慢性肝病肝剪切波速与纤维化分级的相关性研究

Correlativity Analysis between Liver Shear Wave Speed and Fibrosis Grades in Chronic Hepatic Diseases

目的:探讨肝剪切波速与慢性肝病肝纤维化分级之间的关系。材料和方法:以103例慢性肝病患者及26例健康人群为研究对象,利用声触诊组织量化技术分别定量测定肝脏的剪切波速;通过肝穿刺活检,以病理纤维化分级程度对研究对象进行分组,比较各纤维化分级与剪切波速之间的关系。结果:103例肝病组患者中的94例进行肝穿刺活检;F0级的肝病患者与健康对照F0级之间剪切波速比较无显著性差异(P=0.058);除肝纤维化F0级与F1级、F3和F4级之间无显著性差异外,其余各组剪切波速均值之间(F0与F2、F3、F4之间,F1与F2、F3、F4之间,F2与F3、F4之间)的比较都有显著性差异(P<0.05);诊断肝纤维化F≥1、F≥2、F≥3和F=4分别对应的ROC曲线下面积分别为0.834、0.958、0.966、0.895,对应的肝脏剪切波速临界阈值分别为1.42m/s、1.60m/s、2.19m/s、2.41m/s,对应的诊断敏感性分别为72.0%、93.2%、96.3%、93.9%;特异性分别为82.1%、86.4%、88.2%、81.9%。结论:肝纤维化是影响肝脏剪切波速的主要因素;肝脏剪切波速随纤维化分级的增高而增快,是判断慢性肝病肝脏纤维化程度及分级的可靠指标。

Purpose： To explore the correlativity between liver shear-wave speed generated by the method of virtual touch tissue quantification and liver fibrosis in chronic hepatic diseases. Materials and Methods： 103 consecutive chronic hepatitis patients and 26 healthy controls were examined by the method of virtual touch tissue quantification. The liver shear-wave speeds which refer to liver stiffness were obtained quantitatively. Study subjects were divided into groups based on grading of liver fibrosis （METAVIR scoring system） diagnosed by the method of liver biopsy. Results： 94 of 103 patients had undergone percutaneous liver biopsy. The liver shear-wave speeds showed no signifi- cant difference between F0 and healthy control group （P = O. 058 ）. Shear-wave speed was positively correlated with fibrosis grade, in other words, shear-wave speed increased as the grade of liver fibrosis goes higher. All comparison of shear-wave speeds between experimental groups had significant differences except for FO＆F1 and F3＆F4. The outcome indicated that differences between fibrosis stages could be distinguished by the speed of shear-wave produced by Virtual touch tissue quantification technique. The areas under ROC curve for the diagnosis of fibrosis F≥1,F≥2 ,F≥3 and F =4 were 0.834,0.958,0. 966 and 0.895, for the cutoff values of 1. 42m/s,1. 60 m/s,2. 19 m/s and 2.41 m/s respectively. Corresponding values of sensitivity and specificity were 72.0% ,93.2% ,96.3% ,93.9% and 82.1% ,86.4%, 88.2% ,81.9% o Conclusions： Liver fibrosis was the main influence factor of liver stiffness. Liver shear-wave speed generated by the method of virtual touch tissue quantification had positive correlation with fibrosis grades, and could be a stable and reliable modality for non-invasire liver fibrosis diagnosis.