威尔逊病肝硬化：声辐射力脉冲（ARFI）的高、低截断值-与血清纤维化指数的比较和联合。

Cirrhosis of Wilson's disease: High and low cutoff using acoustic radiation force impulse (ARFI) -Comparison and combination with serum fibrosis index.

机构信息

Department of Intervention, The First Affiliated Hospital of Soochow University, Jiangsu, China.

Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Zhejiang, China.

出版信息

Clin Hemorheol Microcirc. 2021;79(4):575-585. doi: 10.3233/CH-211219.

DOI:10.3233/CH-211219

PMID:34334385

Abstract

BACKGROUND

Acoustic Radiation Force Impulse (ARFI), Fibrosis-4(FIB-4) and Aspartate transaminase to platelet ratio index (APRI) are valuable non-invasive methods to evaluate fibrosis in hepatitis virus. Yet, they are rarely used in Wilson's disease.

OBJECTIVE

Evaluate the diagnostic efficacy of ARFI, FIB-4, APRI, combined detection in cirrhosis with WD, and speculate the optimal high, low cutoff.

METHODS

This retrospective study was authorized by hospital ethics Committee (number:2021MCZQ02). 102 patients with WD completed ARFI and laboratory examination on the same day. The intraclass correlation coeffcient (ICC) of ARFI among three sonographers was 0.896 (95%CI:0.859-0.925, p = 0.000). The stage of liver involvement was classified into 5 categories according to clinical manifestations, laboratory examination, and liver morphologic characteristics: I, normal; II, biochemical abnormal only; III, abnormal liver morphologic features without sighs of cirrhosis; IV, clinical and imaging sighs of compensateded cirrhosis (Child-Pugh A); V, decompensated cirrhosis (Child-Pugh B and C). This stage system served as the reference standard. The diagnostic efficacy was analyzed by Logistic regression, ROC curve. The optimal low cut-off with high sensitivity (SE) and low negative likelihood ratio (NLR) and high cut-off with high specificity (SP) and positive likelihood ratio (PLR) were derived.

RESULTS

The diagnostic value of ARFI (0.85, 95%CI:0.77-0.92, p = 0.000) in distiguishing cirrhosis with WD was higher than FIB-4 (0.59, 95%CI: 0.47-0.70, p = 0.127), APRI (0.70, 95%CI: 0.59-0.81, p = 0.000). The low, high cut-off of ARFI for excluding, diagnosing cirrhosis with WD was 1.47 m/s(SE: 98%, NLR:0.09), 2.11 m/s(SP:98%, PLR:27.4), 37 (36%) patients could be spared a liver biopsy. When ARFI was 1.47∼2.11 m/s, liver biopsy was recommended. After combined with ARFI, the AUROC of FIB-4, APRI were increased respectively (p < 0.001), there were not different between ARFI and combined detection(p > 0.05).

CONCLUSION

ARFI could replace some unnecessary liver biopsy according to high diagnostic efficacy for identifying cirrhosis of WD. The combined detection can also be used as an important model to predict cirrhosis in WD.

摘要

背景

声辐射力脉冲（ARFI）、纤维化-4（FIB-4）和天冬氨酸氨基转移酶与血小板比值指数（APRI）是评估乙型肝炎病毒纤维化的有价值的非侵入性方法。然而，它们在威尔逊病中很少使用。

目的

评估 ARFI、FIB-4、APRI 联合检测在 WD 肝硬化中的诊断效能，并推测最佳的高、低截断值。

方法

本回顾性研究经医院伦理委员会批准（编号：2021MCZQ02）。102 例 WD 患者于同日完成 ARFI 和实验室检查。3 名超声医师间 ARFI 的组内相关系数（ICC）为 0.896（95%CI：0.859-0.925，p=0.000）。根据临床表现、实验室检查和肝脏形态学特征，将肝受累程度分为 5 类：I，正常；II，仅生化异常；III，无肝硬化迹象的异常肝脏形态特征；IV，临床和影像学提示代偿性肝硬化（Child-Pugh A）；V，失代偿性肝硬化（Child-Pugh B 和 C）。该分期系统作为参考标准。采用 Logistic 回归、ROC 曲线分析诊断效能。得出具有高灵敏度（SE）和低负似然比（NLR）的最佳低值截断值和具有高特异性（SP）和高阳性似然比（PLR）的最佳高值截断值。

结果

ARFI（0.85，95%CI：0.77-0.92，p=0.000）在鉴别 WD 肝硬化方面的诊断价值高于 FIB-4（0.59，95%CI：0.47-0.70，p=0.127）和 APRI（0.70，95%CI：0.59-0.81，p=0.000）。ARFI 排除、诊断 WD 肝硬化的低、高截断值为 1.47m/s（SE：98%，NLR：0.09）、2.11m/s（SP：98%，PLR：27.4），可使 37（36%）例患者免于肝活检。当 ARFI 在 1.47∼2.11m/s 之间时，建议进行肝活检。联合 ARFI 后，FIB-4、APRI 的 AUC 分别增加（p<0.001），但 ARFI 与联合检测之间无差异（p>0.05）。