关键词: 自身免疫性肝病, 肝纤维化, 实时剪切波弹性成像, 白细胞介素-6/白细胞介素-22

Abstract: Objective To investigate the value of real-time shear wave elastography (SWE) combined with serum interleukin-6 (IL-6)/interleukin-22 (IL-22) levels in evaluating hepatic fibrosis (HF) of patients with autoimmune liver diseases (AILD). Methods A total of 130 patients with AILD admitted to Haian Hospital of Traditional Chinese Medicine from June 2021 to September 2022 were selected as the study subjects. SWE examination was performed and blood routine, liver function, IL-6 and IL-22 levels were determined in all patients. HF staging was evaluated according to liver biopsy and Metavir staging system. Among 108 patients with fibrosis stage F1 to F4, patients with primary biliary cirrhosis (PBC) were treated with ursodeoxycholic acid in combination with prednisolone, and patients with autoimmune hepatitis (AIH) were treated with prednisolone tablets in combination with azathioprine tablets orally for 6 months. Young’s modulus and serum IL-6/IL-22 levels were compared at each stage of HF. The correlation between Young’s modulus and serum IL-6/IL-22 levels and the four items of liver fibrosis and FIB-4 were analyzed by Pearson method. The diagnostic efficiency of Young’s modulus combined with serum IL-6/IL-22 levels for the diagnosis of HF were analyzed by receiver operating characteristic curve (ROC) method. Young’s modulus and serum IL-6/IL-22 levels were observed after 6 months of treatment. Results The Young’s modulus and IL-6/IL-22 levels in the cirrhosis group were 14.50±3.92 kPa and 2.46±0.35, respectively, which were higher than those of 11.17±2.78 kPa and 2.15±0.31 in the advanced HF group, 7.29±1.56 kPa and 1.92±0.28 in the HF group, as well as 4.93±0.71 kPa and 1.67±0.24 in the non-HF group (t=34.681, 13.275, all P<0.05). Pearson analysis showed that Young’s modulus value and serum IL-6/IL-22 level in AILD patients were positively correlated with laminin (LN), hyaluronic acid (HA), type III procollagen (PC-Ⅲ), type IV collagen (Ⅳ-C) and FIB-4 levels (P<0.01). After treatment, the Young’s modulus and serum IL-6/IL-22 levels in AILD patients with HF were 6.90±1.48 kPa and 1.78±0.23 in the effective group, which were lower than 8.35±1.87 kPa and 1.90±0.27 in the effective group, and 9.51±2.24 kPa and 2.04±0.29 in the ineffective group. The difference was statistically significant (t=17.256, 9.037, all P<0.05). The ROC curve analysis showed that the AUC, sensitivity and specificity of Young’s modulus combined with IL-6/IL-22 level in the diagnosis of HF stages of AILD patients were higher than any single efficacy (P<0.05). Conclusion SWE combined serum IL-6/IL-22 level is closely related to the severity of HF in AILD patients, which can objectively reflect and be used to dynamically monitor the treatment effect and the prognosis of disease.

Key words: autoimmune liver diseases, hepatic fibrosis, shear wave elastography, IL-6, IL-22