声学结构定量诊断慢性乙型肝炎肝纤维化的价值  

Value of ultrasonic acoustic structure in quantitative diagnosis of liver fibrosis in chronic hepatitis B

作　　者：张丁丁[1] 张晨[1] 李贺霞 朱永涛[1] 路宾 刘广会[1] 安娜[1] ZHANG Dingding;ZHANG Chen;LI Hexia;ZHU Yongtao;LU Bin;LIU Guanghui;AN Na(Department of Ultrasound,Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院超声科,北京市100102 [2]中国人民解放军总医院第三医学中心器官移植中心

出　　处：《临床超声医学杂志》2021年第12期901-904,共4页Journal of Clinical Ultrasound in Medicine

基　　金：北京市中国中医科学院自由探索项目(ZZ0708085)。

摘　　要：目的探讨声学结构定量(ASQ)诊断慢性乙型肝炎(CHB)肝纤维化的临床应用价值。方法选取于我院就诊的CHB患者122例,均行ASQ检查获得红色曲线均数(RA)、红色曲线众数(RM)、蓝色曲线众数(BM)、蓝色曲线标准差(BSD)和红蓝曲线下面积(FD)比值;然后行超声引导下穿刺或部分肝叶切除活检,采用METAVIR评分对肝纤维化病理组织学分期(F0~F4期)进行评价。分析ASQ参数与肝纤维化病理组织学分期的相关性;绘制受试者工作特征(ROC)曲线分析ASQ参数预测肝纤维化病理组织学分期的诊断效能,计算曲线下面积(AUC)。应用Logistic回归分析肝纤维化病理组织学分期的独立危险因素。结果肝纤维化病理组织学分期结果显示,122例CHB患者中F0期6例,F1期14例,F2期38例,F3期22例,F4期42例。不同肝纤维化病理组织学分期CHB患者RA、RM、BM和FD比值比较差异均有统计学意义(均P<0.05)。相关性分析显示,肝纤维化病理组织学分期与FD比值呈正相关(r=0.71,P=0.000),与RA、RM、BM无相关性。ROC曲线分析显示,FD比值预测肝纤维化病理组织学分期≥F2期、≥F3期、F4期的AUC分别为0.796、0.805、0.832。Logistic回归分析结果显示,FD比值是肝纤维化病理组织学分期的独立危险因素(β=1.562,OR=7.381,95%可信区间4.097~11.053,P=0.000)。结论 ASQ参数中FD比值可较准确地评估CHB肝纤维化的严重程度,是预测肝纤维化病理组织学分期的有效指标。Objective To investigate the clinical application value of ultrasonic acoustic structure quantification(ASQ)in the quantitative diagnosis of liver fibrosis in chronic hepatitis B(CHB).Methods A total of 122 patients with CHB admitted to our hospital were included.All patients received ASQ examination,the red curve mean(RA),red curve mode(RM),blue curve mode(BM),blue curve standard deviation(BSD)and the ratio of area under the red and blue curve(FD)were obtained.METAVIR score was used to evaluate the histopathological staging(F0~F4 stage)of liver fibrosis by ultrasound-guided puncture or partial lobectomy biopsy.The correlation between ASQ parameters and histopathological stages of liver fibrosis were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ASQ parameters in predicting histopathological stages of liver fibrosis,and the area under the curve(AUC)was calculated.Logistic regression analysis was used to determine the independent risk factors for histopathological stages of liver fibrosis.Results Among 122 CHB patients,there were 6 cases in F0 stage,14 cases in F1 stage,38 cases in F2 stage,22 cases in F3 stage,42 cases in F4 stage.There were significant differences of RA,RM,BM and FD in CHB patients with different histopathological stages(all P<0.05).Correlation analysis showed that histopathological stage of liver fibrosis was positively correlated with FD ratio(r=0.71,P=0.000),and was not correlated with RA,RM,BM.ROC curve analysis showed that the AUC of FD ratio in predicting histopathological stages of liver fibrosis ≥F2,≥F3 and F4 stage were 0.796,0.805,and 0.832,respectively.Logistic regression analysis showed that FD ratio was an independent risk factor for histopathological stage of liver fibrosis(β=1.562,OR=7.381,95%CI 4.097~11.053,P=0.000).Conclusion FD ratio can accurately assess the severity of liver fibrosis,and is an effective non-invasive imaging biomarker for predicting the pathological stage of liver fibrosis.

关 键 词：超声检查 声学结构量化 乙型肝炎 慢性 肝纤维化 

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]