基于弹性成像多模态法评估慢性乙型肝炎肝纤维化程度  

Multimodal method based on elastography to stage liver fibrosis in chronic hepatitis B patients

作　　者：李沁园 董常峰[2] 冯程 李志艳 刘李 何秉昊 姜伟 田文硕 杨帅 Li Qinyuan;Dong Changfeng;Feng Cheng;Li Zhiyan;Liu Li;He Binghao;Jiang Wei;Tian Wenshuo;Yang Shuai(Department of Ultrasound,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,China;Department of Ultrasound,Shenzhen Third People's Hospital,Shenzhen 518300,China;Shenzhen Research Institute of Big Data,the Chinese University of Hong Kong,Shenzhen 518172,China;Department of Ultrasound,Huazhong University of Science and Technology Union Shenzhen Hospital,Shenzhen 518051,China;Shenzhen Mindray Bio-Medical Electronics Clinical Research Department,Shenzhen 518000,China)

机构地区：[1]广东医科大学附属医院超声科,广东湛江524000 [2]深圳市第三人民医院超声科,深圳518300 [3]香港中文大学深圳大数据研究院,深圳518172 [4]华中科技大学协和深圳医院超声科,深圳518051 [5]迈瑞生物医学电子临床研究部,深圳518000

出　　处：《中华医学超声杂志（电子版）》2022年第9期976-982,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金面上项目(61031003,81570552);深圳市第三人民医院临床类研究项目(G2022018)。

摘　　要：目的探讨声触诊弹性成像联合二维超声定量评分在无创性评估慢性乙型肝炎(CHB)患者肝纤维化程度的临床应用价值。方法纳入2018年9月至2020年1月深圳市第三人民医院153例完成肝穿刺活检的CHB患者,按METAVIR分级标准入组为肝纤维化各组(F1~F4组),53名健康志愿者作为对照组(F0组),所有受试者接受声触诊弹性成像(STE)、声触诊定量(STQ)技术及二维超声检查和肝功能血生化指标检测。采用方差分析不同肝纤维化组间肝STE值、STQ值和脾STE值的差异。应用逻辑回归分析STE/STQ与二维超声定量评分是否处于同一数量级。绘制STE、STQ、STE联合二维超声定量评分、STQ联合二维超声定量评分诊断CHB肝纤维化各期的受试者工作特征(ROC)曲线。结果CHB肝纤维化各组(F0~F4组)肝STE值及STQ值随肝纤维化程度加重而升高[肝STE值:(5.71±0.68)kPa vs(6.64±0.96)kPa vs(8.00±1.59)kPa vs(10.14±1.82)kPa vs(13.94±2.83)kPa;肝STQ值:(5.98±1.09)kPa vs(7.01±1.42)kPa vs(8.40±2.54)kPa vs(10.14±1.99)kPa vs(14.91±3.09)],各组间肝STE值、肝STQ值差异均具有统计学意义(F=166.28、123.77,P=0.002、0.003);脾STE值随肝纤维化程度加重变化不大[(25.69±5.31)kPa vs(16.30±4.29)kPa、(17.04±3.37)kPa、(17.00±3.79)kPa、(17.41±5.31)kPa],仅在肝硬化组(F4组)与其他组(F0~F3组)间差异存在统计学意义(P<0.05)。二维超声定量评分对应系数μUS/弹性成像对应系数μSTE比值在各期肝纤维化的诊断中均接近于1,即STE值与二维超声定量评分处于同一数量级。ROC曲线分析显示,STE联合二维超声定量评分显示出最佳诊断效能,其诊断为肝纤维化≥F1期、≥F2期、≥F3期的曲线下面积分别为0.944、0.955、0.976,STQ联合二维超声定量评分在诊断F4期肝硬化时,具备最佳诊断效能(曲线下面积=0.979)。结论STE联合二维超声定量评分在评估CHB各期肝纤维化时显示出最佳诊断效能,STQ联合二维超声定量评分诊Objective To investigate the clinical value of combined sound touch elastography(STE)and ultrasonography(US)score in staging liver fibrosis in chronic hepatitis B(CHB)patients.Methods A total of 153 CHB patients who underwent liver biopsy were enrolled into liver fibrosis groups(F1-F4 groups)according to the METAVIR grading standard,and 53 healthy volunteers were included as a control group(F0 group).All subjects received STE/STQ,two-dimensional ultrasound,and liver function biochemical index detection.Logistic regression was used to analyze whether STE/STQ and US quantitative scores were in the same order of magnitude.Receiver operating curve(ROC)analysis of STE,STQ,STE combined with US,and STQ combined with US in the diagnosis of liver fibrosis at each stage was performed.Results There were statistical differences in the liver STE value and liver STQ value among the F0-F4 groups[liver STE value:(5.71±0.68)kPa vs(6.64±0.96)kPa vs(8.00±1.59)kPa vs(10.14±1.82)kPa vs(13.94±2.83)kPa,F=166.28,P=0.002;liver STQ value:(5.98±1.09)kPa vs(7.01±1.42)kPa vs(8.40±2.54)kPa vs(10.14±1.99)kPa vs(14.91±3.09)kPa,F=123.77,P=0.003].The spleen STE value only had statistical difference between the liver cirrhosis(F4)group and other groups[(25.69±5.31)kPa vs(16.30±4.29)kPa,(17.04±3.37)kPa,(17.00±3.79)kPa,and(17.41±5.31)kPa;P<0.05].The ratio ofμUS/μSTE was close to 1,which means that STE and US quantitative scores were at the same level.According to the area under the ROC(AUROC),STE combined with US quantitative scoring showed the best diagnostic performance:≥F1 stage liver fibrosis(AUROC:0.944);≥F2 stage liver fibrosis(AUROC:0.955);≥F3 stage liver fibrosis(AUROC:0.976).For F4 liver cirrhosis,STQ combined with US quantitative scoring had the best diagnostic performance(AUROC:0.979).Conclusion STE combined with US quantitative scoring shows the best diagnostic ability in different stages of liver fibrosis,while STQ combined with US quantitative scoring has the best performance in diagnosing liver cirrhosis.

关 键 词：声触诊弹性成像 声触诊定量 二维超声 慢性乙型肝炎 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]