可视化瞬时弹性成像与声触诊弹性成像诊断慢性乙型肝炎患者肝纤维化效能比较  

Assessment of significant liver fibrosis by visual instantaneous elastography and acoustic palpation elastography in patients with chronic hepatitis B

作　　者：周隽 张忠新[1] 徐海燕[1] Zhou Jun;Zhang Zhongxin;Xu Haiyan(Department of Ultrasound,Second Affiliated Hospital,Nantong University,Nantong 226000,Jiangsu Province,China)

机构地区：[1]南通大学第二附属医院超声科,江苏省南通市226000

出　　处：《实用肝脏病杂志》2024年第6期832-835,共4页Journal of Practical Hepatology

基　　金：南通市基础研究和民生科技计划指导性项目(编号:2021KT029)。

摘　　要：目的比较采用可视化瞬时弹性成像(VIE)与声触诊弹性成像(APE)检测肝脏硬度诊断慢性乙型肝炎(CHB)患者肝纤维化的效能。方法2020年10月~2022年10月我院收治的CHB患者121例,均接受肝活检和超声检查,进行肝纤维化分期和肝脏硬度检测。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),分析诊断效能。结果在本组121例CHB患者中,肝组织学诊断非显著性肝纤维化者26例,显著性肝纤维化者95例;显著性肝纤维化患者VIE和APE检测的肝脏硬度、血清AST和ALT水平分别为(9.3±3.0)kPa、(9.3±3.1)kPa、(127.5±33.4)U/L和(137.8±38.8)U/L,均显著高于非显著性肝纤维化患者【分别为(5.9±1.4)kPa、(6.0±1.5)kPa、(98.6±25.8)U/L和(90.5±28.7)U/L,P<0.05】,而外周血血小板计数为(125.8±41.5)×10^(9)/L,显著低于非显著性肝纤维化患者【(192.3±51.7)×10^(9)/L,P<0.05】;VIE诊断CHB患者显著性肝纤维化的灵敏度为95.8%,特异度为88.5%,准确度为94.2%,阳性预测值为96.8%,阴性预测值为85.2%,APE诊断则分别为94.7%、84.6%、92.6%、95.7%和81.5%,两种检查方法诊断的效能比较,差异无统计学意义(P>0.05)。结论使用超声VIE或APE检测肝脏硬度诊断CHB患者显著性肝纤维化的效能均较高,具有极大的临床应用价值,值得进一步探讨。Objective This study was conducted to investigate the assessment of significant liver fibrosis(SLF)by visual instantaneous elastography(VIE)and acoustic palpation elastography(APE)in patients with chronic hepatitis B(CHB).Methods 121 patients with CHB were encountered in our hospital between October 2020 and October 2022,and all patients underwent liver biopsies for liver fibrosis staging and ultrasonography for liver stiffness measurement(LSM).The area under the receiver operating characteristic curve(AUROC)was drawn to reveal the diagnostic performance of LSM for predicting the SLF.Results Out of the 121 patients with CHB,the liver histo-pathological examination showed SLF in 95 cases,and non-significant liver fibrosis(NSLF)in 26 cases;the LSMvie and LSMape,serum aspartate aminotransferase and alanine aminotransferase levels in patients with SLF were(9.3±3.0)kPa,(9.3±3.1)kPa,(127.5±33.4)U/L and(137.8±38.8)U/L,all significantly higher than[(5.9±1.4)kPa,(6.0±1.5)kPa,(98.6±25.8)U/L and(90.5±28.7)U/L,respectively,P<0.05],while the blood platelet count was(125.8±41.5)×10^(9)/L,much lower than[(192.3±51.7)×10^(9)/L,P<0.05]in patients with NSLF;the sensitivity,specificity,accuracy,positive predictive value and negative predictive value by VIE in predicting SLF in patients with CHB were 95.8%,88.5%,94.2%,96.8%and 85.2%,not significantly different as compared to 94.7%,84.6%,92.6%,95.7%and 81.5%by APE(P>0.05).Conclusion The diagnostic accuracies of VIE and APE in predicting SLF in patients with CHB are both great,which might be useful in clinical practice,and warrants further investigation.

关 键 词：慢性乙型肝炎 肝纤维化 可视化瞬时弹性成像 声触诊弹性成像 诊断 

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] R575.2[医药卫生—临床医学]