摘要
目的探究实时剪切波弹性成像(SWE)测定肝脏杨氏模量对自身免疫性肝炎(AIH)患者肝纤维化分期的诊断价值。方法选取2013年1月—2022年4月就诊于郑州大学第一附属医院的AIH患者75例。应用Scheuer评分系统行肝纤维化分期(S0~S4)。以病理结果为金标准,绘制受试者工作特征曲线(ROC)并计算其曲线下面积(AUC),分析SWE对显著纤维化(≥S2)、进展期肝纤维化(≥S3)及肝硬化(S4)的诊断价值。正态分布的计量资料两组间比较采用独立样本t检验。非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Bonferroni法校正P值。相关性采用Spearman相关分析。应用Logistic回归分析探究影响诊断准确性的因素。结果SWE测定的肝脏杨氏模量测值在不同肝纤维化分期间差异有统计学意义(H=35.186,P<0.001),而年龄、PLT、ALT、AST、TBil、ALP、GGT在不同肝纤维化分期差异均无统计学意义(P值均>0.05)。杨氏模量测值与肝纤维化呈正相关(r=0.675,P<0.05)。SWE诊断≥S2、≥S3及S4的AUC分别为0.839、0.820和0.898,对应的最佳杨氏模量截断值分别为9.2、10.9和14.4 kPa。杨氏模量值与病理肝纤维化分期的总体符合率为57.33%。ALP是影响S0~1期AIH患者SWE诊断准确率的独立影响因素(OR=1.009,95%CI:1.001~1.018,P=0.029)。结论SWE对≥S2、≥S3及S4期的AIH患者均有较好的诊断价值,但其测定的肝脏杨氏模量值与病理纤维化分期的总体符合率较低。
Objective To explore the diagnostic value of Young’s modulus obtained by real-time shear wave elastography(SWE)for liver fibrosis in autoimmune hepatitis(AIH)patients.Methods A total of 75 AIH patients in the First Affiliated Hospital of Zhengzhou University from January 2013 to April 2022 were retrospectively enrolled.Scheuer scoring system was used to evaluate degrees of liver fibrosis(S0-S4).By using pathological examination of liver tissues as the golden standard,the receiver operating characteristic curve(ROC)was plotted and the area under the curve(AUC)was used to evaluate the diagnostic value of SWE for the significant fibrosis(≥S2),advanced liver fibrosis(≥S3),and liver cirrhosis(S4),respectively.Independent sample t test was used for comparison of continuous data with normal distribution between the two groups.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and Bonferroni method was used for further comparison between two groups.The Spearman correlation coefficient was used for correlation analysis.The logistic regression analysis was used to predict the impact factors in diagnosis accuracy.Results The Young’s modulus measured by SWE was statistically significant different among various fibrosis groups(H=35.186,P<0.001)although there was no statistical significance in patients’age and platelet,alanine aminotransferase,aspartate aminotransferase,total bilirubin,alkaline phosphatase,and glutamyl transpeptidase levels(all P>0.05).The Young’s modulus measurement was positively correlated with liver fibrosis(r=0.675,P<0.05).The AUCs of SWE in the diagnosis of≥S2,≥S3,and S4 were 0.839,0.820 and 0.898,respectively and the corresponding optimum cut-off values were 9.2,10.9,and 14.4 kPa,respectively.The overall concordance rate of the liver Young’s modulus measurements vs.fibrosis stages was 57.33%.Moreover,the alkaline phosphatase level was an independent predictor for diagnostic accuracy of SWE for stage 0-1 fibrosis(OR=1.009,95%CI:1.001-1.018,P=0.029).Conclusion The SWE possessed a diagnosis value for the significant fibrosis(≥S2),advanced liver fibrosis(≥S3)and liver cirrhosis(S4),although there was a low overall concordance rate in the liver Young’s modulus measurements obtained using SWE vs.fibrosis stages.
作者
王雪鑫
李颖霞
姜利彬
周明霞
魏大鹏
张晓朋
温洪涛
WANG Xuexin;LI Yingxia;JIANG Libin;ZHOU Mingxia;WEI Dapeng;ZHANG Xiaopeng;WEN Hongtao(Department of Gastroenterology,The First Affiliated Hospital of Zhengzhou Univers)
出处
《临床肝胆病杂志》
CAS
北大核心
2023年第1期97-103,共7页
Journal of Clinical Hepatology
基金
河南省科技攻关项目(212102310131)。
关键词
肝硬化
肝炎
自身免疫性
剪切波弹性成像
诊断
Liver Cirrhosis
Hepatitis,Autoimmune
Shear Wave Elastography
Diagnosis
