Clinical Application Of Ultrasound Combined With Elastography And Serological Model Index In The Early Evaluation Of Liver Fibrosis In Chronic Hepatitis B

Objective:To explore the clinical value of the new technique of combinational elastography(Combi-Elasto)with fibrosis index based on the four factors(FIB-4)and aspartate aminotransferase to platelet ratio index(APRI)to evaluate the early liver fibrosis degree of chronic hepatitis B.Methods:A total of 92 CHB patients clinically diagnosed in our hospital from May 2021 to July 2022 were selected as the subjects,All the 92 patients with CHB completed liver tissue biopsies(liver tissue biopsy,LB),According to the staging criteria for the diagnosis of liver fibrosis(S)included in the Prevention Program of Viral Hepatitis,Thirty patients with liver fibrosis grade S 3 were included in the chronic hepatitis group;Sixty-two patients with liver fibrosis grade S=4 were included in the cirrhotic group,And they were grouped according to the Child-Pugh score,Thirty-two patients with the Child-Pugh A grade were included in the early liver cirrhosis group;A total of 30 patients with Child-Pugh B and C were included in the advanced cirrhosis group.In addition,45 healthy volunteers were selected and included in the normal group.All the above subjects completed the Combi-Elasto examination under strict quality control,and recorded the relevant experimental data including: liver fibrosis index(liver fibrosis index,LF Index),shear wave velocity(velocity of shear wave,Vs),elastic modulus(elastic modulus,E),fibrosis index(fibrosis index,F Index),and inflammatory activity index(activity index,A Index).Serological examination was completed1 day before Combi-Elasto examination,and blood test was performed for more than 8 hours;five blood routine,hepatitis B quantification,liver function,liver fiber and blood coagulation were completed,and APRI and FIB-4 index were calculated.Using the within-group correlation coefficient(Intraclass Correlation Coefficien,ICC)analyzed and evaluated the repeatability of LF Index,Vs,E,F Index,and A Index indicators within and among observers;Differences and correlation analysis of the diagnosis of liver fibrosis between the LF Index,Vs,E,F Index and A Index indexes in Combi-Elasto and the serological models FIB-4 and APRI,The efficacy of the diagnostic model combining F Index with FIB-4,and APRI for the graded diagnosis of liver fibrosis was also evaluated.Results:(1)The intra-observer and inter-observer ICC of the Combi-Elasto indicators LF Index,Vs,E,F Index,and A Index were> 0.75,all showing good reproducibility.(2)The difference between LF Index,Vs,E,F Index and A Index in the normal group and each liver disease group was statistically significant(P <0.05).(3)With the higher degree of fibrosis in the liver(from chronic hepatitis to early cirrhosis and late cirrhosis),LF Index,Vs,E,F Index,A Index levels,An upward trend;Working characteristics of subjects with LF Index,Vs,E,F Index,A Index for chronic hepatitis(receiver operating characteristic,ROC)The area under the curve(area under curve,AUC)are 0.590,0.879,0.877,0.853,and 0.830,respectively;The AUC when diagnosed with early liver cirrhosis was 0.686,0.696,0.694,0.713,and 0.721,respectively;The AUC for the diagnosis of advanced liver cirrhosis was0.631,0.690,0.686,0.677,and 0.698,respectively.(4)Correlation analysis showed that LF Index,Vs,E,F Index,and A Index were all significantly associated with FIB-4,and APRI.The correlation coefficients of LF Index,Vs,E,F Index,and A Index and FIB-4 were0.458,0.722,0.722,0.726,0.680,0.694,respectively,with significant differences(P <0.001),and LF Index,Vs,E,F Index,A Index and APRI were 0.473,0.609,0.607,0.565,0.595(P<0.001).(5)The difference between FIB-4 and APRI between the normal group and each liver disease group was statistically significant(P <0.05).AUC for diagnosed chronic hepatitis by APRI and FIB-4 was 0.779 and 0.587,respectively;AUC for diagnosed early cirrhosis was0.578 and 0.677,respectively,and AUC for the diagnosis of advanced cirrhosis was 0.725 and0.651,respectively.(6)AUC of F Index,FIB-4 and APRI alone was 0.853,0.587,0.779,respectively,AUC of 0.913;AUC at combined diagnosis of early cirrhosis is about0.713,0.677,577,0.578,AUC of 0.764;AUC at combined diagnosis of advanced cirrhosis was about 0.677,0.651,0.725,respectively;AUC at combined diagnosis was 0.684.Conclusion:(1)The new technology Combi-Elasto primary imaging can obtain a variety of parameters to comprehensively evaluate the liver disease,with high reproducibility.In addition to obtaining the index F Index to evaluate liver fibrosis,the inflammatory activity index A Index is also obtained,which has obvious advantages over other types of elastographic imaging methods.(2)The joint application of Combi-Elasto and the serological model index can be used as an evaluation index of the degree of early hepatitis fibrosis in CHB.