剪切波弹性成像及血清学模型评估先天性胆道闭锁肝纤维化程度效能研究

Diagnostic performance of shear wave elastography and serological models in assessing degree of liver fibrosis in congenital biliary atresia

摘要

目的 探索剪切波弹性成像(SWE)、血清学模型[天冬氨酸氨基转移酶-血小板比值指数(APRI)、纤维化-4指数(FIB-4)、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)]及两者联合评估先天性胆道闭锁(CBA)肝纤维化程度的诊断效能。方法 纳入2018年1月至2024年12月均接受肝胆造影及肝组织活检病理检查的持续性黄疸患儿65例,并行SWE检查及常规实验室检查,分别获得超声杨氏模量值及血清学模型(APRI、FIB-4和AAR值)。将患儿分为CBA组及非CBA组,比较两组间一般临床资料的差异;使用多因素Logistic回归分析SWE杨氏模量值及血清学模型与CBA肝纤维化程度之间的相关性。利用受试者工作特征(ROC)曲线计算曲线下面积(AUC)进一步评估两者独立、联合诊断CBA发生进展期肝纤维化的效能。结果 65例患者中经肝胆造影及肝组织活检病理检查诊断CBA患儿49例,非CBA患儿16例;CBA患儿中肝纤维化<S3期18例,≥S3期31例。CBA组患儿血清γ-谷氨酰转肽酶(GGT)及SWE杨氏模量值均显著高于非CBA组患儿(t=5.437、3.914,P<0.05)。多因素Logistic回归分析结果显示:CBA组患儿SWE杨氏模量值、APRI及FIB-4值与肝纤维化程度呈正相关,是其发生进展期肝纤维化的独立危险因素(OR=2.731、9.925、5.402,P<0.05);AAR值与CBA组患儿肝纤维化程度不具有显著相关性。SWE杨氏模量值、APRI及FIB-4值三种方法单独诊断进展性肝纤维化(S≥3期)的AUC分别为0.890、0.867、0.898,三者联合诊断的效能(AUC为0.919)高于三者单独诊断的效能,但无显著性差异(Z=-1.104、-1.509、-0.779,均P>0.05)。结论 无创诊断方法剪切波弹性成像及血清学模型(APRI及FIB-4值)可初步判断先天性胆道闭锁患儿肝纤维化程度,三者联合诊断较单独诊断对先天性胆道闭锁进展期肝纤维化的诊断效能更高。三者对先天性胆道闭锁患儿肝纤维化的诊断和监测具有重要意义,能为进一步的诊疗决策提供重要参考。

Abstract

Objective To explore the diagnostic performance of shear wave elastography (SWE),serological models [aspartate aminotransferase-to-platelet ratio index (APRI),fibrosis-4 index (FIB-4),aspartate aminotransferase/alanine aminotransferase ratio (AAR)],and their combination in evaluating the degree of liver fibrosis in congenital biliary atresia (CBA). Methods A total of 65 infants with persistent jaundice who underwent cholangiography and liver biopsy with pathological examination between January 2018 and December 2024 were enrolled.All subjects also underwent SWE and routine laboratory tests to obtain the ultrasound Young's modulus values and serological model scores (APRI,FIB-4,and AAR).The patients were divided into a CBA group and a non-CBA group,and differences in general clinical data between the two groups were compared.Multivariate Logistic regression analysis was used to assess the correlation between SWE Young's modulus values,serological models,and the degree of liver fibrosis in CBA.Receiver operating characteristic (ROC) curves were generated,and the area under the curve (AUC) was calculated to further evaluate the independent and combined diagnostic performance of these methods for detecting advanced liver fibrosis in CBA. Results Among the 65 patients,49 were diagnosed with CBA and 16 with non-CBA conditions based on cholangiography and liver biopsy.Among the CBA patients,18 had liver fibrosis <stage S3,and 31 had liver fibrosis ≥ stage S3.Serum gamma-glutamyl transferase (GGT) levels and SWE Young's modulus values were significantly higher in the CBA group than in the non-CBA group (t=5.437 and 3.914,respectively,P <0.05).Multivariate Logistic regression analysis showed that SWE Young's modulus values,APRI,and FIB-4 scores were positively correlated with the degree of liver fibrosis in the CBA group and were independent risk factors for advanced liver fibrosis (OR=2.731,9.925 and 5.402,respectively,P<0.05).The AAR was not significantly correlated with the degree of liver fibrosis in the CBA group.The AUCs for SWE Young's modulus,APRI,and FIB-4 alone in diagnosing advanced liver fibrosis (stage≥S3) were 0.890,0.867,and 0.898,respectively.The combined diagnostic performance of the three methods was higher than that of any single method (AUC=0.919).However,no significant differences were observed between the combined and individual diagnostic methods (Z= -1.104,-1.509 and -0.779,respectively,P > 0.05). Conclusion The noninvasive diagnostic methods of shear wave elastography and serological models (APRI and FIB-4) can preliminarily assess the degree of liver fibrosis in children with congenital biliary atresia.The combination of the three methods has a higher diagnostic performance for advanced liver fibrosis in children with CBA than any single method alone.These three methods are of great significance for the diagnosis and monitoring of liver fibrosis in children with CBA and can provide important references for further clinical diagnosis and treatment decisions.

关键词

婴幼儿 / 先天性胆道闭锁 / 肝纤维化 / 剪切波弹性成像 / 血清学模型

Key words

infant / congenital biliary atresia / liver fibrosis / shear wave elastography / serological model

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基金资助

江西省教育厅科学技术研究项目(GJJ210208)

江西省卫健委科技计划项目(202210456)

江西省科技厅赣鄱人才555工程项目(700110002)