BACKGROUND:Acoustic Radiation Force Impulse (ARFI), Fibrosis-4(FIB-4) and Aspartate transaminase to platelet ratio index (APRI) are valuable non-invasive methods to evaluate fibrosis in hepatitis virus. Yet, they are rarely used in Wilson’s disease. OBJECTIVE:Evaluate the diagnostic efficacy of ARFI, FIB-4, APRI, combined detection in cirrhosis with WD, and speculate the optimal high, low cutoff. METHODS:This retrospective study was authorized by hospital ethics Committee (number:2021MCZQ02). 102 patients with WD completed ARFI and laboratory examination on the same day. The intraclass correlation coeffcient (ICC) of ARFI among three sonographers was 0.896 (95%CI:0.859–0.925, p = 0.000). The stage of liver involvement was classified into 5 categories according to clinical manifestations, laboratory examination, and liver morphologic characteristics: I, normal; II, biochemical abnormal only; III, abnormal liver morphologic features without sighs of cirrhosis; IV, clinical and imaging sighs of compensateded cirrhosis (Child-Pugh A); V, decompensated cirrhosis (Child-Pugh B and C). This stage system served as the reference standard. The diagnostic efficacy was analyzed by Logistic regression, ROC curve. The optimal low cut-off with high sensitivity (SE) and low negative likelihood ratio (NLR) and high cut-off with high specificity (SP) and positive likelihood ratio (PLR) were derived. RESULTS:The diagnostic value of ARFI (0.85, 95%CI:0.77–0.92, p = 0.000) in distiguishing cirrhosis with WD was higher than FIB-4 (0.59, 95%CI: 0.47–0.70, p = 0.127), APRI (0.70, 95%CI: 0.59–0.81, p = 0.000). The low, high cut-off of ARFI for excluding, diagnosing cirrhosis with WD was 1.47 m/s(SE: 98%, NLR:0.09), 2.11 m/s(SP:98%, PLR:27.4), 37 (36%) patients could be spared a liver biopsy. When ARFI was 1.47∼2.11 m/s, liver biopsy was recommended. After combined with ARFI, the AUROC of FIB-4, APRI were increased respectively (p < 0.001), there were not different between ARFI and combined detection(p > 0.05). CONCLUSION:ARFI could replace some unnecessary liver biopsy according to high diagnostic efficacy for identifying cirrhosis of WD. The combined detection can also be used as an important model to predict cirrhosis in WD.

中文翻译：

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威尔森氏病肝硬化：使用声辐射力脉冲 (ARFI) 的高和低截止 - 与血清纤维化指数的比较和组合

背景：声辐射力脉冲（ARFI）、Fibrosis-4（FIB-4）和天冬氨酸转氨酶与血小板比率指数（APRI）是评估肝炎病毒纤维化的有价值的非侵入性方法。然而，它们很少用于威尔逊氏病。目的：评价ARFI、FIB-4、APRI、联合检测对肝硬化WD的诊断疗效，并推测最佳的高、低截止值。方法：本回顾性研究经医院伦理委员会批准（编号：2021MCZQ02）。102名WD患者在同一天完成了ARFI和实验室检查。三位超声医师之间 ARFI 的组内相关系数 (ICC) 为 0.896 (95%CI:0.859–0.925, p = 0.000)。肝脏受累分期根据临床表现、实验室检查、和肝脏形态学特征：I，正常；二、生化异常而已；三、肝脏形态异常，无肝硬化之征；IV、代偿期肝硬化的临床和影像学叹息（Child-Pugh A）；V，失代偿性肝硬化（Child-Pugh B 和 C）。这个阶段系统作为参考标准。采用Logistic回归、ROC曲线分析诊断效能。推导出具有高灵敏度（SE）和低阴性似然比（NLR）的最佳低截止值以及具有高特异性（SP）和阳性似然比（PLR）的高截止值。结果：ARFI (0.85, 95%CI:0.77–0.92, p = 0.000) 在区分肝硬化与 WD 中的诊断价值高于 FIB-4 (0.59, 95%CI: 0.47–0.70, p = 0.127), APRI (0.70, 95% CI: 0.59–0.81, p = 0.000)。用于排除的 ARFI 的低、高截止，WD 诊断肝硬化为 1.47 m/s(SE: 98%, NLR:0.09), 2.11 m/s(SP:98%, PLR:27.4)，37 (36%) 名患者可以免于肝活检。当ARFI为1.47∼2.11 m/s时，推荐肝活检。联合ARFI后，FIB-4、APRI的AUROC分别增加（p < 0.001），ARFI与联合检测无差异（p > 0.05）。结论:ARFI对WD肝硬化的鉴别诊断效率高,可替代部分不必要的肝活检。联合检测也可作为预测WD肝硬化的重要模型。ARFI与联合检测无差异(p>0.05)。结论:ARFI对WD肝硬化的鉴别诊断效率高,可替代部分不必要的肝活检。联合检测也可作为预测WD肝硬化的重要模型。ARFI与联合检测无差异(p>0.05)。结论:ARFI对WD肝硬化的鉴别诊断效率高,可替代部分不必要的肝活检。联合检测也可作为预测WD肝硬化的重要模型。