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肝脏硬度值对HBeAg阳性慢性HBV感染者肝纤维化程度的诊断价值
Value of liver stiffness measurement in the diagnosis of liver fibrosis degree in HBeAg-positive patients with chronic HBV infection
文章发布日期:2019年05月13日  来源:  作者:刘娜,李春霞,东冰,等  点击次数:340次  下载次数:64次

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【摘要】:目的评估肝脏硬度值(LSM)对HBeAg阳性慢性HBV感染者肝纤维化程度的诊断价值。方法采用回顾性研究方法,纳入2013年10月-2018年8月在延安大学附属医院住院行肝活组织检查的HBeAg阳性慢性HBV感染者330例,根据肝组织学病理结果,分为轻微肝纤维化(F0~F1)和明显肝纤维化(F2~F4)两组。计量资料两组间比较采用t检验或非参数 Mann-Whitney U 检验,计数资料两组间比较采用χ2检验。通过logistic单因素及多因素分析筛选诊断明显肝纤维化的指标,然后对筛选后的指标绘制受试者工作特征(ROC)曲线评估其在诊断明显肝纤维化患者中的预测价值。结果330例患者中轻微纤维化(F0~F1)有245例,明显肝纤维化(F2~F4)有85例。两组在临床指标HBV DNA、HBsAg、HBeAg、抗-HBc、ALT、AST、TBil和LSM水平上比较差异均有统计学意义(P值均<0.05)。多因素分析显示,HBsAg与LSM是明显肝纤维化的独立危险因素(P值均<0.05)。ROC曲线分析发现只有LSM有诊断价值,ROC曲线下面积为0.744(95%可信区间:0.680~0.808)。以LSM≥6.15 kPa为界值,预测明显肝纤维化的敏感度为62.4%,特异度为76.3%,准确度为72.1%,阳性预测值为72.5%,阴性预测值为67.0%。结论LSM对明显肝纤维化的HBeAg阳性慢性HBV感染者有较好的预测价值。
【Abstract】:To investigate the value of liver stiffness measurement (LSM) in the diagnosis of liver fibrosis degree in HBeAg-positive patients with chronic HBV infection. Methods A retrospective analysis was performed for the clinical data of 330 HBeAg-positive patients with chronic HBV infection who were hospitalized in Affiliated Hospital of Yan’an University from October 2013 to August 2018 and underwent liver biopsy, and according to liver pathological results, these patients were divided into mild liver fibrosis group (F0-F1) and significant liver fibrosis group (F2-F4). The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate analyses were performed to screen out the indices for the diagnosis of significant liver fibrosis, and the receiver operating characteristic (ROC) curve was plotted for these indices to evaluate their value in the diagnosis of significant liver fibrosis. Results Of all 330 patients, 245 had mild liver fibrosis and 85 had significant liver fibrosis. There were significant differences between the two groups in HBV DNA, HBsAg, HBeAg, HBcAb, alanine aminotransferase, aspartate aminotransferase, total bilirubin, and LSM (all P<0.05). The multivariate analysis showed that HBsAg and LSM were independent risk factors for significant liver fibrosis (both P<0.05). The ROC curve analysis showed that only LSM had a diagnostic value, with an area under the ROC curve of 0.744 (95% confidence interval: 0.680-0.808). At the optimal cut-off value of 6.15 kPa, LSM had a sensitivity of 62.4%, a specificity of 76.3%, an accuracy of 72.1%, a positive predictive value of 72.5%, and a negative predictive value of 67.0% in predicting significant liver fibrosis. ConclusionLSM has a good value in predicting significant liver fibrosis in HBeAg-positive patients with chronic HBV infection.
【关键字】:肝炎, 乙型, 慢性; 肝炎e抗原, 乙型; 肝硬化; 肝脏硬度值; 诊断
【Key words】:hepatitis B, chronic; hepatitis B e antigens; liver cirrhosis; liver stiffness measurement; diagnosis
【引证本文】:LIU N, LI CX, DONG B, et al. Value of liver stiffness measurement in the diagnosis of liver fibrosis degree in HBeAg-positive patients with chronic HBV infection[J]. J Clin Hepatol, 2019, 35(6): 1262-1265. (in Chinese)
刘娜, 李春霞, 东冰, 等. 肝脏硬度值对HBeAg阳性慢性HBV感染者肝纤维化程度的诊断价值[J]. 临床肝胆病杂志, 2019, 35(6): 1262-1265.

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