摘要：
Objective To investigate the differences in factors that affect the Fibroscan elastic value in different levels of hepatic enzymes and clinical stages in patients with chronic hepatitis B.Methods Clinical data of 110 patients with chronic hepatitis B were collected and analyzed the relationship between Fibroscan elastic value and the elevation level of hepatic enzymes and the patients' clinical stage.The correlation between Fibroscan elastic value and possible influential indexes was also analyzed.Results ①There was no significant difference in liver fibrosis when the inflammatory groups were divided according to the level of ALT (F=0.307,P=0.820).When groups divided in accordance to AST or GGT,the fibrosis of liver exacerbated as the inflammation of liver increased (F=5.012,10.970,P=0.003,0.000).②Pearson correlation analysis showed that LSM was positively correlated with age,SBP,glucose metabolism status,FPG,HOMA-IR,hepatitis B virus carrying age,AST,ALP,GGT (r=0.324、0.200、0.229、0.202、0.287、0.264、0.322、0.270、0.354,P=0.001、0.036、0.016、0.034、0.002、0.005、0.001、0.004、0.000,respectively),and might be negatively correlated with APOA1 (R=-0.214,0.053).There was no significant correlation between LSM and other indicators.When AST≤1.5ULN,Pearson correlation analysis showed that LSM was only positively correlated with BMI and HOMA-IR (r=0.340,0.329,P=0.030,0.036,respectively),and negatively correlated with TG (r=-0.345,P=0.030),and there might be a positive correlation with APOA1 (r=-0.274,0.083).The correlation between LSM and other indicators did not exist.③There was a positive correlation between LSM and TC,TG,APOB,FPG,ALP,GGT,GLO,CHE,Pi,PT,PT-INR,IgG and IgA in patients with chronic moderate to severe hepatitis(r=0.359、0.417、0.378、0.340、0.342、0.546、0.442、0.421、0.345、0.356、0.367、0.397、0.576,P=0.034、0.013、0.036、0.037、0.038、0.000、0.006、0.016、0.036、0.028、0.023、0.018、0.000,respectively).And LSM was negatively correlated with HBeAg,A / G,PA,Na,CK,PT%(r=-0.608、-0.525、-0.365、-0.435、-0.346、-0.354,P=0.0001、0.001、0.040、0.008、0.041、0.029,respectively).There was no significant correlation between LSM and other indicators.In patients with mild hepatitis,LSM was only positively correlated with CR,C3(r=0.388、0.428,P=0.031、0.033,respectively),and was negatively correlated with APOA1(r=-0.488,P=0.021).And correlations between LSM and other indicators did not exist.Conclusion There were different influencing factors for Fibroscan elastic value when the degree of liver injury and clinical stages of hepatitis differed.As AST≤1.5ULN and the clinical grade was mild,the amount of influencing factors was smallest and the influence was mildest.%目的 探讨慢性乙型肝炎不同肝脏酶学水平及不同临床分度者Fibroscan弹性值影响因素的差异.方法 分析110例慢性乙肝患者不同肝脏酶学升高程度及不同临床分度间Fibroscan弹性值的差异与各项指标的相关关系,分析肝脏酶学及临床分度对Fibroscan弹性值的影响.结果 ①以ALT在1.5ULN、1.5~2ULN、2~3ULN、3~5ULN分组比较,不同肝脏炎症组间肝纤维化差异无统计学意义(F=0.307,P=0.820);以AST、GGT在1.5ULN、1.5~2ULN、2~3ULN、3~5ULN分组比较,肝纤维化随着肝脏炎症程度的加重而加重(F=5.012、10.970,P=0.003、0.000).②Pearson相关分析显示,LSM与年龄、SBP、糖代谢状态、FPG、HOMA-IR、乙肝病毒携带年限、AST、ALP、GGT呈正相关(r=0.324、0.200、0.229、0.202、0.287、0.264、0.322、0.270、0.354,P=0.001、0.036、0.016、0.034、0.002、0.005、0.001、0.004、0.000),与APOA1有一定的负相关关系(r=-0.214,0.053),与其他指标间无明显相关关系;限制AST≤1.5ULN时,Pearson相关分析显示,LSM仅与BMI、HOMA-IR呈正相关(r=0.340、0.329,P=0.030、0.036),与TG呈负相关(r=-0.345,P=0.030),与APOA1有一定的正相关关系(r=-0.274,0.083),与其他指标间无相关关系.③慢性中重度患者LSM与TC、TG、APOB、FPG、ALP、GGT、GLO、CHE、Pi、PT、PT-INR、IgG、IgA呈正相关(r=0.359、0.417、0.378、0.340、0.342、0.546、0.442、0.421、0.345、0.356、0.367、0.397、0.576,P=0.034、0.013、0.036、0.037、0.038、0.000、0.006、0.016、0.036、0.028、0.023、0.018、0.000),与HBeAg、A/G、PA、Na、CK、PT%呈负相关(r=-0.608、-0.525、-0.365、-0.435、-0.346、-0.354,P=0.0001、0.001、0.040、0.008、0.041、0.029),与其他指标间无相关关系;慢性轻度乙肝患者LSM仅与CR、C3呈正相关(r=0.388、0.428,P=0.031、0.033),与APOA1呈负相关(r=-0.488,P=0.021),与其他指标间无相关关系.结论 慢性乙肝患者不同肝功损害程度及不同临床分度者Fibroscan弹性值的影响因素不同,AST≤1.5ULN及临床分度为轻度时Fibroscan弹性值的影响因素最少、影响最小.
