剪切波弹性成像对慢性乙型肝炎肝纤维化分期的诊断价值  

Di agnostic value for chronic hepatitis B fibrosis base on shear wave elastog-raphy technology

作　　者：高志玲[1] 何峥[1] 翁志菁 李胜[1] 梅和平 吴凡[1] 黄凌鹰[2] 吕佳[2] 高月求[2] 刘坤[3] 郭佳 GAO Zhi-ling;HE Zheng;WENG Zhi-jing;GUO Jia(Department of Ultrasonic Diagnosis,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine(Shanghai,201203),China.)

机构地区：[1]上海中医药大学附属曙光医院超声中心,上海201203 [2]上海中医药大学附属曙光医院肝病科 [3]上海中医药大学附属曙光医院病理科

出　　处：《中西医结合肝病杂志》2023年第8期723-727,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：上海中医药大学附属曙光医院中西医结合研究专项(No.SGZXY-201908);上海中医药大学预算内项目(No.2021LK086);。

摘　　要：目的:探讨剪切波弹性成像(SWE)对慢性乙型肝炎(CHB)患者肝纤维化分期评估的临床应用价值。方法:选取在上海中医药大学附属曙光医院肝病科就诊的110例CHB患者作为研究对象,行常规超声、SWE技术检查及病理学检查。以肝穿刺活检为金标准,分析比较常规超声参数和肝脏SWE杨氏模量与肝纤维化分期之间的相关性,评估剪切波弹性成像技术对CHB肝纤维化的诊断效能。结果:病理检查结果显示,F0期16例,F1期29例,F2期44例,F3期9例,F4期12例,非显著性肝纤维化(F0~F1期)45例,显著性肝纤维化(F2~F4期)65例。各期SWE杨氏模量分别为F0期(4.3±0.44)kPa,F1期(5.3±1.44)kPa,F2期(7.1±3.59)kPa,F3期(7.5±0.49)kPa,F4期(10.1±2.02)kPa。不同分期肝纤维化SWE杨氏模量差异具有统计学意义(F=11.7,P<0.01),且SWE杨氏模量与肝纤维化程度呈正相关(r=0.753,P<0.01)。根据肝脏活检病理结果,SWE杨氏模量诊断肝纤维化>F0/F1期ROC曲线下面积为0.837,临界值为5.25 kPa,对应的敏感度、特异度分别为84.1%、80.0%;肝纤维化>F2期ROC曲线下面积为0.782,临界值为6.75kPa,对应的敏感度、特异度分别为100%、72.7%;肝纤维化>F3期ROC曲线下面积为0.907,临界值为8.50 kPa,对应的敏感度、特异度分别为75.0%、100%。结论:采用SWE技术可定量检测CHB肝纤维化程度及分期,SWE杨氏模量与肝纤维化程度呈正相关,对肝纤维化具有较高的诊断效能。且SWE操作安全、简便、无创、可重复性好,为临床慢性乙型肝炎肝纤维化诊断提供了一种便捷的影像学检查方法。Objective:To investigate the value of measurement of liver tissue hardness with shear wave elastography(SWE)technology in the diagnosis of staging of liver fibrosis in chronic hepatitis B(CHB).Methods:A total of 110 patients with CHB who were treated in the Department of Hepatology of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine were selected as the research objects,and routine ultrasound,SWE technology and pathological examination were performed.Taking liver biopsy as the gold standard,the correlation between conventional ultrasound parameters,Young's modulus of liver SWE and liver fibrosis stage was analyzed and compared,and the diagnostic efficacy of shear wave elastography for liver fibrosis in CHB was evaluated.Results:Pathological examination showed that 16 cases of F0 stage,29 cases of F1 stage,44 cases of F2 stage,9 cases of F3 stage and 12 cases of F4 stage.There were 45 cases of non-significant liver fibrosis(F0-F1 stage)and 65 cases of significant liver fibrosis(F2-F4 stage).The Young′s modulus of SWE in each stage was(4.3±0.44)kPa in F0 stage,(5.3±1.44)kPa in F1 stage,(7.1±3.59)kPa in F2 stage,(7.5±0.49)kPa in F3 stage,and(10.1±2.02)kPa in F4 stage.The Young′s modulus of SWE was significantly different in different stages of liver fibrosis(F=11.7,P<0.01),and there was a positive correlation between the Young′s modulus of SWE and the degree of liver fibrosis(r=0.753,P<0.01).According to the pathological results of liver biopsy,The area under ROC curve of SWE Young′s modulus in diagnosing liver fibrosis>F0/F1 stage was 0.837,the threshold values was 5.25 kPa,the corresponding sensitivity and specificity were 84.1%and 80.0%,respectively.Liver fibrosis>F2 phase,the area under ROC curve was 0.782,the threshold values was 6.75 kPa,the corresponding sensitivity and specificity were 100%and 72.7%,respectively.Liver fibrosis>F3 phase,the area under ROC curve was 0.907,the threshold values was 8.50 kPa,the corresponding sensitivity and specificity were 75.0%an

关 键 词：剪切波弹性成像 超声检查 慢性乙型肝炎 肝纤维化 

分 类 号：R575[医药卫生—消化系统]