声辐射力脉冲成像技术对肝纤维化分级的应用价值  

Application of acoustic radiation force impulse elastography to liver fibrosis stage

作　　者：刘倚河[1] 廖瑞真[1] 秦青秀[1] 吴秀艳[1] 郑瑞丹[2] 刘舜辉[1] 孟家榕[3] 王莉[1] 

机构地区：[1]厦门大学附属东南医院(解放军第175医院)超声科,福建漳州363000 [2]厦门大学附属东南医院(解放军第175医院)肝病中心,福建漳州363000 [3]厦门大学附属东南医院(解放军第175医院)病理科,福建漳州363000

出　　处：《临床军医杂志》2013年第3期300-303,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨声辐射力脉冲成像技术(ARFI)对慢性乙型肝炎病毒引起的肝纤维化的诊断价值。方法对239例经肝穿刺活检病理检查、26例临床确诊的乙肝肝硬化患者(列为F4级),应用ARFI技术测定肝脏剪切波速,检测肝纤维化程度,根据病理S0～S4分期,将患者分为F0～F4级。比较ARFI与血清肝纤维化标志物对肝纤维化程度的诊断价值,建立本地区的最佳界限值。设立50例正常对照组。结果 239例肝活检患者中病理诊断为S0～S4期的病例数分别为58例、48例、54例、59例和20例,ARFI平均值分别为(1.17±0.25)m/s、(1.39±0.36)m/s、(1.91±0.49)m/s、(2.66±0.51)m/s、(2.75±0.41)m/s。265例中,F0期与F1期,F3期与F4期的ARFI值之间差异无统计学意义。F0期与F2期、F3期、F4期之间,F1期与F2期、F3期、F4期之间,F2期与F3期、F4期之间差异有统计学意义(P<0.05)。ARFI分级结果与肝纤维化病理分期的相关性高于血清肝纤维化标志物,肝剪切波速中值数2.7是ARFI检查肝纤维化与肝硬化的交界点。结论 ARFI技术可较客观的评价肝纤维化分级,为临床提供一种无创评价肝纤维化程度的检查方法。Objective To explore the application value of acoustic radiation force impulse （ARFI） elastography in confirmation of the degree of hepatic fibrosis caused by chronic hepatitis B virus. Methods ARFI was applied to the patients with hepatic cirrhosis caused by HBV, 239 of whom were confirmed by aspiration biopsy and the other 26 of whom were clinically defined, in order to find out the degree of hepatic fibrosis via shear-wave speed. According to S0 - $4 scale by pathology, the cases were ranked as different stages （ F0 - F4 ）. The diagnostic values of liver fibrosis were compared between ARFI and fibrotic marker in serum. The regional optimal cutoff value was established, Another 50 cases were enrolled as normal controls. Results Among the 239 cases of biopsy, the numbers ranked at the stage of So - S4 were 58, 48, 54, 59,20, respectively, and the mean values of liver shear wave speed in 5o-$4 were （1.17±0.25）m/s, （1.39±0.36）m/s, （1.91 ±0.49）m/s, （2.66 ± 0. 51） m/s and （2.75±0.41）m/s, re- spectively. Among 265 cases, there were no significant differences in the mean value of ARFI between F0 and F1 subgroups, or be- tween F3 and F4 subgroups. But there were significant differences in the mean value of ARFI between F0 and any of F2 - F4 sub- groups, or F1 and any of F2 - F4 subgroups, or between F2 and any of F3 - F4 subgroups （P 〈 0.05）. The correlation between ARFI grading and pathologic staging was higher than that between serum markers and pathologic staging. In ARFI elastography, the optimal cutoff value was 2.7 （ liver shear-wave speed） as the separating point of liver fibrosis and liver cirrhosis. Conclusion ARFI technology can evaluate liver fibrosis stage, and it is a new noninvasive method to the assessment of liver fibrosis.

关 键 词：肝纤维化 声辐射力脉冲成像技术 血清肝纤维化标志物 病理分期 

分 类 号：R575.2[医药卫生—消化系统]