| ObjectiveTo analysis the characteristics and influential factors of liver stiffness measurement(LSM) by FibroScan(?) on chronic hepatitis B(CHB) patients in our Hepatology Unit.At the same time,try to use FibroScan(?) for predicting prognosis of patients with liver failure caused by HBV,and observe dynamic changes of LSM by FibroScan(?) on some patients with jaundice.To explore the value of FibroScan(?) in CHB patients and provide clinical basis for FibroScan(?) as a mean of routine monitoring in CHB patients' follow-up.Patients and Methods1.Analysis of characteristics and influential factors of LSM by FibroScan(?) on a large sample of CHB patientsA total of 666 cases of hospitalized patients received FibroScan test from MAR 2008 to MAR 2009.All the patients had clear HBV infection for more than 6 months, and exclusion criteria included autoimmune liver disease,evidence of alcoholic or fatty liver disease;drug induced liver injury,metabolic disease,combined positive for other hepatitis virus markers and FibroScan(?) detect losers.Examination,inspection indicators include:(1) Hepatitis conventional blood indicators:platelet(PLT),prothrombin activity(PTA),serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin,globulin,protein A/G ratio,total bilirubin(TBIL);(2) fasting ultrasound indicators:the liver surface, liver parenchyma,gallbladder,hepatic vessel,splenomegaly;(3) FibroScan(?) test.Statistical analysis was performed by SPSS software version 13.0.Continuous variables were expressed as mean±SD.Completely randomized design analysis of K independent samples nonparametric test(Kruskal-Wallis H test) was used for comparison of differences in LSM by FibroScan(?).Linear regression analysis was performed to construct the influential factors model about LSM by FibroScan(?). Box-type diagram gave the distribution of LSM by FibroScan(?) with different PLT, PTA,A/G ratio,ALT,AST and TBIL.A two-sided P value of less than 0.05 was considered statistically significant.2.The value of prediction about prognosis in patients with liver failure by FibroScan(?)45 patients with liver failure induced by HBV from NOV 2007 to AUG 2008 were diagnosed according to Diagnostic and treatment guidelines for liver failure,and all the objects included were given the classification and staging diagnosis.Exclusion criteria included autoimmune liver disease,evidence of alcoholic or fatty liver disease, drug induced liver injury,metabolic disease,combined positive for other hepatitis virus markers,with primary kidney disease and FibroScan(?) detect losers.All the patients' abdominal B-ultrasonography and FibroScan(?) test results within 24 h admitted to hospital,blood(WBC,HGB,PLT),coagulation(PT,PTA,INR), liver and kidney function(ALT,AST,TBIL,ALB,CR ) results and the observation of whether there is hepatorenal syndrome,hepatic encephalopathy,upper gastrointestinal bleeding,spontaneous bacterial peritonitis and other complications were collected. Then,calculate ultrasound scores and Child-Turcotte-Puge(CTP) scores.And end-stage liver disease model(MELD) scores were in accordance with the formula 3.8Ln[BIL(mg / dL)]+11.2 Ln(INR) +9.6 Ln[Cr(mg /dL)]+6.4(etiology:biliary or alcoholic to 0,the other one) basis in all patients.Statistical analysis was performed by SPSS software version 13.0.Continuous variables were expressed as mean±SD.Partial correlation analysis were used to evaluate correlation between LSM by FibroScan(?) and prognosis.Binary logistic regression was used to construct the model of prognosis.The diagnostic value of FibroScan(?),CTP score and MELD score were assessed by AUROC.One-way ANOVA was used to compare disparity of LSM by FibroScan(?) on patients with different staging and classification.A two-sided P value of less than 0.05 was considered statistically significant.3.Analysis of dynamic changes of LSM by FibroScan(?) in patients with jaundice From DEC 2007 to NOV 2008,CHB patients in our units within 24 h received detection of routine liver function,coagulation function,FibroScan(?) test and abdominal B-ultrasonography,and accepted periodic review of blood liver function, coagulation function and FibroScan(?) test during hospitalization.Exclusion criteria included accept antiviral therapy with nucleoside drugs or interferon who were re-treated or naive-treated patients more than 12 weeks,autoimmune liver disease, evidence of alcoholic or fatty liver disease,drug induced hepatic injury,metabolic disease,combined positive for other hepatitis virus markers and FibroScan(?) detect losers.There were 31 cases in line with the selected standards.Then,collected these patients' PLT,INR,GLO,ALB,ALT,AST,TBIL results at the time points of TBIL peak,1 / 2 peak＞TBIL＞3(2)×ULN,TBIL＜3(2)×ULN,and the LSM results by FibroScan(?) within three days. Statistical analysis was performed by SPSS software version 13.0.Continuous variables were expressed as mean±SD.Correlation analysis of every detection index in all three time point used ANOVA for the repeated measures.A number of independent samples nonparametric test(Kruskal-Wallis H test) was used to compare the differences at different time points.A two-sided P value of less than 0.05 was considered statistically significant.Results1.The analysis of characteristics and influential factors of LSM by FibroScan(?) on a large sample of CHB patientsThere were these characteristics in homo-LSM by FibroScan(?),including male, more than 50 years old,HBeAg negative,HBV DNA≥10~7 cp/ml,not received antiretroviral treatment,PLT≤100G/L,PTA≤60%,AST＞90U/L,A/G ratio≤1.5, TBIL＞85.5umol/l,ultrasound score＞9 points.The model based on LSM with linear regression contained sex,body mass index,whether or not received antiviral therapy, A / G ratio and TBIL.2.The value of prediction about prognosis in patients with liver failure by FibroScan(?)The coefficient of partial correlation between LSM by FibroScan(?) and prognosis was 0.226(P=0.199).Bivariate analysis showed the significant correlation between LSM and prognosis(P=0.010).The area under the ROC curve of LSM by FibroScan(?) for prognosis was 0.724,cut-off value 61.3kPa can achieve the greatest summation of sensitivity and specificity.The difference between early and late phases was significant(P=0.024).The model of prognosis by binary logistic regression only contained MELD(OR=1.732).3.Analysis of dynamic changes of LSM by FibroScan(?) in patients with jaundiceThe peak level of LSM by FibroScan(?) was consistent with the peak of TBIL,ALT, AST,INR and was parallel to the downward trend.The differences about LSM by FibroScan(?) at three time points were significant(P＜0.05).ConclusionsThere were these characteristics in homo-LSM,including male,age greater than 50 years old,HBeAg negative,HBV DNA≥10~7 cp/ml,not received antiretroviral treatment,PLT≤100G/L,PTA≤60%,AST＞90U/L,A/G ratio≤1.5, TBIL＞85.5umol/l,ultrasound score＞9 points.LSM by FibroScan(?) was influenced by the level of A/G ratio and TBIL.LSM by FibroScan(?) had predictive value on short-term prognosis of patients with liver failure and there exists a positive correlation,but its efficacy was not as good as MELD scores well.Combination with LSM by FibroScan(?) cannot improve the efficacy of MELD scores on prognosis.But the conclusion maybe need large sample to confirm.On the patients with jaundice, with the TBIL,ALT,AST and INR reduce,it also declined gradually. |
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