慢性乙型肝炎患者肝脏病理分期与中医体质、FibroScan 的相关性分析
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R512.6+2

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广东省中医药局科研项目(20182056);广东省科技计划项目(20170215)


Correlation Analysis Between Pathological Stage of Liver, Chinese Medicine Constitu⁃ tion and FibroScan in Patients with Chronic Hepatitis B
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    摘要:

    目的:探讨慢乙肝患者肝纤维化病理学分期与中医体质、FibroScan 的相关性。方法:对341 例在本院进行肝穿活检的慢性乙型肝炎患者进行回顾性研究分析,参照《慢性乙型肝炎防治指南(2015 年版)》进行分期,并按肝纤维化程度进行分组,同时根据中医体质九分法进行体质分析,行FibroScan 检查检测肝脏瞬时弹性值LSM(Liver stiffness measurement,LSM)、CAP(Controlled attenuation parameter,CAP) 及肝功能检查,探讨上述指标与患者纤维化程度的关系。结果:341 例肝穿患者中平和质、气虚质、气郁质、湿热质、痰湿质、特禀质、阳虚质、阴虚质、瘀血质所占比例分别为:3.81%,18.77%,27.27%,13.78%,34.31%,0,0.59%,0.29%,1.17%,将所有患者按纤维化程度分组,对3 组患者进行统计学分析后发现痰湿质在各组中人数均最多,差异均有统计学意义(P<0.05)。纤维化程度与LSM、CAP、AST/ALT (Aspartate aminotransferase/Alanineaminotransferase,AST/ALT) 呈相关性,差异均有统计学意义(P<0.05),将3 个检测项目根据是否明显肝纤维化、肝硬化再分组,进行ROC 曲线分析,在诊断明显乙肝肝纤维化方面,LSM、CAP、AST/ALT 的ROC 曲线AUC 分别为0.800,0.371,0.628,敏感度分别为:0.741,0.509,0.679,特异度分别为:0.788,0.491,0.520,其诊断效能从高到低顺序依次为:LSM>AST/ALT>CAP,诊断效能差异有统计学意义(P<0.05)。在诊断乙肝肝硬化方面,LSM、CAP、AST/ALT 的ROC 曲线AUC 分别为0.911、0.477、0.627,CAP 的ROC 曲线的P 值>0.05,差异无统计学意义,LSM 和AST/ALT 诊断肝硬化的敏感度分别为:0.852、0.593,特异度分别为:0.855、0.618,二者诊断效能差异有统计学意义(P<0.05)。结论:痰湿质患者在各级肝纤维化患 者均为最多,在各项常用诊断指标中,LSM、CAP、AST/ALT 与患者的肝纤维化程度相关程度更高,而LSM 在肝硬化的患者中有更高的诊断价值。

    Abstract:

    Abstract: Objective: To discuss the correlation between pathological stage of the liver fibrosis, Chinese medicine constitution and FibroScan in patients with chronic hepatitis B. Methods:A total of 341 cases of patients with chronic hepatitis B undergoing the liver biopsy in our hospital were retrospectively studied and analyzed. All the patients were assigned to different stages based on The Guideline of Prevention and Treatment for Chronic Hepatitis B(2015 Version). All the patients were divided into different groups according to the degree of the liver fibrosis;the constitution analysis was conducted based on nine constitution types in Chinese medicine. The values of instantaneous elasticity,namely,liver stiffness measurement (LSM) and controlled attenuation parameter(CAP) were tested through FibroScan;the examination of the liver function was conducted;the relationship between the above indexes and the fibrosis degree was discussed. Results:Among a total of 341 cases of patients undergoing the liver biopsy, the balanced constitution accounted for 3.81% , the qi- deficiency constitution 18.77%,the qi- depression constitution 27.27%,the dampness- heat constitution 13.78%,the dampness- phlegm constitution 34.31% , the yang- deficiency constitution 0.59% , the static blood constitution 1.17% , the special intrinsic constitution for zero and the yin-deficiency constitution accounting for 0.29%;all the patients were divided into three groups according to the fibrosis degree;after statistical analysis,it was found that the proportion of the dampness-phlegm constitution was the highest in all the three groups;differences were significant(P<0.05). There was correlation between the fibrosis degree and LSM,CAP as well as AST/ALT(Aspartate aminotransferase/Alanine aminotransferase),differences being significant(P<0.05). Based on the indexes of LSM, CAP and AST/ALT, the patients with obvious liver fibrosis or cirrhosis were selected and regrouped respectively; the ROC curve analysis was conducted. In terms of the diagnosis of obvious fibrosis of hepatitis B, the AUC of LSM, CAP and AST/ALT in ROC curve was 0.800, 0.371 and 0.628 respectively; the sensitivity of the above three indexes was 0.741,0.509 and 0.679 respectively;the specificity of the above three indexes was 0.788,0.491 and 0.520 respectively;the highest diagnostic efficiency was LSM,followed by AST/ALT and CAP,the difference being significant(P<0.05). In terms of the diagnosis of cirrhosis in patients with hepatitis B,the AUC of LSM,CAP and AST/ALT in ROC curve was 0.911,0.477 and 0.627 respectively,and the P value of CAP in ROC curve was more than 0.05,there was no significance in the difference. The sensitivity of LSM and AST/ALT in diagnosis of the liver cirrhosis was 0.852 and 0.593 respectively; the specificity of the above two indexes was 0.855 and 0.618 respectively, the difference being significant(P<0.05). Conclusion:The largest group in patients with the liver fibrosis at each stage was patients with the dampness-phlegm constitution. In each commonly-used diagnostic index,LSM,CAP and AST/ALT are more closely related to the degree of the liver fibrosis,and LSM has higher diagnostic value in patients with the liver cirrhosis.

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张秀娟,万泽民,施梅姐,池晓玲.慢性乙型肝炎患者肝脏病理分期与中医体质、FibroScan 的相关性分析[J].新中医,2020,52(18):23-27

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  • 在线发布日期: 2020-09-20
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