ALT水平对乙型肝炎肝硬化患者肝脏硬度值的影响

周家玲; 吴晓宁; 孙亚朦; 孟彤彤; 关秋爽; 武珊珊; 王冰琼; 施漪雯; 陈姝延; 何志颖; 马红; 贾继东; 欧晓娟; 尤红

doi:10.3969/j.issn.1001-5256.2018.08.016

ALT水平对乙型肝炎肝硬化患者肝脏硬度值的影响

DOI: 10.3969/j.issn.1001-5256.2018.08.016

1. 首都医科大学附属北京友谊医院国家消化系疾病临床医学研究中心肝硬化转化医学北京市重点实验室肝病中心
2. 首都医科大学附属北京友谊医院国家消化系疾病临床医学研究中心肝硬化转化医学北京市重点实验室临床流行病学与循证医学中心

基金项目:

国家科技重大专项(2013ZX10002004,2017ZX10203202-003)；北京市科委科技计划重大项目(Z171100002217082,Z151100004015084)；首都医科大学附属北京友谊医院院启动课题(yyqdkt2015-24)；

详细信息

中图分类号: R512.62;R575.2
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出版历程
- 收稿日期: 2018-06-05
- 出版日期: 2018-08-20

Effect of ALT level on liver stiffness measurement in patients with hepatitis B cirrhosis

Liver Research Center, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Disease & Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis

Research funding:

摘要

摘要: 目的探讨ALT水平对乙型肝炎肝硬化肝脏硬度值（LSM）分布的影响。方法选取2012年1月-2015年5月在北京友谊医院及各分中心经肝穿刺诊断为乙型肝炎肝硬化的初治患者,收集入组患者的人口学特征、血常规、生化、HBV DNA、AFP、LSM、腹部超声和肝穿刺资料。比较乙型肝炎肝硬化患者中不同ALT水平的LSM分布特征。组间比较采用单因素方差分析或Kruskal-Wallis H检验,计数资料组间比较采用χ2检验,相关性分析采用Pearson相关和偏相关。结果共入组104例患者,根据ALT水平分成3组[≤2倍正常值上限（ULN）、25 ULN和≥5 ULN],3组在性别构成比、BMI、HBeAg状态、HBV DNA水平、Alb水平、PLT方面差异均无统计学意义（P值均>0.05）。3组患者的LSM中位值分别为15.4、18.8及29.9 k Pa,LSM随着ALT升高而升高,3组间差异有统计学意义（χ2=10.07,P<0.05）。校正年龄后乙型肝炎肝硬化患者的LSM与ALT仍呈正相关（r=0.220,95%可信...
- 肝硬化 /
- 肝炎,乙型,慢性 /
- 丙氨酸转氨酶 /
- 肝脏硬度值
Abstract: Objective To investigate the effect of alanine aminotransferase ( ALT) level on liver stiffness measurement ( LSM) in patients with hepatitis B cirrhosis. Methods The patients who were diagnosed with hepatitis B cirrhosis by liver biopsy in Beijing Friendship Hospital from January 2012 to May 2015 and did not receive antiviral therapy were enrolled. Their demographic characteristics, routine blood test results, biochemical parameters, hepatitis B virus ( HBV) DNA level, alpha-fetoprotein level, LSM, abdominal ultrasound findings, and liver biopsy data were collected. LSM was compared between hepatitis B cirrhosis patients with different ALT levels. The one-way analysis of variance or rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data. Pearson correlation analysis and partial correlation analysis were performed. Results A total of 104 patients were recruited and divided into three groups according to their ALT levels ( ≤2 × upper limit of normal [ULN], 2-5 × ULN, and ≥5 × ULN) . There were no significant differences between the three groups in sex ratio, body mass index, HBeAg status, HBV DNA level, albumin level, and platelet count ( all P > 0. 05) . The median values of LSM for the three groups were 15. 4 k Pa, 18. 8 k Pa, and 29. 9 k Pa, respectively, suggesting that LSM increased as the ALT level increased, and there was a significant difference in LSM between the three groups ( χ2= 10. 07, P < 0. 05) . After adjusting for age, which was significantly different between the three groups, LSM was still found to be positively correlated with ALT level ( r = 0. 220, 95% confidence interval: 0. 101-0. 468, P < 0. 05) . Conclusion In patients with hepatitis B cirrhosis, LSM increased with the increasing ALT level, and the positive correlation remains after adjusting for age.
- liver cirrhosis /
- hepatitis B, chronic /
- alanine transaminase /
- liver stiffness measurement

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参考文献(16)

[1]REN X, WU P, WANG L, et al.Changing epidemiology of hepatitis A and hepatitis E viruses in China, 1990-2014[J].Emerg Infect Dis, 2017, 23 (2) :276-279.

[2]WANG FS, FAN JG, ZHANG Z, et al.The global burden of liver disease:The major impact of China[J].Hepatology, 2014, 60 (6) :2099-2108.

[3]COOKE GS, LEMOINE M, THURSZ M, et al.Viral hepatitis and the global burden of disease:A need to regroup[J].J Viral Hepat, 2013, 20 (9) :600-601.

[4]Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[5]SARINSK, KUMAR, LAU GK, et al.Asian-Pacific clinical practice guidelines on the management of hepatitis B:A 2015 update[J].Hepatol Int, 2016, 10 (1) :1-98.

[6]European Association for the Study of the Liver.EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J].J Hepatol, 2017, 67 (2) :370-398.

[7]TERRAULT NA, LOK ASF, MCMAHON BJ, et al.Update on prevention, diagnosis, and treatment of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J].Hepatology, 2018, 67 (4) :1560-1599.

[8]JIA JD, HOU JL, DING HG, et al.Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B[J].J Gastroenterol Hepatol, 2015, 30 (4) :756-762.

[9]EASL-ALEH Clinical Practice Guidelines.Non-invasive tests for evaluation of liver disease severity and prognosis[J].J Hepatol, 2015, 63 (1) :237-264.

[10]Consensus Expert Committee on Clinical Application of Transient Elastography (TE) .Expert consensus on clinical application of transient elastography (TE) (2015) [J/CD].Chin J Liver Dis:Electronic Edition, 2015, 7 (2) :12-18. (in Chinese) 瞬时弹性成像技术 (TE) 临床应用共识专家委员会.瞬时弹性成像技术 (TE) 临床应用专家共识 (2015年) [J/CD].中国肝脏病杂志:电子版, 2015, 7 (2) :12-18.

[11]KEMP W, LEVY M, WELTMAN M, et al.Australian Liver Association (ALA) expert consensus recommendations for the use of transient elastography in chronic viral hepatitis[J].J Gastroenterol Hepatol, 2015, 30 (3) :453-462.

[12]LIANG XE, ZHANG Q, CHEN YP, et al.The correlation of serum alanine aminotransferase level and liver stiffness measurement (Fibro Scan) in patients with chronic hepatitis B flare[J].J Clin Hepatol, 2010, 26 (5) :500-514. (in Chinese) 梁携儿, 张淇, 陈永鹏, 等.血清ALT与慢性乙型肝炎、肝硬化Fibro Scan弹性值动态检测结果的相关性[J].临床肝胆病杂志, 2010, 26 (5) :500-514.

[13]ZHAO CS, HE WY, WANG NF, et al.Correlation of liver stiffness measured by Fibro Scan with sex and age in healthy adults undergoing physical examination[J].J Clin Hepatol, 2016, 32 (4) :724-727. (in Chinese) 赵崇山, 何文艳, 王宁方, 等.健康体检成人Fibro Scan检测肝脏硬度值与年龄、性别的相关性[J].临床肝胆病杂志, 2016, 32 (4) :724-727.

[14]ZHAO XX, WU YS, MIAO Y, et al.Ultrasonic elastographic evaluation of liver for healthy people[J].Med J Natl Defend Forces Northwest China, 2012, 33 (5) :539-541. (in Chinese) 赵夏夏, 吴永胜, 苗英, 等.不同年龄段人群正常肝脏弹性成像定量的相关性分析[J].西北国防医学杂志, 2012, 33 (5) :539-541.

[15]GENG XX, LIN JM, YANG XX, et al.Influencing factors of fibroscan in diagnosis of liver fibrosis in chronic HBV carrier with ALT level less than two-time up limit of normal[J].Pract J Clin Med, 2015, 12 (2) :34-36. (in Chinese) 耿晓霞, 林健梅, 杨兴祥, 等.肝脏瞬时弹性超声诊断ALT小于2倍正常上限慢性HBV感染者肝纤维化的影响因素分析[J].实用医院临床杂志, 2015, 12 (2) :34-36.

[16]XIE QX, XU N, JIANG XP, et al.Role of Fibro Scan in liver fibrosis evaluation in patients with chronic hepatitis B virus infection and related influencing factors[J].Chin J Hepatol, 2016, 24 (9) :659-664. (in Chinese) 谢琴秀, 徐楠, 江晓平, 等.Fibro Scan对慢性乙型肝炎病毒感染者肝纤维化评估的影响因素分析[J].中华肝脏病杂志, 2016, 24 (9) :659-664.

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