瞬时弹性成像评价慢性乙型肝炎患者抗病毒治疗的效果  

Value of transient elastography in assessing efficacy of antiviral therapy in chronic hepatitis B patients

作　　者：施娜 邱文倩[1] 何丹青[1] 张超学[1] 毛萍 杨艳婷 Shi Na;Qiu Wenqian;He Danqing;Zhang Chaoxue;Mao Ping;Yang Yanting(Department of Ultrasound,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Ultrasonic Center,The 901st Hospital of Joint Logistics Support Force,Hefei 230031,China)

机构地区：[1]安徽医科大学第一附属医院超声科,合肥230022 [2]联勤保障部队第901医院超声中心,合肥230031

出　　处：《中华医学超声杂志（电子版）》2022年第5期328-333,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：安徽省重点研究与开发计划(202004j07020031)。

摘　　要：目的对比分析应用瞬时弹性成像动态检测慢性乙型肝炎患者抗病毒治疗前后肝硬度值的变化,评价抗病毒药物对慢性乙型肝炎患者肝纤维化的临床治疗效果.方法选取2015年1月至2019年10月在安徽医科大学第一附属医院和联勤保障部队第901医院就诊的125例使用拉米夫定(LAM组)、阿德福韦(ADV组)和二者联合(LAM+ADV组)治疗的慢性乙型肝炎患者,分别检测其抗病毒治疗前、后(6~24个月)的肝硬度值、谷丙转氨酶(ALT)和血清肝纤维化指标的变化情况,采用单因素重复测量方差分析抗病毒治疗前后患者肝硬度值、ALT值、肝纤维化指标值的差异,并采用Pearson相关分析肝硬度值与ALT值和肝纤维化指标的相关性.结果抗病毒治疗后患者的肝硬度值明显下降,从治疗前的(15.25±2.28)kPa下降至24个月后的(6.79±1.76)kPa,差异具有统计学意义(F=330.784,P<0.001),LAM组、ADV组和LAM+ADV组中治疗后6个月与治疗前(t=5.597、6.399、6.721,P均<0.001)、12个月与6个月(y=4.779、5.284、6.006,P<0.001、=0.001、<0.001)、18个月与12个月(t=3.109、3.456、3.638,P=0.003、=0.001、<0.001)、24个月与12个月(t=2.801、3.160、3.173,P=0.007、0.002、0.002)肝硬度值比较,差异均具有统计学意义.治疗24个月后患者ALT恢复率为84.8%(106/125),其中LAM组为83.78%(31/37),ADV组为84.45%(38/45),LAM+ADV组为86.05%(37/43).24个月后患者血清中的透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)及Ⅳ型胶原(ⅣC)等指标值均明显降低,差异具有统计学意义(LAM组:t=20.184、5.312、7.740、18.267,P均<0.001;ADV组:t=21.315、3.361、9.064、20.428,P均<0.001;LAM+ADV组:t=21.492、7.158、10.687、21.543,P均<0.001).肝硬度值与ALT值、肝纤维化指标(HA、LN、PCⅢ and ⅣC)值的变化相一致,均呈正相关性(r=0.745、0.689、0.695、0.687、0.697,P均<0.05).结论瞬时弹性成像可动态检测慢性乙型肝炎患者的肝纤维化,观察和评价抗病毒药物的治Objective To assess the value of transient elastography in assessing the effectiveness of antiviral drugs in chronic hepatitis B(CHB)patients by dynamically detecting the changes of liver hardness before and after antiviral therapy.Methods A total of 125 CHB patients who received lamivudine(LAM),adefovir(ADV),or LAM+ADV treatment at the First Affiliated Hospital of Anhui Medical University and the 901st Hospital of Joint Logistics Support Force form January 2015 to October 2019 were selected.Fibroscan values,alanine aminotransferase(ALT),and serum liver fibrosis indicators before and after(0~24 months)antiviral treatment were tested,and the results were compared by using one-way ANOVA.Pearson correlation coefficient was used to analyze the correlation of Fibroscan values with ALT and serum liver fibrosis indicators.Results The patient's liver hardness values decreased significantly from(15.25±2.28)kPa before treatment to(6.79±1.76 kPa)24 months after treatment(P<0.001).Liver hardness values in the LAM group,ADV group,and LAM+ADV group were statistically different before treatment vs 6 months after treatment(t=5.597,6.399,and 6.721,respectively,P<0.001 for all),12 months vs 6 months after treatment(t=4.779,5.284,and 6.006,P<0.001,=0.001,and<0.001,respectively),18 months&12 months after treatment(t=3.109,3.456,and 3.638,P=0.003,=0.001,<0.001,respectively),and 24 months vs 12 months after treatment(t=2.801,3.160,and 3.173,P=0.007,0.002,and 0.002,respectively).After 24 months of treatment,the ALT recovery rate in the overall patient population reached 84.8%(106/125),and it was 83.78%(31/37)in the LAM group,84.45%(38/45)in the ADV group,and 86.05%(37/43)in the LAM+ADV group.The values of serum hyaluronic acid(HA),laminin(LN),typeⅢprocollagen(PCⅢ)and typeⅣcollagen(ⅣC)decreased significantly after 24 months of treatment(LAM group:t=20.184,5.312,7.740,and 18.267,P<0.001;ADV group:t=21.315,3.361,9.064,and 20.428,P<0.001;LAM+ADV group:t=21.492,7.158,10.687,and 21.543,P<0.001,respectively).Liver hardness values we

关 键 词：瞬时弹性成像 慢性乙型肝炎 抗病毒治疗 肝纤维化 

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