| Background Chronic hepatitis B still seriously affects human health.Early and timely detection of liver pathology and functional changes and intervention measures can delay or even reduce the occurrence of end-stage liver disease.Due to the drawbacks of invasive and poor repeatability in gold standard liver biopsy,non-invasive instantaneous elastic imaging is now widely used.Objective To explore the relationship between liver hardness values and serological and imaging indicators,and to study the changes of patient laboratory indicators during dynamic changes in liver hardness values.Methods According to the inclusion and exclusion criteria,a total of 200 inpatients with chronic viral hepatitis B and hepatitis B cirrhosis diagnosed in the Department of infectious diseases from July 2020 to November 2022 were selected from the Sinopharm Gezhouba Central Hospital.The basic information of all patients,such as age and gender,were collected,and the transient elastography(FT)was improved to obtain the liver hardness value(LSM);Collect serological indicators such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),hemoglobin(Hb),platelet(PLT),total bile acid(TBA),alkaline phosphatase(ALP),albumin(ALB),total cholesterol(TC),prothrombin time(PT),collagen type IV(IVcol),procollagen type Ⅲ N-terminal peptide(PⅢNP),laminin(LN),and hyaluronic acid(HA);Collect liver magnetic resonance imaging findings;Describe the overall characteristics of all the above indicators,and use bivariate rank correlation analysis Spearman to evaluate the correlation coefficient r between liver hardness values and serological and imaging indicators in 200 patients.According to the correlation coefficient | r |≥ 0.5,p<0.05,it indicates that the relationship is close and accepted as the final observation indicator;Among them,30 patients underwent liver biopsy and pathological grade S(fibrosis grade).The correlation between liver hardness and liver fibrosis grade in 30 patients was analyzed using Spearman method.According to the Fibro Touch(LSM value),classified using descriptive statistical methods to determine the range of serological indicators,expressed as M(P25,P75);Mann Whitney U rank sum test was used to compare the serological indexes of the non fibrosis group(F0-F1)and the fibrosis group(F2-F4)with the rank sum test,to evaluate how the serum levels in the normal and abnormal liver stiffness groups change and whether there is statistical significance;Analyze the diagnostic ability of serological indicators for different stages of liver fibrosis,draw ROC curves,and screen out serological indicators that affect the liver hardness value using binary multivariate logistic regression.Results(1)The comparison between chronic viral hepatitis B group and hepatitis B cirrhosis group showed statistically significant differences in age,sex,liver hardness,hemoglobin,platelets,glutamic oxalacetic transaminase,total bile acid,prothrombin time,total cholesterol,albumin,type IV collagen,type Ⅲ procollagen,hyaluronic acid,laminin and imaging findings between the two groups(P < 0.05).(2)There was a positive correlation between the pathological S-grade of liver biopsy and the liver hardness value,and r was 0.681(P < 0.001),which verified that there was a good correlation and consistency between instantaneous elastic imaging and the results of liver biopsy.(3)chronic liver disease patients with liver stiffness value and hemoglobin,platelet,prothrombin type,type IV collagen,three former collagen,hyaluronic acid and laminin,closely related to aspertate aminotransferase(| r | acuity 0.5,p < 0.05),The correlation coefficients were-0.629,-0.574,0.666,0.651,0.612,0.684,0.592 and 0.604,respectively,and the P values were all less than 0.001.(4)The serological changes between the two groups with and without liver fibrosis were compared using the rank sum test.When the LSM was at F2(i.e.,F1 mild liv er fibrosis stage),PⅢNP and HA indicators were abnormal.Compared with the non li ver fibrosis stage,only HA had statistical significance between the two groups(P<0.05);When LSM was in F2-F3(i.e.,F2 significant hepatic fibrosis stage),there was a statistically significant difference in PⅢNP,HA,AST,PLT,and IVcol compared with non hepatic fibrosis stage(P<0.05),but there was no significant change in AST,PLT,and IVcol values(M=31.00U/L,M=126.00x109/L,M=54.37ng/m L);When LSM is in F3-F4 and F4 stages(i.e.,F3 advanced liver fibrosis and F4 cirrhosis),PT,Hb,AST,P LT,IVcol,PⅢNP,HA,LN,etc.have significant statistical significance compared with non fibrosis stage(P<0.001).It can be seen that the higher the liver hardness value,th e more significant the serological changes.When the liver hardness value is in F3 pro gression of liver fibrosis,LN is still within the normal range(M=104.93 ng/m L).(5)On the contrary,the area under the liver fibrosis curve(AUC)of serological indicators for diagnosis of F2 and F2-F3 was 0.654 and 0.778,respectively.For diagnosis of F3-F4 and F4 stages,the minimum AUC was 0.715 and the maximum AUC was 0.942.(6)Serum indicators HA,PⅢNP,and AST have a statistically significant impact o n the results of liver hardness values,including HA(OR=1.005,95% CI1.002-1.007,P=0.002),PⅢNP(OR=1.074,95%CI1.027,1.123,P=0.002),AST(OR=1.027,95%CI1.007-1.047,P=0.008).Conclusion(1)Instantaneous elastic imaging measures liver stiffness to assess the degree of liver fibrosis and reduce the rate of liver biopsy.(2)Instantaneous elastic imaging liver hardness has a significant correlation with the degree of liver damage and liver fibrosis indicators,and is most closely related to hyaluronic acid;It can preliminarily determine the changes in serological indicators and evaluate the reserve function of the liver.(3)Serological indexes PT,AST,IVcol,PⅢNP,HA and LN have different degrees of diagnostic ability for hepatic fibrosis,and HA,PⅢNP and AST may have a certain degree of influence on liver hardness.(4)Instantaneous elastography combined with serological indicators can provide a more comprehensive analysis and judgment of the condition of patients with chronic hepatitis B,providing clinicians with a more sufficient theoretical basis for rational diagnosis and treatment. |
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