摘要
目的应用肝脏瞬时弹性成像技术,了解慢性乙型肝炎病毒(HBV)感染者肝纤维化的检出率、人口学特点及其与HBV相关指标的关系。方法该研究为横断面研究。采用单纯随机抽样法选取2021年11月1日至2022年4月30日在武汉大学中南医院肝病门诊接受肝脏瞬时弹性成像检查的初始治疗慢性HBV感染患者2689例为研究对象,根据肝硬度值进行肝纤维化严重程度分级,分析慢性HBV感染者不同肝纤维化程度的检出率以及不同性别、年龄段和不同生理阶段的检出率差异,并进一步对肝硬度值与HBV DNA拷贝数、乙型肝炎表面抗原(HBsAg)、乙型肝炎病毒e抗原(HBeAg)、丙氨酸转氨酶、天冬氨酸转氨酶和血清白蛋白水平进行相关性分析。结果2689例慢性HBV感染者中,男性1417例,年龄46(34,57)岁,女性1272例,年龄45(33,55)岁。1382例(51.03%)患者发生不同程度肝纤维化,其中显著性肝纤维化381例(14.20%),进展期肝纤维化259例(9.60%)。男性总体肝纤维化检出率高于女性[60.78%(840/1382)比39.22%(542/1382),χ^(2)=74.566,P<0.001];不同年龄组肝硬度值和肝纤维化检出率组间差异有统计学意义(F=46.516、199.079,均P<0.001);<60岁的男性患者肝硬度值[(9.41±4.49)kPa比(8.10±3.89)kPa,t=9.011,P<0.001]和肝纤维化检出率[61.59%(643/1044)比38.41%(401/1044),χ^(2)=78.418,P<0.001]均高于同龄组女性,>60岁人群中,男性与女性患者肝纤维化检出率[73.80%(200/271)比71.71%(142/198),χ^(2)=0.252,P>0.05]和显著性肝纤维化检出率[20.30%(55/271)比21.21%(42/198),χ^(2)=0.059,P>0.05]差异无统计学意义。慢性HBV感染者女性绝经前和围绝经期肝纤维化检出率低于同年龄段男性[50.20%(332/661)比29.70%(188/633),χ^(2)=56.683,P<0.001;64.50%(202/313)比52.20%(154/295),χ^(2)=9.519,P=0.029],而绝经后女性肝纤维化检出率与同龄男性差异无统计学意义[65.40%(220/336)比72.20%(319/441),χ^(2)=5.822,P=0.061]。与绝经前相比,女性绝经后肝纤维化检出率增加显著[38.40%(497/1294)比67.50%(532/787),χ^(2)=56.683,P=0.002]。HBV感染者的肝硬度值与总胆红素、天冬氨酸转氨酶水平、丙氨酸转氨酶水平呈弱正相关(r=0.208、0.227、0.218,均P<0.05)。结论在慢性HBV感染者中,应用肝脏瞬时弹性成像技术检出肝纤维化的检出率较高,肝硬度值及检出率男性高于女性,<80岁患者中随年龄增长逐渐增高,女性绝经后检出率增高;肝硬度值与肝脏部分生化指标相关。
Objective To investigate the prevalence of liver fibrosis in patients with HBV infection detected by ultrasound transient elastography.Methods A total of 2689 patients with HBV infection who received liver transient elastography examination at the Department of Hepatology,Zhongnan Hospital of Wuhan University from November 2021 to April 2022 were enrolled in the study.The severity of liver fibrosis was graded according to the liver stiffness value.The association of liver fibrosis detection rate with gender,age and physiological stages of patients was analyzed,and the correlation between liver stiffness value and HBV DNA,HBsAg,HBeAg level,alanine aminotransferase(AST),aspartate aminotransferase(ALT)and serum albumin levels was further analyzed.Results Among 2689 patients with chronic HBV infection,there were 1417 males aged 46(34,57)years and 1272 females aged 45(33,55)years.A total of 1382 patients(51.03%)showed varying degrees of liver fibrosis,including 381 cases(14.20%)of significant liver fibrosis and 259(9.60%)cases of progressive fibrosis.Male patients had a significantly higher prevalence of liver fibrosis than that of female patients[60.78%(840/1382)vs.39.22%(542/1382),χ^(2)=74.566,P<0.001].There were significant differences in liver stiffness values and liver fibrosis detection rates(F=46.516,199.079,P<0.001)among patients of different age groups.The liver stiffness index(9.41±4.49 vs.8.10±3.89,t=9.011,P<0.001)and the prevalence of liver fibrosis in males was higher than those in females in age groups younger than 60 years[61.59%(643/1044)vs.38.41%(401/1044),χ^(2)=78.418,P<0.001];However,there was no significant gender difference in people over 60 years of age[73.80%(200/271)vs.71.71%(142/198),χ^(2)=0.252,P>0.05;20.30%(55/271)vs.21.21%(42/198),χ^(2)=0.059,P>0.05].The prevalence of liver fibrosis was significantly lower in premenopausal and perimenopausal females than that in males of the same age groups[29.70%(188/633)and 52.20%(154/295)vs.64.50%(202/313),χ^(2)=56.683,P<0.001;χ^(2)=9.519,P=0.029],whereas there was no significant difference between postmenopausal females and males in the same age group[65.40%(220/336)vs.72.20%(319/441),χ^(2)=5.822,P=0.061].The prevalence of liver fibrosis increased significantly in postmenopausal females as compared to premenopausal females[38.40%(497/1294)vs.67.50%(532/787),χ^(2)=56.683,P=0.002].The value of liver stiffness in patients with chronic HBV infection was positively correlated with total bilirubin,AST and ALT levels(r=0.208,0.227,0.218,P<0.05).Conclusions The prevalence of liver fibrosis detected by ultrasound transient elastography in chronic HBV-infected patients is substantial,the liver stiffness value and detection rate are higher in males than those in females,however,the prevalence is increased in postmenopausal females.The liver stifness value is related to some biochemical indicators of the liver.
作者
袁瑞
刘焕
桂静
王燕
张永喜
柯亨宁
熊勇
杨蓉蓉
Yuan Rui;Liu Huan;Gui Jing;Wang Yan;Zhang Yongxi;Ke Hengning;Xiong Yong;Yang Rongrong(Department of Infectious Diseases,Zhongnan Hospital of Wuhan University,Center for AIDS Research,Wuhan University,Wuhan 430071,China)
出处
《中华全科医师杂志》
2023年第12期1281-1287,共7页
Chinese Journal of General Practitioners
基金
国家自然科学基金 (82003511)。
