声触诊组织成像与量化技术评价慢性肝病肝纤维化分期的研究

Virtual Touch tissue imaging and quantification for hepatic fibrosis in patients with chronic liver diseases

目的探讨应用声触诊组织成像与量化技术评价肝脏纤维化分期的意义及其临床应用价值。方法筛选33例健康志愿者为对照组(S0),再选择经肝组织活检已证实肝脏纤维化程度的弥漫性肝病患者77例(S1～S4),其中73例为HBV感染者,应用声触诊组织成像与量化技术测量所有受检者肝脏的s3、s4、s5、s6、s7、s8段以及肝包膜的剪切波速度,运用二维超声测量肝、脾大小与门静脉主干内径。按照肝脏组织学病理结果将77例弥漫性肝病患者分为无肝脏纤维化(S1)组、肝脏纤维化(S2～S3)组、早期肝硬化(S4)组。结果 S4组患者肝脏各段剪切波速度较S0组、S1组和S2～S3组患者的各肝段剪切波速度显著增快,且差异具有统计学意义(P<0.05),S2～S3组与S0组、S1组间的相应肝段剪切波速度相比也显著增快(P<0.05),S1组与S0组间、各组间肝包膜剪切波速度比较差异无统计学意义(P>0.05)。结论声触诊组织成像与量化技术定量分析肝脏组织的弹性、剪切波速度等生物力学属性,从而无创评估肝脏纤维化程度,方法简易且准确、重复性强、取样点多,值得推广应用。

Objective To investigate the value of Virtual Touch tissue imaging and quantification （VTQ） in evaluating the stage of hepatic fibrosis in patients with chronic liver diseases. Methods Total of 33 normal subjects group （ So ） and 77 patients with diffuse hepatic disease performed liver biopsy （ S1-S4 ） were selected to accept VTQ, the shear wave velocity of hepatic segments s3, s4, s5, s6, s7, s8 and liver capsule were measured. The size of liver, spleen and portal veins diameter were also acquired. All of the 77 patients were divided into three groups ： without hepatic fibrosis （ S1 ）, hepatic fibrosis （ S2-S3 ）, early-stage cirrhosis （ S4 ）. Results The shear wave velocity of hepatic segments s3, s4, sS, s6, s7 and s8 in S4 group were significantly faster than So, S1 and S2-S3 group （ P 〈 0.05 ）. Among S2-S3 , So and S1 groups, the shear wave velocity of hepatic segments s3, s4, s5, s6, sT, s8 also had statistical difference （ P 〈 0.05 ） , there were no significant difference in other parameters （ P 〉 0.05 ）. Conclusions The invasive Virtual Touch tissue imaging and quantification （ VTQ ） could evaluate the stage of hepatic fibrosis in patients suffered from diffuse hepatic disease. The measurement was accurate, feasible and suitable for clinical application.