肝细胞性黄疸对实时二维剪切波弹性成像评估肝纤维化分期的影响  

Effect of Hepatocellular Jaundice on Two-dimensional Shear-wave Elastography For Fibrosis Assessment

作　　者：郭欢仪[1] 吕素琴[1] 廖梅[1] 金洁玚 曾婕[1] 郑荣琴[1] Guo Huanyi;Lii Suqin;Liao Mei;Jin Jieyang;Zeng Jie;Zheng Rongqin(Department of Mdical Ultrasonics and Guangdong Key Laboratory of Liver Disease Research,The Third Affiliated Hospital of Sun Yat-sen University,Guangdong 510630,China)

机构地区：[1]中山大学附属第三医院超声科

出　　处：《中国超声医学杂志》2019年第10期912-915,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家重点研发计划(No.2017YFC0112000);国家自然科学基金青年科学基金项目(No.81601503)

摘　　要：目的分析肝细胞性黄疸对实时二维剪切波弹性成像(2D-SWE)评估肝纤维化分期的影响。方法选择于我院就诊的慢性乙型肝炎患者973例。所有病例均行2D-SWE和肝穿刺活检检查,同时记录临床及实验室血生化指标。胆红素测值水平进行分组分析并比较不同组别数据。受试者工作特征曲线分析2D-SWE评估肝纤维化分期的诊断阈值及效能。结果胆红素升高组2D-SWE评估肝纤维化分期(≥F2、≥F3及F4)的诊断阈值(10.46、10.94、15.88kPa)高于胆红素正常组(7.62、8.26、11.01kPa)。胆红素升高组2D-SWE评估肝纤维化分期(≥F3及F4)的准确性(70.9%、70.0%)低于胆红素正常组(80.2%、84.5%),肝纤维化分期(≥F2、≥F3及F4)假阳性率(44.6%、45.1%、39.6%)高于胆红素正常组(20.7%、17.1%、14.4%)。结论胆红素升高导致2D-SWE评估肝纤维化分期的准确性偏低,假阳性率升高。Objective To evaluate the impact of intrahepatic cholestasis on diagnosis performance of 2D-SWE for liver fibrosis staging in patients with chronic hepatitis B.Methods A total of 973 patients with CHB infection were enrolled to collect clinical,2D-SWE,biochemical variables and histologicaldata,dividing into normal total bilirubin(TB)and abnormal TB.ROC curves were used to assess the diagnostic performance.Results For patients with abnormal TB level,the optimal cutoff values tend to be higher than those for patients with normal TB level.LSMs assessed fibrosis stage generally showed lower accuracy and higher false positive rate in patients with abnormal TB level than those in patients with normal TB.Conclusions With elevated total bilirubin level,liver fibrosis staging with LSMs has lower accuracy and higher false positive rate.

关 键 词：肝细胞性黄疸 乙型肝炎 肝纤维化 剪切波弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575[医药卫生—诊断学] R512.62[医药卫生—临床医学]