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实时剪切波弹性成像对自身免疫性肝炎纤维化的诊断价值

王雪鑫 李颖霞 姜利彬 周明霞 魏大鹏 张晓朋 温洪涛

引用本文:
Citation:

实时剪切波弹性成像对自身免疫性肝炎纤维化的诊断价值

DOI: 10.3969/j.issn.1001-5256.2023.01.015
基金项目: 

河南省科技攻关项目 (212102310131)

伦理学声明:本研究方案于2022年8月25日经由郑州大学第一附属医院伦理委员会审批,批号:2022-KY-0908-002。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:王雪鑫负责论文构思和设计,研究实施,资料分析,论文撰写;李颖霞、姜利彬、周明霞负责课题制定及指导;魏大鹏、张晓朋参与数据收集,论文指导;温洪涛负责研究设计,论文指导和修改。
详细信息
    通信作者:

    温洪涛,wenhongtao68@163.com(ORCID: 0000-0002-3054-0468)

Diagnostic value of real-time shear wave elastography for liver fibrosis in patients with autoimmune hepatitis

Research funding: 

Science and Technology Project of Henan Province (212102310131)

More Information
  • 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。

     

  • 图  1  杨氏模量测值与纤维化分期之间的箱图

    Figure  1.  Box plot between Young's modulus measurement and fibrosis stage

    图  2  SWE判断≥S2期的ROC曲线

    Figure  2.  ROC of SWE in the assessment of significant liver fibrosis

    图  3  SWE判断≥S3期的ROC曲线

    Figure  3.  ROC of SWE in the assessment of advanced liver fibrosis

    图  4  SWE判断S4期的ROC曲线

    Figure  4.  ROC of SWE in the assessment of liver cirrhosis

    表  1  不同肝纤维化分期患者基线资料及杨氏模量测值比较

    Table  1.   Comparison of baseline data and Young's modulus measurements between different liver fibrosis stages

    指标 S0期(n=6) S1期(n=18) S2期(n=22) S3期(n=16) S4期(n=13) H P
    年龄(岁) 48.00(26.50~61.00) 50.50(43.25~55.75) 48.50(38.25~62.50) 58.00(50.75~62.00) 56.00(51.00~71.00) 7.470 0.113
    ALT(U/L) 28.00(6.50~45.25) 61.00(21.00~126.75) 89.00(33.75~236.75) 96.50(31.50~370.75) 75.00(30.50~167.00) 6.552 0.162
    AST(U/L) 19.50(15.75~59.75) 94.00(23.50~178.25) 100.00(55.00~220.00) 188.50(36.50~478.50) 82.00(51.00~155.50) 8.656 0.070
    ALP(U/L) 76.00(52.75~122.25) 100.50(57.25~177.00) 118.50(76.00~154.75) 129.50(85.75~199.00) 90.00(68.00~114.00) 6.875 0.143
    GGT(U/L) 16.00(10.00~103.25) 75.50(20.75~262.00) 95.5(49.75~167.00) 127.00(58.00~162.00) 67.00(42.50~94.50) 7.600 0.107
    TBil(μmol/L) 7.95(4.65~24.67) 16.15(7.25~38.83) 15.85(9.80~42.35) 15.78(12.08~33.68) 38.00(16.18~48.31) 7.889 0.096
    PLT(×109/L) 185.50(152.00~251.75) 180.50(114.75~229.75) 119.50(90.00~189.75) 157.00(107.50~186.75) 115.00(71.50~160.00) 8.876 0.064
    杨氏模量测值(kPa) 5.80(4.60~7.35)1)2) 7.01(5.68~12.33)2) 11.35(7.88~14.28)2) 11.55(11.00~16.60) 19.40(14.60~21.00) 35.186 <0.001
    注: 1)与S3期比较,P<0.01;2)与S4期比较,P<0.01。
    下载: 导出CSV

    表  2  SWE判断肝纤维化分期的ROC曲线结果

    Table  2.   The ROC curve results in determining liver fibrosis stage

    分期 最佳截断值(kPa) AUC 95%CI 灵敏度(%) 特异度(%) 约登指数 阳性似然比 阴性似然比 P
    ≥S2 9.2 0.839 0.736~0.913 84.31 79.17 0.634 8 4.05 0.20 <0.001
    ≥S3 10.9 0.820 0.715~0.900 89.66 65.22 0.548 7 2.58 0.16 <0.001
    S4 14.4 0.898 0.807~0.956 84.62 80.65 0.652 6 4.37 0.19 <0.001
    下载: 导出CSV

    表  3  肝脏杨氏模量测值与Scheuer评分系统对肝纤维化分期的符合率

    Table  3.   The concordance rate of Young's modulus measurements vs Scheuer scoring system

    分期(杨氏模量测值) Scheuer评分(例) 合计(例) 符合率(%)
    S0~1期 S2期 S3期 S4期
    S0~1期(≤9.2 kPa) 19 6 2 0 27 70.37
    S2期(>9.2且≤10.9 kPa) 0 5 1 0 6 83.33
    S3期(>10.9且≤14.4 kPa) 3 6 8 2 19 42.11
    S4期(>14.4 kPa) 2 5 5 11 23 47.82
    注:总体符合率为57.33%。
    下载: 导出CSV

    表  4  影响SWE诊断肝纤维化分期准确性的单因素分析

    Table  4.   Univariate analysis of factors associated with the disagreement between SWE and liver fibrosis stage

    指标 准确组(n=43) 不准确组(n=32) 统计值 P
    ALT(U/L) 45.00(23.00~186.00) 104.50(36.50~205.50) Z=-1.736 0.083
    AST(U/L) 62.00(22.00~144.00) 118.50(55.00~359.75) Z=-2.464 0.014
    ALP(U/L) 92.00(67.00~138.00) 124.50(79.50~162.50) Z=-2.180 0.029
    GGT(U/L) 65.00(22.00~129.00) 114.00(50.75~197.25) Z=-2.389 0.017
    TBil(μmol/L) 15.50(7.80~32.70) 26.15(13.85~69.88) Z=-2.630 0.009
    PLT(×109/L) 159.91±63.11 142.34±79.64 t=1.065 0.290
    下载: 导出CSV
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  • 收稿日期:  2022-06-13
  • 录用日期:  2022-07-21
  • 出版日期:  2023-01-20
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