| Objective:To investigate the factors influencing the transient elastography(Fibro Scan)in patients with chronic hepatitis B.To provide a basis for the clinical assessment of the degree of liver fibrosis and the correct interpretation of liver stiffness measurement values(LSM values)in patients with Chronic hepatitis B.Methods:The patients with chronic hepatitis B who visited the Department of Infectious Diseases,The First Hospital of Shanxi Medical University from January 2019 to December 2020 and underwent at least two Fibro Scan examinations were collected,and the interval between the two examinations was at least half a year.According to the changes of liver stiffness measurement(LSM value)of the patients before and after the two Fibro Scan results,the patients were divided into the group without increased in LSM value and the group with increased in LSM value,and the general data,laboratory examination and clinical diagnosis results of the two groups were compared.Results:1.A total of 105 patients with chronic hepatitis B were included in this study,including53 patients(50.5%)with increased LSM and 52 patients(49.5%)without increased LSM.There were 32 males(61.5%)and 20 females(38.5%)in the group without increased LSM;There were 41 males(77.4%)and 12 females(22.6%)in the increased LSM group;There was no significant difference in gender between the two groups(P>0.05).There were 5 cases(9.6%)under 30 years old,42 cases(80.8%)between 30 and 60years old,and 5 cases(9.6%)over 60 years old in the group without increased LSM;In the increased LSM group,5 patients(9.6%)were under 30 years old,39 patients(73.6%)were31-60 years old,and 9 patients(17.0%)were over 60 years old;There was no significant difference in age between the two groups(P>0.05).There were no significant differences in BMI,duration of disease and whether antiviral therapy was taking place at baseline between the two groups(P>0.05).2.There were 26 HBe Ag-negative patients(50.0%)and 26 HBe Ag-positive patients(50.0%)in the group without increased LSM value;There were 37 HBe Ag-negative patients(69.8%)and 16 HBe Ag-positive patients(30.2%)in the increased LSM group;There was significant difference in baseline HBe Ag positive rate between the two groups(~2=4.292,P=0.038).There were no significant differences in ALT,AST,TP,TBIL,DBIL,CHE,ALP,γ-GT,blood glucose,AFP,HBs Ag,HBV DNA and CAP between the group without increased LSM and the group with increased LSM at baseline(P>0.05).3.ALT(Z=-4.001,P<0.001),AST(Z=-5.877,P<0.001)and TBIL(Z=-3.503,P<0.001),Blood glucose(t=-2.077,P=0.040)during follow-up in the group with increased LSM was significantly higher than that of the group without increased LSM.There were no significant differences in TP,DBIL,CHE,ALP,γ-GT,AFP,HBs Ag,HBV DNAand CAP between the group without increased LSM value and the group with increased LSM value at follow-up(P>0.05).4.Changes in ALT(~2=33.150,P<0.001),AST(~2=36.676,P<0.001),TP(~2=25.148,P<0.001),CHE(~2=5.071,P=0.024)andγ-GT(~2=7.491,P=0.006)during the course of disease in the group without increased LSM value and the group with increased LSM value showed statistically significant differences.There was no statistical significance in changes of TBIL,DBIL,ALP,Blood glucose,AFP,HBs Ag,HBV DNA and CAP during the course of disease between the group with no increased LSM value and the group with increased LSM value(P>0.05).There was no significant difference in antiviral treatment between the group without increased LSM value and the group with increased LSM value during the follow-up period(P>0.05).In the group without increased LSM,46 patients(88.5%)were in stable condition and 6 patients(11.5%)developed disease progression.In the increased LSM group,11 patients(20.8%)were in stable condition and 42 patients(79.2%)developed disease progression.5.The independent variables with significant differences between the two groups in univariate analysis were included in multivariate Logistic regression analysis,and the results showed that AST(OR=1.109,95%CI:1.012-1.229,P=0.028)and ALT changes during the course of disease(OR=18.271,95%CI:3.067-108.853,P=0.001),AST changes during the course of disease(OR=14.687,95%CI:2.175-99.188,P=0.006),TP changes during the course of disease(OR=0.020,95%CI:0.002-0.173,P<0.001)were independent influencing factors of LSM value change,the LSM value can be increased by the influence of high AST during the follow-up visit,the increased ALT during the course of the disease,and the increased AST during the course of the disease.LSM values can be decreased by the influence of elevated TP during the course of the disease.Conclusions:The levels or changes of ALT,AST and TP in chronic hepatitis B patients have certain influence on the determination of LSM value.The LSM value can be increased by the increase of ALT and AST,while the LSM value can be decreased by the increase of TP. |
PDF Full Text Request