实时剪切波弹性成像诊断慢性乙型肝炎肝纤维化的影响因素  

Factors influencing accuracy of fibrosis diagnosis using shear wave elastrography in patients with chronic hepatitis B

作　　者：叶俊钊 王伟[2] 廖冰[3] 王漾[2] 吴艳琴[1] 廖献花[1] 钟碧慧[1] 

机构地区：[1]中山大学附属第一医院消化科,广州市510080 [2]中山大学附属第一医院超声科,广州市510080 [3]中山大学附属第一医院病理科,广州市510080

出　　处：《实用医学杂志》2016年第15期2454-2458,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81170392);广东省科技计划项目(编号:2013B021800290;2014A020212118);中国肝炎防治基金会天晴肝病研究基金项目(编号:TQGB20140083)

摘　　要：目的：探讨影响实时剪切波弹性成像（SWE）诊断乙型肝炎相关肝纤维化准确性的因素。方法：261例乙肝相关肝纤维化患者进行SWE检查（133例肝穿活检并按Metavir分期诊断,128例诊断肝硬化失代偿）,同时检测人体学指标、生化指标和病毒学指标,采用受试者工作特征（ROC）曲线评估SWE诊断各期肝纤维化的准确性。Logistic回归分析影响SWE诊断肝纤维化分期准确性的因素。结果：以肝脏组织学及临床诊断肝硬化失代偿为标准,诊断肝纤维化≥F2期、≥F3期和≥F4期的SWE的ROC曲线下面积（AUC）分别为0.891、0.932和0.910,合并超声诊断脂肪肝（OR=3.92,95%CI：1.99～11.2,P=0.011）是影响SWE诊断准确性的变量。结论：SWE对乙肝肝纤维化程度有较好的诊断价值,但测值对肝纤维化的评估准确性受合并脂肪肝的影响。Aims The purpose of this study is to investigate thediagnostic value of SWEfor fibrosis in patients with CHBand the factorsinfluencing the accuracy. Methods From July 2013 to October 2015, 261 patients with CHB were recruited from the First Affiliated Hospital of Sun Yat-sen University.All patients received SWE, anthropometry measurement, blood cell count, liver function test and virological indicators measurement.Liver fibrosis was staged from F0 to F4 by METAVIR scorebased onliver biopsy results of 133 CHB patients,while 128 patients were diagnosed as decompensated cirrhosis. Diagnostic accuracyof SWE were evaluated by Receiver Operating Characteristic Curve（ROC） using liver hepatic pathology and decompensated cirrhosis as gold standards. Logistic model was used to find out confounding factors that influence the accuracy of SWE.Results The Area Under ROC（AUC） for liver stiffness measurement with SWE were 0.891, 0.932 and 0.910 for the diagnosis of significant fibrosis（≥ F2）, advanced fibrosis（≥F3） and cirrhosis（F4）, respectively. A multifactor logistic regression combined modelwas built and showed that hepatic steatosis will decrease the accuracy of SWE. Conclusion SWE could be a valuable method for the noninvasive liver fibrosis assessment.The accuracy of SWE may be influenced by hepatic steatosis.

关 键 词：慢性乙型肝炎 肝纤维化 剪切波弹性成像 影响因素 

分 类 号：R512.62[医药卫生—内科学]