瞬时弹性测定对无创诊断早期乙型肝炎相关肝硬化的价值评价

摘要

目的 研究瞬时弹性测定与肝纤维化病理分期以及门静脉自由压的关系,探讨瞬时弹性测定对早期乙型肝炎相关肝硬化诊断的价值及影响因素.方法 2014年1月至2016年5月于首都医科大学附属佑安医院接受脾切+断流术+肝活检术的60例病人术前进行瞬时弹性测定检测肝脏硬度值(liver stiffness measurement,LSM),术中测量门自由压(free portal pressure,FPP)及取肝组织活检,并结合临床资料及病理进行分析.结果 LSM为(17.6±13.9)kPa,切脾前门静脉压力为(34.99±6.52)cmH2O(1cmH2O=0.098 kPa),切脾后门静脉压力为(25.52±4.50)cmH2O,断流后门静脉压力为(26.28±4.36)cmH2O,3组差异有统计学意义(P<0.05).活体组织病理诊断S0 3例,S1 7例,S2 8例,S3 6例,S4 36例.G1 45例,G1~G2 9例,G2 6例.瞬时弹性测定诊断早期肝硬化的曲线下面积(area under the curve,AUC)为0.876,cut-off值7.7 kPa,敏感度和特异度分别为100%、66.67%.LSM与肝脏病理分期呈正相关(r=0.684,P<0.05).多元线性回归发现AFP为LSM的独立影响因素.结论 瞬时弹性测定对肝硬化失代偿期早期、无创诊断有重要的考参价值.%Objective To study the relationship among the transient elasticity measurement and the fibrosis staging and free portal pressure,explore the diagnostic value and influence factors of transient elastography in early hepatitis B-related liver cirrhosis.Methods Sixty patients who were undertaken splenectomy and devascularization and liver biopsy surgery from January 2014 to May 2016 in Youan Hospital affiliated to Capital Medical University were involved.We detected liver stiffness measurement (LSM)with transient elastographypreoperatively,measured free portal pressure(FPP)and took Wedge biopsy of liver intraoperatively,analyzed in conjunction with clinical and pathologic data.Results LSM was (17.6±13.9) kPa,presplenectomy free portal pressure was (34.99±6.52)cmH2O (1 cmH2O=0.098 kPa),postsplenectomy free portal pressure was (25.52±4.50)cmH2O,postdevascularization free portal pressure was (26.28±4.36)cmH2O.Data of three groups had a significant difference (P<0.05).According topathological diagnosis,S0 3 cases,S1 7cases,S2 8cases,S3 6cases,S4 36 cases.G1 45 cases,G1-G2 9cases,G2 6 cases.The area under the curve (AUC) for diagnosis of cirrhosis was 0.876,cut-off value 7.7 kPa,the sensitivity and specificity were 100% and 66.67% by transient elasticity measurement.LSM was positively correlated with the stage of liver fibrosis (r=0.684,P<0.05).Multiple linear regression revealed that AFP was an independent factor for LSM.Conclusion Measurement of transient elastography had important reference value with early non-invasive diagnostic in decompensated cirrhosis.