎病情严重程度的研究.中华内科杂志,2011,50(9):758-762.
[4]陈高峰,平键,顾宏图,等.慢性乙型肝炎患者FibroTouch和FibroScan检测肝脏硬度与肝组织学Ishak纤维化评分的相关性分析.中华肝脏病杂志,2017,25(2):145-150.
[5]Sanchez-Conde M,Montes-Ramirez ML,Miralles P,et al.Comparison of transient elastography and liver biopsy for the assessment of liver fibrosis in HIV/hepatitis C virus-coinfected patients and correlation with noninvasive serum markers.JViral Hepat,2010,17(4):280-286.
[6]Afdhal NH,Nunes D.Evaluation of liver fibrosis:a concise review.Am J Gastroenterol,2004,99(6):1160-1174.
[7]Maor Y,Halfon P,Bashari D,et al.Fibrotest or Fibroscan for evaluation of liver fibrosis in haemophilia patients infected with hepatitis C.Haemophilia,2010,16(1):148-154.
[8]Kim SU,Kim DY,Ahn SH,et al.The impact of steatosis on liver stiffness measurement in patients with chronic hepatitis B.Hepatogastroenterology,2010,57(101):832-838.
[9]Sebastiani G,Halfon P,Castera L,et al.SafeE biopsy:a validated method for large-scale s taging of liver fibrosis in chronic hepatitis C.Hepatology,2009,49(6):1821-1827.
[10]李建成,刘友德,范璐,等.瞬时弹性测定的影响因素研究进展.国际消化病杂志,2012,32(3):153-156.
[11]宋乐,江晓静.瞬时弹性检测技术在肝脏疾病诊断中的应用.实用肝脏病杂志,2016,19(1):105-108.
[12]中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):Ⅴ-ⅩⅩⅢ.
[13]Coco B,Oliveri F,Maina AM,et al.Transient elastography:a new surrogate marker of liver fibrosis influenced by major changes of transaminases.J Viral Hepat,2007,14(5):360-369.
[14]Colletta C,Smirne C,Fabris C,et al.Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferases.Hepatology,2005,42(4):838-845.
[15]Oliveri F,Coco B,Ciccorossi P,et al.Liver stiffness in the hepatitis B virus carrier:a non-invasive marker of liver disease influenced by the pattern of transaminases.World J Gastroenterol,2008,14(40):6154-6162.
[16]Ding H,Wu T,Ma K,et al.Noninvasive measurement of liver fibrosis by transient elastography and influencing factors in patients with chronic hepatitis B:A single center retrospective study of 466 patients.J Huazhong Univ Sci Technolog Med Sci,2012,32(1):69-74.
[17]钤培国,廉晓晓,郭晓霞.无创诊断模型诊断乙型肝炎和肝硬化患者肝纤维化价值评价.实用肝脏病杂志,2016,19(5):578-582.
[18]谢琴秀,徐楠,江晓平,等.Fibro Scan对慢性乙型肝炎病毒感染者肝纤维化评估的影响因素分析.中华肝脏病杂志,2016,24(9):659-664.
[19]Foucher J,Castera L,Bernard PH,et al.Prevalence and factors associated with failure of liver stiffness measurement using FibroScan in a prospective study of 2114 examinations.Eur JGastroenterol Hepatol,2006,18(4):411-412.
[20]程小飞,梁雄波,熊晓青,等.多普勒超声测定乙型肝炎肝硬化患者肾动脉血流参数与Fibroscan测值的相关性分析.中国肝脏病杂志(电子版),2016,8(2):107-109.
[21]Piscaglia F,Salvatore V,Mulazzani L,et al.Corrigendum to“Differences in liver stiffness values obtained with new ultrasound elastography machines and fibroscan:A comparative study”.Dig Liver Dis,2018,50(6):633-640.
[22]Harata M,Hashimoto S,Kawabe N,et al.Liver stiffness in extrahepatic cholestasis correlates positively with bilirubin and negatively with alanine aminotransferase.Hepatol Res,2011,41(5):423-429.
[23]Millonig G,Reimann FM,Friedrich S,et al.Extrahepatic cholestasis increases liver stiffness(FibroScan)irrespective of fibrosis.Hepatology,2008,48(5):1718-1723.