肝脏超声剪切波弹性成像在乙肝肝硬化患者肝纤维化程度评估中的应用价值

Application value of liver shear wave elastography in assessing hepatic fibrosis severity in patients with hepatitis B-related cirrhosis

摘要:

目的 探讨肝脏超声剪切波弹性成像（SWE）在乙肝肝硬化（HBC）患者肝纤维化程度评估中的应用价值。方法 选取2023年2月—2024年2月西安交通大学附属西安市第九医院收治的98例HBC患者为观察组，其中Child-Pugh分级A级35例、B级33例、C级30例；另选取同期该院慢性乙型肝炎患者98例为对照组。比较两者的弹性模量值、肝纤维化程度，以及血清学指标［透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）、层粘连蛋白（LN）］。绘制受试者工作特征（ROC）曲线分析弹性模量值、血清学指标用于诊断HBC的价值。结果 观察组弹性模量值、肝纤维化程度、HA水平、Ⅳ-C水平及LN水平均高于对照组（P <0.05）。ROC曲线分析结果显示，弹性模量值、HA、Ⅳ-C、LN用于诊断HBC的敏感性分别为81.6%（95% CI：0.764，0.853）、82.7%（95% CI：0.792，0.886）、75.5%（95% CI：0.671，0.805）、79.6%（95% CI：0.685，0.824）；特异性分别为91.8%（95% CI：0.876，0.981）、79.6%（95% CI：0.732，0.843）、75.5%（95% CI：0.705，0.817）、78.6%（95% CI：0.722，0.836）；曲线下面积分别为0.886（95% CI：0.832，0.940）、0.844（95% CI：0.785，0.902）、0.815（95% CI：0.755，0.876）、0.791（95% CI：0.724，0.858）。Child-Pugh分级A级患者的弹性模量值、HA水平、Ⅳ-C水平、LN水平均低于B、C级患者（P <0.05）；Child-Pugh分级B级患者低于C级患者（P <0.05）。结论 肝脏弹性模量值与HBC患者肝纤维化程度关系密切，SWE技术可客观、量化地评估HBC患者肝纤维化程度。

Abstract:

Objective To evaluate the application value of liver shear wave elastography (SWE) in assessing hepatic fibrosis severity in patients with hepatitis B-related cirrhosis (HBC).Methods A total of 98 HBC patients admitted to Xi'an Ninth Hospital Affiliated to Xi'an Jiaotong University from February 2023 to February 2024 were enrolled as the observation group (Child-Pugh class A: 35 cases; B: 33 cases; C: 30 cases). Ninety-eight patients with chronic hepatitis B (CHB) during the same period were selected as the control group. Elastic modulus values, hepatic fibrosis severity, and serological markers [hyaluronic acid (HA), type Ⅳ collagen (Ⅳ-C), and laminin (LN)] were compared between groups. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic efficacy of elastic modulus values and serological markers for HBC.Results The observation group exhibited significantly higher elastic modulus values, hepatic fibrosis severity, HA, Ⅳ-C, and LN levels compared to the control group (all P < 0.05). ROC analysis revealed the following diagnostic performance for HBC: elastic modulus [sensitivity: 81.6% (95% CI: 0.764, 0.853), specificity: 91.8% (95% CI: 0.876, 0.981), AUC: 0.886 (95% CI: 0.832, 0.940） ]; HA [sensitivity: 82.7% (95% CI: 0.792, 0.886), specificity: 79.6% (95% CI: 0.732, 0.843), AUC: 0.844 (95% CI: 0.785, 0.902) ]; Ⅳ-C [sensitivity: 75.5% (95% CI: 0.671, 0.805), specificity: 75.5% (95% CI: 0.705, 0.817), AUC: 0.815 (95% CI: 0.755, 0.876) ); LN [sensitivity: 79.6% (95% CI: 0.685, 0.824), specificity: 78.6% (95% CI: 0.722, 0.836), AUC: 0.791 (95% CI: 0.724, 0.858) ]. Patients with Child-Pugh class A had lower elastic modulus values, HA, Ⅳ-C, and LN levels than those with classes B and C (P < 0.05); class B patients had lower values than class C (P < 0.05).Conclusion Elastic modulus values strongly correlate with hepatic fibrosis severity in HBC patients, demonstrating that SWE provides an objective and quantitative assessment of liver fibrosis in this population.