声触诊组织量化成像评价慢性乙型肝炎肝纤维化价值探讨  

Diagnostic value of virtual touch tissue quantification in the evaluation of liver fibrosis in patientswith chronic hepatitis B

作　　者：林森浩[1] 沈文[1] 丁红[1] 毛丽娟[1] 许建芳[2] 黄备建[1] 王文平[1] 

机构地区：[1]复旦大学附属中山医院上海市影像医学研究所,200032 [2]复旦大学附属中山医院病理科

出　　处：《中华全科医师杂志》2013年第9期726-729,共4页Chinese Journal of General Practitioners

基　　金：国家自然科学基金项目（30872409）;上海市重点学科建设项目（B112）

摘　　要：目的探讨声触诊组织量化成像评价慢性乙型肝炎（乙肝）患者肝纤维化及炎症程度的临床价值。方法对181例慢性乙肝患者进行前瞻性的声触诊组织量化成像检查，得卅间接反映肝组织硬度的剪切波速度，以病理组织学的肝纤维化分期和炎症分级为金标准，评估剪切波速度与肝纤维化分期和炎症分级的关系。结果剪切波速度与肝纤维化分期之间具有较高相关性（r=0．812，P〈0．001）。除纤维化S0与S1、S1与S2组间剪切波速度差异无明显统计学意义外，余不同纤维化分期各组间的剪切波速度差异均具有明显的统计学意义（P〈0．05）。剪切波速度预测肝纤维化1期及以上、2期及以上、3期及以上、4期的受试者工作特征曲线（ROC）曲线下面积分别为0．971、0．961、0．969和0．908。剪切波速度与炎症分级之间具有一定的相关性（r=0．476，P〈0．001）。当剪切波速度取1．35m／s时，预测1级及以上炎症程度的ROC曲线下面积为0．816（P〈0．001），敏感性77．7％，特异性80．0％。结论声触诊组织量化成像可以用于慢性乙肝肝纤维化的分期，并可初步用于炎症程度的分级，为临床慢性乙肝患者肝纤维化的早期诊断以及疗效预后的评估提供帮助。Objective To explore the diagnostic value of virtual touch tissue quantification （VTQ） for the assessment of liver fibrosis in patients with chronic hepatitis B. Methods VTQ was prospectively performed in 181 patients with chronic hepatitis B and a shear wave velocity （Vs） indirectly reflecting liver stiffness was obtained for each patient. With the gold standards of fihrotic stages and inflammation grades, the relationship between Vs, fibrotic stages and inflammation grades was evaluated. Results A relatively high correlation existed between Vs and liver fihrotie stages （r = 0. 812, P 〈 0.001 ）. Significant differences existed among groups with different fibrotic stages except for groups SO vs. S1 and S1 vs. S2 （ P 〈 0. 05 ）. The areas under the ROC curve were 0. 971, 0. 961 , 0. 969 and 0. 908 for Vs predicting S0≥S1, S≥S2, S ≥S3 and S = S4 fibrosis respectively. Moderate correlation existed between Vs and inflammation grades （ r = 0. 476, P = 0. 000 ）. Conclusion Capable of staging liver fibrosis and preliminarily grading inflammation, VTQ is helpful for the early diagnosis of liver fibrosis and assessment of therapeutic follow-up and prognosis in patients with chronic hepatitis B.

关 键 词：超声检查 肝炎 乙型 慢性 肝硬化 

分 类 号：R512.62[医药卫生—内科学]