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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
DOI: 10.3969/j.issn.1001-5256.2023.01.015
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。
Diagnostic value of real-time shear wave elastography for liver fibrosis in patients with autoimmune hepatitis
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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。 Abstract:Objective To explore the diagnostic value of Young's modulus obtained by real-time shear wave elastography (SWE) for liver fibrosis in autoimmune hepatitis (AIH) patients. Methods A total of 75 AIH patients in the First Affiliated Hospital of Zhengzhou University from January 2013 to April 2022 were retrospectively enrolled. Scheuer scoring system was used to evaluate degrees of liver fibrosis (S0-S4). By using pathological examination of liver tissues as the golden standard, the receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was used to evaluate the diagnostic value of SWE for the significant fibrosis (≥S2), advanced liver fibrosis (≥S3), and liver cirrhosis (S4), respectively. Independent sample t test was used for comparison of continuous data with normal distribution between the two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and Bonferroni method was used for further comparison between two groups. The Spearman correlation coefficient was used for correlation analysis. The logistic regression analysis was used to predict the impact factors in diagnosis accuracy. Results The Young's modulus measured by SWE was statistically significant different among various fibrosis groups (H=35.186, P < 0.001) although there was no statistical significance in patients' age and platelet, alanine aminotransferase, aspartate aminotransferase, total bilirubin, alkaline phosphatase, and glutamyl transpeptidase levels (all P > 0.05). The Young's modulus measurement was positively correlated with liver fibrosis (r=0.675, P < 0.05). The AUCs of SWE in the diagnosis of≥S2, ≥S3, and S4 were 0.839, 0.820 and 0.898, respectively and the corresponding optimum cut-off values were 9.2, 10.9, and 14.4 kPa, respectively. The overall concordance rate of the liver Young' s modulus measurements vs. fibrosis stages was 57.33%. Moreover, the alkaline phosphatase level was an independent predictor for diagnostic accuracy of SWE for stage 0-1 fibrosis (OR=1.009, 95%CI: 1.001-1.018, P=0.029). Conclusion The SWE possessed a diagnosis value for the significant fibrosis (≥S2), advanced liver fibrosis (≥S3) and liver cirrhosis (S4), although there was a low overall concordance rate in the liver Young's modulus measurements obtained using SWE vs. fibrosis stages. -
Key words:
- Liver Cirrhosis /
- Hepatitis, Autoimmune /
- Shear Wave Elastography /
- Diagnosis
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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
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值 P值 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。 
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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值 ≥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
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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%。
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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值 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
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