PDF下载 ( 2599 KB)
FibroTouch、FibroScan及ARFI在原发性胆汁性胆管炎相关肝纤维化中的诊断价值
DOI: 10.3969/j.issn.1001-5256.2021.04.019
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：王民负责研究实施，资料分析，撰写论文；罗文萍、张冠华参与收集数据，修改论文；赵新颜负责病理读片；马红、田瑛负责课题制定及指导；王宇负责拟定写作思路，指导撰写文章并最后定稿。
Diagnostic value of FibroTouch, FibroScan, and acoustic radiation force impulse for liver fibrosis in patients with primary biliary cholangitis
-
摘要:
目的 评估FibroTouch与FibroScan、声辐射力脉冲成像(ARFI)对原发性胆汁性胆管炎(PBC)患者肝纤维化程度的诊断效能。 方法 回顾性纳入2014年9月—2018年10月在首都医科大学附属北京友谊医院行肝穿刺活检明确诊断为PBC的患者。采用METAVIR评分系统评估肝纤维化和炎症程度。在肝活检1周内分别应用瞬时弹性成像(FibroTouch和FibroScan)和ARFI技术检测肝脏硬度值(LS)；以病理结果作为金标准，采用受试者工作特征曲线下面积(AUC)比较3种超声弹性成像技术对PBC肝纤维化的诊断价值，并分析其影响因素；采用Youden指数计算不同程度肝纤维化的诊断界值。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。采用Spearman进行相关性分析，采用多重线性回归模型进行多因素分析。 结果 研究共纳入68例PBC患者，其中肝纤维化F0、F1、F2、F3和F4分别为13、15、18、12和10例。FibroTouch获得的LS(FT-LS)、FibroScan获得的LS(FS-LS)和ARFI获得的LS (ARFI-LS)与肝纤维化程度均呈强正相关(r值分别为0.798、0.782和0.742，P值均＜0.001)。FT-LS诊断F≥2、F≥3、F=4 AUC分别为0.922、0.881、0.926，对应的cut-off值分别为10.5、15.8和17.5 kPa；FS-LS诊断F≥2、F≥3、F=4 AUC分别为0.918、0.878、0.939，对应的cut-off值分别为10.1、12.9和18.2 kPa；ARFI-LS诊断F≥2、F≥3、F=4 AUC分别为0.904、0.869、0.928，对应的cut-off值分别为1.45、1.83和2.08 m/s。3种超声成像技术对各期纤维化程度的诊断差异无统计学意义(P＞0.05)。多因素分析结果显示，FT-LS的影响因素有肝纤维化程度(β=0.399，P＜0.001)、TBil水平(β=0.466，P＜0.001)和PTA(β=-0.195，P=0.020)；FS-LS的影响因素有肝纤维化程度(β=0.370，P＜0.001)、AST(β=0.450，P＜0.001)、PTA(β=-0.303，P=0.001)和ALP(β=-0.187，P=0.042)；而ARFI-LS的影响因素有肝纤维化程度(β=0.489，P＜0.001)、AST(β=0.467，P＜0.001)和PLT(β=-0.188，P=0.028)。 结论 FibroTouch与FibroScan和ARFI在诊断PBC肝纤维化程度的效能相似，特别是对显著纤维化(F≥2)和肝硬化(F=4)具有较高的诊断效能，可作为诊断PBC患者肝纤维化程度的可靠手段。 Abstract:Objective To investigate the diagnostic efficiency of FibroTouch, FibroScan, and acoustic radiation force impulse (ARFI) for liver fibrosis in patients with primary biliary cholangitis (PBC). Methods A retrospective analysis was performed for the patients who underwent liver biopsy and were then diagnosed with PBC in Beijing Friendship Hospital, Capital Medical University, from September 2014 to October 2018, and the METAVIR scoring system was used to evaluate the degree of liver fibrosis and inflammation. Within 1 week after liver biopsy, FibroTouch, FibroScan, and ARFI were used to measure liver stiffness (LS); with pathological results as the gold standard, the area under the ROC curve (AUC) was used to compare the value of FibroTouch, FibroScan, and ARFI in the diagnosis of liver fibrosis in PBC patients, and related influencing factors were analyzed; Youden index was used to calculate the cut-off values of LS for different degrees of liver fibrosis. The Kruskal-Wallis H test was used for comparison between multiple groups, and P value corrected by the Bonferroni method was used for further comparison between two groups. A Spearman correlation analysis was performed, and a multiple linear regression model was used for multivariate analysis. Results A total of 68 patients with PBC were enrolled in the study, among whom 13 had F0 liver fibrosis, 15 had F1 liver fibrosis, 18 had F2 liver fibrosis, 12 had F3 liver fibrosis, and 10 had F4 liver fibrosis. LS obtained by FibroTouch (FT-LS), LS obtained by FibroScan (FS-LS), and LS obtained by ARFI (ARFI-LS) were strongly positively correlated with the degree of liver fibrosis (r=0.798, 0.782, and 0.742, all P < 0.001). FT-LS had AUCs of 0.922, 0.881, and 0.926, respectively, in the diagnosis of F≥2, F≥3, and F=4 liver fibrosis, and the corresponding cut-off values were 10.5 kPa, 15.8 kPa, and 17.5 kPa, respectively; FS-LS had AUCs of 0.918, 0.878, and 0.939, respectively, in the diagnosis of F≥2, F≥3, and F=4 liver fibrosis, and the corresponding cut-off values were 10.1 kPa, 12.9 kPa, and 18.2 kPa, respectively; ARFI-LS had AUCs of 0.904, 0.869, and 0.928, respectively, in the diagnosis of F≥2, F≥3, and F=4 liver fibrosis, and the corresponding cut-off values were 1.45 m/s, 1.83 m/s, and 2.08 m/s, respectively. There was no significant difference in diagnosing the same stage of liver fibrosis between FibroTouch, FibroScan, and ARFI (P > 0.05). The multivariate analysis showed that degree of liver fibrosis (β=0.399, P < 0.001), total bilirubin (β=0.466, P < 0.001), and prothrombin time activity (β=-0.195, P=0.020) were influencing factors for FT-LS; degree of liver fibrosis (β=0.370, P < 0.001), aspartate aminotransferase (β=0.450, P < 0.001), prothrombin time activity (β=-0.303, P=0.001), and alkaline phosphatase (β=-0.187, P=0.042) were influencing factors for FS-LS; degree of liver fibrosis (β=0.489, P < 0.001), aspartate aminotransferase (β=0.467, P < 0.001), and platelet count (β=-0.188, P=0.028) were influencing factors for ARFI-LS. Conclusion FibroTouch has similar efficiency to FibroScan and ARFI in the diagnosis of liver fibrosis in PBC patients, with relatively high diagnostic efficiency for significant liver fibrosis (F≥2) and liver cirrhosis (F=4), and therefore, it can be used as a reliable method for the diagnosis of liver fibrosis in PBC patients. -
Key words:
- Liver Cirrhosis, Biliary /
- Liver Cirrhosis /
- Elasticity Imaging Techniques /
- Diagnosis
-
表 1 68例PBC患者的临床基本特征
指标 参数 男/女(例) 8/60 年龄(岁) 51.5(44.3~58.8) BMI(kg/m2) 22.7(20.3~24.8) ALT(U/L) 44(27~75) AST(U/L) 58.9(34.0~95.9) ALP(U/L) 198.0(117.3~334.3) GGT(U/L) 162.0(78.8~260.8) TBil(μmol/L) 16.11(11.88~24.93) Alb(g/L) 36.8(34.1~40.8) Cr(mmol/L) 58.5(52.6~65.3) PLT(×109/L) 178.5(99.8~236.3) PTA(%) 98.4(98.3~112.4) 肝纤维化分期[例(%)] F0 13(19.1) F1 15(22.1) F2 18(26.5) F3 12(17.6) F4 10(14.7) 
下载: 导出CSV
表 2 不同肝纤维化分期的FT-LS、FS-LS和ARFI-LS水平
指标 F0 F1 F2 F3 F4 H值 P值 FT-LS(kPa) 5.5(4.6~7.5) 8.0(7.0~10.5) 13.7(11.3~16.1) 16.9(11.7~25.4) 43.2(19.9~51.2) 43.242 ＜0.001 FS-LS(kPa) 5.6(4.9~8.0) 7.0(6.5~8.3) 11.9(8.8~15.0) 15.1(9.5~29.9) 34.4(24.9~46.1) 42.110 ＜0.001 ARFI-LS(m/s) 1.27(1.09~1.57) 1.35(1.19~1.53) 1.81(1.55~2.08) 1.92(1.86~2.19) 2.42(2.15~2.61) 38.798 ＜0.001
下载: 导出CSV
表 3 FT-LS、FS-LS和ARFI-LS对PBC肝纤维化的诊断效能
纤维化分期 AUC(95%CI) cut-off值 敏感度 特异度 F≥2 FT-LS 0.922(0.831~0.973) 10.5 kPa 0.900 0.857 FS-LS 0.918(0.826~0.971) 10.1 kPa 0.800 0.929 ARFI-LS 0.904(0.808~0.962) 1.45 m/s 0.950 0.714 F≥3 FT-LS 0.881(0.780~0.947) 15.8 kPa 0.727 0.913 FS-LS 0.878(0.776~0.945) 12.9 kPa 0.818 0.869 ARFI-LS 0.869(0.765~0.939) 1.83 m/s 0.909 0.804 F=4 FT-LS 0.926(0.836~0.975) 17.5 kPa 0.900 0.879 FS-LS 0.939(0.853~0.982) 18.2 kPa 0.900 0.914 ARFI-LS 0.928(0.838~0.976) 2.08 m/s 1.000 0.845
下载: 导出CSV
-
[1] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and therapy of hepatic fibrosis(2019)[J]. J Clin Hepatol, 2019, 35(10): 2163-2172. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.10.007中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 肝纤维化诊断及治疗共识(2019年)[J]. 临床肝胆病杂志, 2019, 35(10): 2163-2172. DOI: 10.3969/j.issn.1001-5256.2019.10.007 [2] Foundation for Hepatitis Prevention and Control; Chinese society of Infectious Disease and Chinese Society of Hepatology, Chinese Medical Association; Liver Disease Committee of Chinese Research Hospital Association. Consensus on clinical application of transient elastrography detecting liver fibrosis: A 2018 update[J]. Chin J Hepatol, 2019, 27(3): 182-191. (in Chinese)中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会和中国研究型医院学会肝病专业委员会. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J]. 中华肝脏病杂志, 2019, 27(3): 182-191. [3] LOOMBA R, ADAMS LA. Advances in non-invasive assessment of hepatic fibrosis[J]. Gut, 2020, 69(7): 1343-1352. DOI: 10.1136/gutjnl-2018-317593 [4] DIETRICH CF, BAMBER J, BERZIGOTTI A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version)[J]. Ultraschall Med, 2017, 38(4): e48. DOI: 10.1055/a-0641-0076 [5] Chinese Society of Hepatology, Chines Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and management of primary biliary cirrhosis(cholangitis) (2015)[J]. J Clin Hepatol, 2015, 31(12): 1980-1988. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2015.12.004中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J]. 临床肝胆病杂志, 2015, 31 (12) : 1980-1988. DOI: 10.3969/j.issn.1001-5256.2015.12.004 [6] DUAN WJ, WANG XZ, MA AL, et al. Multicenter prospective study to validate a new transient elastography device for staging liver fibrosis in patients with chronic hepatitis B[J]. J Dig Dis, 2020, 21(9): 519-525. DOI: 10.1111/1751-2980.12924 [7] FERRAIOLI G, WONG VW, CASTERA L, et al. Liver ultrasound elastography: An update to the world federation for ultrasound in medicine and biology guidelines and recommendations[J]. Ultrasound Med Biol, 2018, 44(12): 2419-2440. DOI: 10.1016/j.ultrasmedbio.2018.07.008 [8] BARR RG, WILSON SR, RUBENS D, et al. Update to the society of radiologists in ultrasound liver elastography consensus statement[J]. Radiology, 2020, 296(2): 263-274. DOI: 10.1148/radiol.2020192437 [9] BEDOSSA P, POYNARD T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group[J]. Hepatology, 1996, 24(2): 289-293. DOI: 10.1002/hep.510240201 [10] CORPECHOT C, EL NAGGAR A, POUJOL-ROBERT A, et al. Assessment of biliary fibrosis by transient elastography in patients with PBC and PSC[J]. Hepatology, 2006, 43(5): 1118-1124. DOI: 10.1002/hep.21151 [11] CORPECHOT C, CARRAT F, POUJOI-ROBERT A, et al. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis[J]. Hepatology, 2012, 56(1): 198-208. DOI: 10.1002/hep.25599 [12] GÓMEZ-DOMINGUEZ E, MENDOZA J, GACIA-BUEY L, et al. Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis[J]. Aliment Pharmacol Ther, 2008, 27(5): 441-447. http://europepmc.org/abstract/med/18081731 [13] ZHANG DK, CHEN M, LIU Y, et al. Acoustic radiation force impulse elastography for non-invasive assessment of disease stage in patients with primary biliary cirrhosis: A preliminary study[J]. Clin Radiol, 2014, 69(8): 836-840. DOI: 10.1016/j.crad.2014.03.019 [14] GOERTZ RS, GABMANN L, STROBEL D, et al. Acoustic Radiation Force Impulse (ARFI) elastography in autoimmune and cholestatic liver diseases[J]. Ann Hepatol, 2019, 18(1): 23-29. DOI: 10.5604/01.3001.0012.7858 [15] ZHANG YG, ZHAO SX, ZHOU GD, et al. Correlation of FibroTouch and FibroScan with the stage of primary biliary cirrhosis[J]. Chin J Hepatol, 2016, 24(12): 902-906. (in Chinese) DOI: 10.3760/cma.j.issn.1007-3418.2016.12.005张玉果, 赵素贤, 周光德, 等. FibroTouch、FibroScan与原发性胆汁性肝硬化分期的相关性分析[J]. 中华肝脏病杂志, 2016, 24(12): 902-906. DOI: 10.3760/cma.j.issn.1007-3418.2016.12.005 [16] ZHANG DK, ZHAO YY, CHEN M, et al. The initial clinical study of acoustic radiation force impulse imaging in quantitative evaluating the degree of primary biliary cirrhosis[J]. J Chin Clin Med Imaging, 2014, 25(4): 248-251. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201404010.htm张大鹍, 赵媛媛, 陈敏, 等. 声脉冲辐射力成像在原发性胆汁性肝硬化定量诊断中的应用研究[J]. 中国临床医学影像杂志, 2014, 25(4): 248-251. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX201404010.htm [17] LI B, JI D, NIU XX, et al. Diagnostic value of FibroScan for liver fibrosis in patients with primary biliary cirrhosis[J]. Chin Hepatol, 2014, 19(8): 585-587. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZUAN201408008.htm李冰, 纪冬, 牛小霞, 等. FibroScan对原发性胆汁性肝硬化患者肝纤维化的诊断价值[J]. 肝脏, 2014, 19(8): 585-587. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUAN201408008.htm [18] GUO H, LIAO M, JIN J, et al. How intrahepatic cholestasis affects liver stiffness in patients with chronic hepatitis B: A study of 1197 patients with liver biopsy[J]. Eur Radiol, 2020, 30(2): 1096-1104. DOI: 10.1007/s00330-019-06451-x -
本文二维码
图(1) / 表(3)
计量
- 文章访问数: 841
- HTML全文浏览量: 401
- PDF下载量: 108
- 被引次数: 0
