剪切波弹性成像和血清肝纤维化标志物检测对婴儿肝炎综合征肝纤维化的预测价值

摘要

[目的]探讨剪切波弹性成像(SWE)和血清肝纤维化标志物在预测婴儿肝炎综合征(IHS)肝纤维化的应用价值.[方法]选择2016年3月至2017年5月在本院确诊的婴儿IHS 60例作为研究对象,按照慢性肝炎纤维化分期标准分为S1～4期,选取同期体检的20名健康婴儿为对照组.采用SWE检测患儿肝硬度(LS),同时检测患儿血清肝纤维化标志物水平.[结果]患儿年龄、血红蛋白(HB)、总胆红素(TB)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、LS与肝纤维化程度具有显著的相关性(P＜0.05),HB与肝纤维化呈显著负相关,其他均为显著正相关.HA、Ⅳ-C、LS与肝纤维化呈极显著正相关(P＜0.01).天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和γ-谷氨酰转肽酶(GGT)与肝纤维化分期之间没有显着相关性(P＞0.05).与HA和Ⅳ-C相比,使用SWE检测LS在轻度纤维化、中度纤维化和重度纤维化分析中均具有最高的曲线下面积,依次为0.866、0.904和0.893.在轻度纤维化ROC曲线分析中,HA曲线下面积(0.837)大于Ⅳ-C(0.716),而在中度纤维化和高度纤维化ROC曲线分析中,Ⅳ-C曲线下面积分别为0.812和0.854,均分别高于HA(0.722和0.830).[结论]SWE和血清肝纤维化标志物(HA和Ⅳ-C)在婴儿IHS肝纤维化方面均具有良好的诊断效能,SWE要优于血清肝纤维化标志物.%[Objective] To investigate the value of shear wave elastography (SWE) and serum markers of hepatic fibrosis in predicting hepatic fibrosis in infantile hepatitis syndrome (IHS).[Methods] Sixty infants with IHS diagnosed in our hospital from March 2016 to May 2017 were selected as the subjects,According to the staging criteria of chronic hepatitis fibrosis,it is divided into S1～4 stage,At the same time,20 healthy infants were selected as control group.Liver stiffness (LS) was detected by SWE,and serum markers of liver fibrosis were detected in children.[Results] Age,hemoglobin (HB),total bilirubin (TB),hyaluronic acid (HA),type Ⅳ collagen (Ⅳ-C),LS were significantly correlated with the degree of liver fibrosis (P ＜0.05),and HB was negatively correlated with liver fibrosis,and the others were significantly positively correlated.There was a significant positive correlation between HA,Ⅳ-C,LS and liver fibrosis (P ＜0.01).Aspartate aminotransferase (AST),alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT)were not significantly correlated with liver fibrosis stages (P ＞0.05).Compared with HA and Ⅳ-C,the detection of LS with SWE showed the highest curve area in mild fibrosis,moderate fibrosis and severe fibrosis analysis,followed by 0.866,0.904 and 0.893.In the ROC curve analysis of mild fibrosis,the area under the HA curve (0.837) was greater than that of Ⅳ-C (0.716),In the ROC curve of moderate fibrosis and high fibrosis,the area under the Ⅳ-C curve was 0.812 and 0.854,respectively,which were higher than those of HA (0.722 and 0.830) respectively.[Conclusion]SWE and serum markers of liver fibrosis (HA and Ⅳ-C) have good diagnostic efficacy in infants with IHS liver fibrosis,and SWE is superior to serum markers of liver fibrosis.