超声SWV值、血清APRI与胆道闭锁患儿肝纤维化程度的相关性分析

doi:10.7517/issn.1674-0475.220521

摘要/Abstract

摘要： 本研究探讨肝脏剪切波速度（SWV）、血清天冬氨酸转氨酶（AST）与血小板比率指数（APRI）诊断胆道闭锁（BA）患儿肝纤维化程度的临床价值。选取102例BA患儿为BA组，50例同龄健康婴儿为对照组。两组均接受超声检查及实验室指标检测，并根据肝纤维化程度进行分组对比，分析SWV、APRI值诊断BA的价值，分析SWV、APRI值与肝纤维化指标的关系。BA组患儿的AST、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）、APRI指标均高于对照组，BA组患儿的血小板（PLT）值低于对照组（P<0.05）；BA组患儿的层黏蛋白（LN）、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（Ⅳ-Col）测定值均高于对照组（P<0.05）；BA组患儿的肝纤维化评分、SWV值均高于对照组（P<0.05）；BA组患儿的SWV值与LN、HA、PCⅢ、Ⅳ-Col、肝纤维化评分均呈正相关关系（P<0.05）；APRI值与肝纤维化评分呈正相关关系（P<0.05）；纤维化分级≥F2的BA组患儿的SWV值、APRI值均高于纤维化分级P<0.05）；SWV值、APRI值在鉴别诊断BA患儿发生明显肝纤维化的AUC值分别为0.980、0.858。SWV值、APRI值对于诊断BA患儿发生肝纤维化及其纤维化严重程度方面具有一定的价值，且与肝纤维化指标具有相关性。

关键词: 肝脏剪切波速度, 天冬氨酸转氨酶, 血小板, 胆道闭锁, 肝纤维化, 黄疸

Abstract: This study investigated the clinical value of liver shear wave velocity (SWV) and serum aspartate aminotransferase (AST) to platelet ratio index (APRI) in the diagnosis of liver fibrosis in children with biliary atresia (BA). 102 children with BA were selected as the BA group, and 50 healthy infants of the same age were selected as the control group. Both groups received ultrasound examination and laboratory index detection, and they were grouped and compared according to the degree of liver fibrosis. The value of SWV and APRI values in diagnosing BA was analyzed, and the relationship between SWV and APRI values and liver fibrosis indexes was analyzed. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), direct bilirubin (DBIL) and APRI indexes of the children in the BA group were higher than those in the control group. The platelet (PLT) value of the children in the BA group was lower than that in the control group (P<0.05). The measured values of laminin (LN), hyaluronic acid (HA), type Ⅲ procollagen (PCⅢ) and type Ⅳ collagen (Ⅳ-Col) in the BA group were higher than those in the control group (P<0.05). The liver fibrosis score and SWV value of the children in the BA group were higher than those of the control group (P<0.05). The SWV value of children in BA group was positively correlated with LN, HA, PCⅢ, Ⅳ-Col and liver fibrosis score (P<0.05). APRI value was positively correlated with liver fibrosis score (P<0.05). The SWV value and APRI value of children in BA group with fibrosis grade ≥ F2 were higher than those of children with P<0.05). The AUC values of SWV value and APRI value in differential diagnosis of obvious liver fibrosis in children with BA were 0.980 and 0.858 respectively. SWV value and APRI value have certain value in diagnosing liver fibrosis and the severity of fibrosis in children with BA, and are correlated with liver fibrosis indicators.

Key words: hepatic shear wave velocity, aspartate aminotransferase, platelets, biliary atresia, liver fibrosis, jaundice

张洁媛, 蒲思宇. 超声SWV值、血清APRI与胆道闭锁患儿肝纤维化程度的相关性分析[J]. 影像科学与光化学, 2022, 40(5): 1200-1204.

ZHANG Jieyuan, PU Siyu. Correlation Analysis of Ultrasound SWV Value, Serum APRI and the Degree of Liver Fibrosis in Children with Biliary Atresia[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(5): 1200-1204.

参考文献

[1] 吴宙光, 王斌, 程珍, 等. 胆道闭锁患儿肝组织中GPC3和α-SMA表达与肝功能指标的相关性分析[J]. 吉林大学学报(医学版), 2021, 47(5):1237-1243.
[2] 管志伟, 詹江华, 胡晓丽, 等. APRI评价胆道闭锁和胆汁淤积综合征肝脏纤维化程度的临床意义[J]. 中华小儿外科杂志, 2012, 33(11):815-819.
[3] 邵国强, 韩建奎. 胆道闭锁和婴儿肝炎综合征影像学诊断和鉴别诊断[J]. 医学影像学杂志, 2009, 19(6):769-772.
[4] 刘柯慧, 吴海清, 阮隽, 等. Fibroscan在慢性乙型肝炎肝纤维化诊断中的作用及影响因素[J]. 肝脏, 2012, 17(9):621-625.
[5] 王晓鹏, 苏河, 田宏伟, 等. 梗阻性黄疸患者经皮经肝胆管引流术后应用异甘草酸镁治疗肝损害的疗效观察[J]. 临床肝胆病杂志, 2014, 30(6):563-566.
[6] 毛卓, 廖爱军, 廖金卯, 等. 血清壳多糖酶3样蛋白1水平与肝脏弹性值测定对肝纤维化诊断价值的比较[J]. 医学临床研究, 2021, 38(6):806-810.
[7] 高坎坎, 陈峥嵘, 彭小芳, 等. APRI在评估婴儿胆道闭锁肝脏纤维化程度中的应用[J]. 中华检验医学杂志, 2015(5):337-340.
[8] 马德佳, 何新发, 李燕妮. HA、PC-Ⅲ、Ⅳ-C及LN对肝纤维化的诊断价值[J]. 广西医学, 2011, 33(3):312-314.
[9] 韩一江, 胡书奇, 陈宝海, 等. GGT联合DBIL、APRI对胆道闭锁的诊断价值[J]. 天津医药, 2022, 50(1):11-14.
[10] 沈秋龙, 陈亚军, 王增萌, 等. 瞬时弹性成像应用于胆道闭锁肝纤维化评估的研究[J]. 中华小儿外科杂志, 2014, 35(4):275-279.
[11] 姜爽爽, 李士星, 张鑫鑫, 等. 胆道闭锁和婴儿肝炎综合征肝脏超声实时组织弹性成像改变探讨[J]. 中国超声医学杂志, 2015, 31(3):228-231.
[12] 于瑞娜, 滑少华, 贺晓, 等. ARFI在婴儿胆道闭锁鉴别诊断及评价肝纤维化程度中的应用价值[J]. 中国临床医学影像杂志, 2020, 31(7):500-502.
[13] 宫颖新, 王萍, 白玉坤, 等. 胆道闭锁患儿血清microRNA-21水平的表达及与肝纤维化的相关性分析[J]. 中国现代医学杂志, 2021, 31(13):77-82.
[14] 段星星, 彭娅, 杨柳, 等. 剪切波弹性成像评估胆道闭锁Kasai术前肝纤维化程度[J]. 中华超声影像学杂志, 2020, 29(2):143-148.
[15] 邬向军, 蔺莉, 钱彦卿, 等. 产前超声诊断胎儿胆道闭锁并肝硬化的临床分析[J]. 中国超声医学杂志, 2020, 36(10):923-926.