摘要
目的:探析超声声像特征联合循环游离DNA(cfDNA)及总胆固醇(TC)水平对乙型肝炎(CHB)肝硬化(LC)的诊断价值。方法:选择2022年3月至2024年6月收治的120例CHB患者进行研究,根据病理活检是否发生LC分为LC组(n=33)、单纯CHB组(n=87)。采用全自动生化分析仪检测TC、TG、LDL-C、HDL-C;采用RT-PCR检测cfDNA水平。采用彩色多普勒超声诊断仪获取声像特征。对比LC组、单纯CHB组患者基线资料及实验室指标和超声声像特征;Cox回归分析CHB患者发生LC的影响因素;采用ROC曲线分析超声声像特征联合cfDNA、TC对CHB患者发生LC的诊断效能。结果:LC组、单纯CHB组患者的Child Pugh分级、TC、cfDNA差异有统计学意义(P<0.05),而两组患者其余资料比较差异无统计学意义(P>0.05)。LC组患者各项超声声像特征(肝实质回声、肝包膜、肝静脉清晰度、肝脏边缘形态、脾脏厚度)半定量评分及总分均高于单纯CHB组(P<0.05)。COX回归分析显示,Child Pugh分级、cfDNA、半定量评分为CHB患者发生LC的危险因素,TC为保护因素(P<0.05)。ROC曲线结果显示,超声声像特征半定量评分联合cfDNA、TC诊断CHB患者发生LC的灵敏性、特异性分别为87.23%、75.64%,AUC为0.842,均高于超声半定量评分(Z/P=2.943/0.015)、cfDNA(Z/P=2.678/0.023)、TC(Z/P=3.287/0.011)单独诊断。结论:超声声像特征、cfDNA、TC水平均可用于CHB发生LC诊断,且联合应用可进一步提高对CHB发生LC的诊断效能。
Objective:To explore the diagnostic value of ultrasound echo characteristics combined with circulating cell-free DNA(cfDNA)and total cholesterol(TC)levels in patients with chronic hepatitis B(CHB)and liver cirrhosis(LC).Methods:A total of 120 CHB patients treated in our hospital from March 2022 to June 2024 were consecutively included and retrospectively selected for the study,divided into the LC group(n=33)and the simple CHB group(n=87)based on pathological biopsy for LC occurrence.TC,TG,LDL-C,and HDL-C were detected using a fully automatic biochemical analyzer;cfDNA levels were detected using RT-PCR.And ultrasound echo characteristics were obtained using a color Doppler ultrasound diagnostic instrument.The baseline data and laboratory indicators,as well as ultrasound echo characteristics,were compared between the LC group and the simple CHB group.Cox regression analysis was used to analyze the influencing factors of CHB patients developing LC.And the ROC curve was used to analyze the diagnostic efficacy of ultrasound echo characteristics combined with cfDNA and TC for CHB patients developing LC.Results:There were differences in Child Pugh grading,TC,and cfDNA between the LC group and the simple CHB group(P<0.05),while the rest of the data showed no significant differences(P>0.05).The semi-quantitative scores and total scores of various ultrasound echo characteristics(liver parenchyma echo,liver capsule,hepatic vein clarity,liver edge morphology,and spleen thickness)in the LC group were higher than those in the simple CHB group(P<0.05).COX regression analysis showed that Child Pugh grading,cfDNA,and semi-quantitative scores were risk factors for CHB patients developing LC,while TC was a protective factor(P<0.05).The ROC curve results showed that the sensitivity and specificity of ultrasound echo characteristics semi-quantitative scoring combined with cfDNA and TC for diagnosing CHB patients developing LC were 87.23%and 75.64%,respectively,with an AUC of 0.842,all higher than those of ultrasound semi-quantitative scoring alone(Z/P=2.943/0.015),cfDNA alone(Z/P=2.678/0.023),and TC alone(Z/P=3.287/0.011).Conclusion:Ultrasound echo characteristics,cfDNA,and TC levels can all be used for the diagnosis of CHB developing LC,and their combined application can further improve the diagnostic efficacy of CHB developing LC.
作者
梁盼
张亚男
宇文乙丹
LIANG Pan;ZHANG Ya-nan;YUWEN Yi-dan(Affiliated Hospital of Shijiazhuang Medical College,Department of Ultrasound,Shijiazhuang City,Hebei Shijiazhuang,050800,China.)
出处
《中西医结合肝病杂志》
2025年第11期1379-1383,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
关键词
乙型肝炎
肝硬化
超声
循环游离DNA
总胆固醇
hepatitis B
liver cirrhosis
ultrasound
circulating cell-free DNA
total cholesterol
