Ultrasound score combined with liver stiffness measurement by sound touch elastography for staging liver fibrosis in patients with chronic hepatitis B: a clinical prospective study.
Ultrasound score combined with liver stiffness measurement by sound touch elastography for staging liver fibrosis in patients with chronic hepatitis B: a clinical prospective study.
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超声评分结合声触弹性成像肝脏硬度测量对慢性乙型肝炎患者肝纤维化分期：一项临床前瞻性研究
DOI：
10.21037/atm-22-505
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发表时间：
2022-03
影响因子：
--
通讯作者：
Dong, Changfeng
中科院分区：
文献类型：
--
作者：
Huang, Kun;Li, Qinyuan;Zeng, Weimei;Chen, Xin;Liu, Li;Wan, Xiang;Feng, Cheng;Li, Zhiyan;Liu, Zhong;Dong, Changfeng
关键词：
对慢性乙型肝炎（CHB）患者的肝纤维化进行无创且精准的诊断，对于确定最佳治疗时机与策略以及预测治疗反应至关重要。本研究旨在评估超声（US）评分和声触诊弹性成像（STE）的肝脏硬度测量（LSM）在诊断肝纤维化分期中的诊断效能，并探究联合这些方法是否能改善肝纤维化分期的判断。
对纳入的CHB患者进行US和STE检查，以肝活检作为参考标准。建立一种由US评分和STE的LSM最佳线性组合（LC）构成的诊断标志物，即LC标志物，用于无创评估肝纤维化分期。通过受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）评估LC标志物的诊断效能。
共纳入291名受试者，其中包括242例CHB患者和49名健康志愿者。相关性分析显示，肝纤维化分期与LC标志物的相关性（斯皮尔曼相关系数r = 0.846，P < 0.001）高于单独的LSM（r = 0.771，P < 0.001）或US评分（r = 0.825，P < 0.001）。结果表明，LC标志物在预测纤维化分期≥F1、≥F2、≥F3和=F4时的总体诊断效能｛AUC分别为0.943 [95%置信区间（CI）：0.917 - 0.948]、0.906（0.871 - 0.915）、0.953（0.923 - 0.969）和0.961（0.922 - 0.973）｝优于US评分｛AUC分别为0.916（0.883 - 0.948，P = 0.014）、0.875（0.835 - 0.915，P < 0.001）、0.934（0.898 - 0.969，P = 0.001）和0.918（0.864 - 0.973，P < 0.001）｝或LSM｛AUC分别为0.858（0.812 - 0.948，P < 0.001）、0.867（0.826 - 0.915，P = 0.006）、0.930（0.894 - 0.969，P < 0.023）和0.958（0.918 - 0.973，P = 0.778）｝。
由LSM和US评分最佳组合而成的LC标志物可被视为一种有前景的肝纤维化无创分期诊断模型。
Background A noninvasive and precise diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB) is crucial for establishing the optimal time and strategy of therapy and for predicting treatment response. This study aimed to assess the diagnostic performance of ultrasound (US) score and liver stiffness measurement (LSM) of sound touch elastography (STE) in diagnosing liver fibrosis stages and to investigate whether combining these methods would improve liver fibrosis staging. Methods US and STE examinations were performed in CHB patients included. Liver biopsy was used as a reference standard. A diagnostic marker with the optimal linear combination (LC) of US score and LSM of STE, namely LC marker, was established for noninvasive assessment of liver fibrosis stages. The diagnostic performance of the LC marker was evaluated by using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Results A total of 291 subjects, including 242 patients with CHB and 49 healthy volunteers, were included. Correlation analysis showed that the correlation of liver fibrosis stages to the LC marker (Spearman’s r=0.846, P<0.001) was higher than that of LSM (r=0.771, P<0.001) or US score (r=0.825, P<0.001) alone. The results showed that the overall diagnostic performance of the LC marker in predicting a fibrosis stage of ≥F1, ≥F2, ≥F3, and =F4 {AUCs: 0.943 [95% confidence interval (CI): 0.917–0.948], 0.906 (0.871–0.915), 0.953 (0.923–0.969), and 0.961 (0.922–0.973), respectively} were better than those of the US score [AUCs: 0.916 (0.883–0.948, P=0.014), 0.875 (0.835–0.915, P<0.001), 0.934 (0.898–0.969, P=0.001), and 0.918 (0.864–0.973, P<0.001), respectively] or LSM [AUCs: 0.858 (0.812–0.948, P<0.001), 0.867 (0.826–0.915, P=0.006), 0.930 (0.894–0.969, P<0.023), and 0.958 (0.918–0.973, P=0.778), respectively]. Conclusions The LC marker with the optimal combination of LSM and US score may be considered as a promising diagnostic model for noninvasive staging of liver fibrosis.
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