实时与瞬时弹性成像在肝纤维化评价中的应用  

Application of real-time tissue elastography and FibroScan in evaluation of liver fibrosis

作　　者：翟哲 张超学[1] Zhai Zhe;Zhang Chaoxue(Dept of Ultrasound,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Ultrasound,North Hospital,Xinhua Medical Group,Huainan City,Anhui Province,Huainan 232082)

机构地区：[1]安徽医科大学第一附属医院超声科,合肥230022 [2]安徽省淮南市新华医疗集团北方医院超声科,淮南232082

出　　处：《安徽医科大学学报》2019年第5期817-820,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1708085MH205)

摘　　要：目的探讨超声实时组织弹性成像(RTE)与瞬时弹性成像(FS)在慢性乙肝患者肝纤维化程度评价中的应用价值。方法选取210例慢性乙肝患者作为观察组,另选取120例健康志愿者作为对照组。对两组研究对象实施超声RTE与FS检查,观察组最终通过穿刺活检确定肝纤维化程度。对比两组研究对象的肝纤维化指数、肝脏硬度值,分析RTE、FS检查指标与肝纤维化程度的关系。结果对照组与观察组各亚组的应变均值(MEAN)、标准偏差(SD)、复杂度(COMP)、偏度(SKEW)、蓝色领域百分比(AREA)值比较,差异均有统计学意义(P<0.05)。观察组中,F0期患者的MEAN、SD、COMP、SKEW、AREA值与对照组比较,差异无统计学意义(P>0.05)。随着肝纤维化分期的升高,MEAN呈现出下降趋势(F0期>F1期>F2期>F3期>F4期),SD、COMP、SKEW、AREA水平均呈现出升高趋势(F0期<F1期<F2期<F3期<F4期)。对照组与观察组各亚组的肝纤维化指数(LF Index)、肝硬度值(LSM)比较,差异均有统计学意义(P<0.05),LF Index、LSM均随着肝纤维化分期的升高而升高。相关性分析显示LF Index、LSM与肝纤维化分期均呈正相关性(P<0.05)。以F2期为分界点,LF Index和LSM值的ROC曲线下面积(AUC值)分别为0.892和0.905,以F3期为分界点,LF Index和LSM值的AUC值分别为0.886和0.872。结论超声RTE与FS检查均能有效评估慢性乙肝患者的肝纤维化程度,二者对肝纤维化程度的评估能力相当,且都具有无创、快速的优点。Objective To investigate the value of real-time tissue ultrasound elastography (RTE) and FibroScan (FS) in the evaluation of liver fibrosis in patients with chronic hepatitis B. Methods A total of 210 patients with chronic hepatitis B were studied to develop the liver fibrosis index 120 healthy volunteers were served as a control group. Liver elasticity was measured with ultrasound RTE and FS examination the stage of liver fibrosis was determined by percutaneous liver biopsy. The liver fibrosis index and liver hardness values of the two groups were compared,and the relationship between RTE and FS examination indexes and liver fibrosis degree were analyzed. Results The different of MEAN,SD,COMP,SKEW and AREA value of the control group and the observation group were significant ( P <0.05). In the observation group,the MEAN,SD,COMP,SKEW,and AREA values of the F0 patients were not significantly different from those of the control group ( P >0.05). MEAN shows a downward trend (F0 phase>F1 phase>F2 phase>F3 phase>F4 phase).The SD,COMP,SKEW and AREA levels showed an increasing trend with the increase of liver fibrosis stage (F0 phase <F1 phase <F2 phase <F3 phase <F4 phase). The LF Index and LSM values of the control group and the observation group were significantly different ( P <0.05),LF Index and LSM values increased with the increase of liver fibrosis stage. Correlation analysis showed that LF Index,LSM and liver fibrosis stage were positively correlated ( P <0.05). Taking the F2 phase as the demarcation point,the area under the ROC curve (AUC value) of the LF Index and the LSM value respectively were 0.892 and 0.905.Taking the F3 phase as the demarcation point,the AUC values of the LF Index and the LSM value respectively were 0.886 and 0.872. Conclusion Both ultrasound RTE and FS can effectively evaluate the degree of liver fibrosis in patients with chronic hepatitis B. The evaluation of liver fibrosis is equivalent,and the advantages of non-invasive and rapid between two inspection methods.

关 键 词：肝纤维化 慢性乙肝 瞬时弹性成像 实时组织超声弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学]