瞬时弹性成像联合血清HBsAg水平对慢性HBV感染者肝纤维化的无创诊断价值

发布时间：2018-05-04 22:21

本文选题：乙肝表面抗原定量 + 瞬时弹性成像　；参考：《安徽医科大学学报》2017年04期

【摘要】：目的探讨瞬时弹性成像联合血清乙型肝炎病毒表面抗原(HBsAg)水平对慢性乙型病毒性肝炎(CHB)感染者肝纤维化的无创诊断价值。方法选取接受肝穿刺检查的195例CHB感染者,将其分为乙型肝炎病毒E抗原(HBeAg)阳性及阴性组。以肝穿刺病理结果为金标准,分析血清HBsAg水平、瞬时弹性成像两个指标单独和联合诊断的受试者工作曲线(ROC曲线),探索其对肝脏纤维化程度的无创诊断价值。结果 HBeAg阳性患者随着肝纤维化程度加重HBsAg水平逐渐降低,HBsAg与纤维化程度呈负相关性(r_s=-0.377,P0.05);经二分类Logistic回归分析显示在性别、年龄、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、血小板(PLT)、HBsAg、乙型肝炎病毒DNA(HBV DNA)、肝脏硬度测量值(LSM)等因素中,HBsAg为HBeAg阳性患者严重肝纤维化独立预测因素(P0.05)。ROC曲线分析HBsAg诊断严重肝纤维化的曲线下面积(AUC)为0.750,敏感度(SN)为89.50%,特异度(SP)为57.20%。瞬时弹性成像诊断严重肝纤维化的AUC为0.787,SN为83.6%,SP为68.3%,阳性预测值(PPV)为38.10%,阴性预测值(NPV)为94.91%。将瞬时弹性成像与血清HBsAg联合诊断严重肝纤维化较单独诊断相比,串联方法显示两者联合后SP提升为86.43%,PPV提升为56.27%;并联方法显示两者联合后SN提高至98.34%,NPV提高至99.03%。HBeAg阴性患者血清HBsAg与纤维化程度呈正相关性(r_s=0.223,P0.05),经二分类Logistic回归分析提示HBsAg不是HBeAg阴性组肝纤维化独立预测因素。结论在HBeAg阳性的慢性HBV感染者中,HBsAg与瞬时弹性成像联合诊断可提高严重肝脏纤维化的诊断价值。
[Abstract]:Objective to investigate the non invasive diagnostic value of transient elastography combined with serum hepatitis B virus surface antigen (HBsAg) level for liver fibrosis in patients with chronic hepatitis B (CHB) infection. Methods 195 cases of CHB infected by liver biopsy were selected to be divided into hepatitis B virus E antigen (HBeAg) positive and negative group. Results for the gold standard, the serum HBsAg level, the two indexes of the instantaneous elastic imaging (ROC curve) and the combined diagnostic test curve (ROC curve) were used to explore the non invasive diagnostic value of the liver fibrosis degree. Results the HBeAg positive patients gradually decreased with the degree of liver fibrosis, and the HBsAg was negatively correlated with the degree of fibrosis. Sex, age, alanine transaminase (ALT), gluten transaminase (AST), albumin (ALB), platelet (PLT), HBsAg, hepatitis B virus DNA (HBV DNA) and liver hardness measurement value (LSM) were the independent predictors of severe liver fibrosis in the two classified Logistic regression analysis. The curve analysis of HBsAg was 0.750, the sensitivity (AUC) was 0.750, the sensitivity (SN) was 89.50%, the specificity (SP) was 0.787, SN was 83.6%, SP was 68.3%, the positive predictive value (PPV) was 38.10%, and the negative predictive value (NPV) was 94.91%. with the combination of the instantaneous elastic imaging and the serum HBsAg. Compared with the diagnosis of severe liver fibrosis, the series method showed that the SP enhancement was 86.43% and the PPV increased to 56.27% after the combination of the two. The parallel method showed that the SN increased to 98.34% after the combination of the two, and the serum HBsAg was positively correlated with the degree of fibrosis in the 99.03%.HBeAg negative patients (r_s=0.223, P0.05), and the two classification Logistic regression analysis was used. It is suggested that HBsAg is not an independent predictor of liver fibrosis in HBeAg negative group. Conclusion the combined diagnosis of HBsAg and transient elastography can improve the diagnostic value of severe liver fibrosis in patients with HBeAg positive chronic HBV infection.

【作者单位】：安徽医科大学第二附属医院肝病科;
【基金】：安徽省自然科学基金(编号:1608085MH164)
【分类号】：R512.62;R575.2

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