实时组织弹性成像与肝纤维化指标联合诊断肝纤维化的研究

Combined detection of real-time tissue elastography and indicators of hepatic fibrosis in diagnosing hepatic fibrosis

目的:通过对慢性肝病患者进行肝脏实时组织弹性成像(RTE)检查以及透明质酸、层黏连蛋白、IV型胶原蛋白的检测,探讨联合检测对诊断肝纤维化的临床应用价值。方法:29例慢性肝炎患者、27例肝硬化患者、25例健康体检者被纳入研究,行RTE检查和应用酶联免疫法检测肝纤维化指标。结果:RTE评为阳性者36例,评为阴性者20例,RTE诊断肝纤维化的敏感度、特异度、准确率分别为96.30%(26/27)、65.52%(19/29)和80.36%(45/56);与正常对照组相比,慢性肝炎组和肝硬化组患者肝纤维化指标(透明质酸、层黏连蛋白、IV型胶原)明显增高(P<0.01)。随着病变进展,肝硬化组透明质酸和IV型胶原含量较慢性肝炎组进一步增高,差异有统计学意义(P<0.05)。结论:RTE为诊断肝纤维化提供了新的手段,是一项具有发展前景的新的无创性诊断方法,联合肝纤维化指标(透明质酸、层黏连蛋白、IV型胶原)对慢性肝病患者肝纤维化诊断具有重要临床意义,并可预示病变进展程度。

Objective：To observe the clinical value of real -time tissue elastography （RTE） and Indicators of hepatic fibrosis （ HA, LN and IV - C） in diagnosing hepatic fibrosis in chronic hepatitis patients. Methods： Twenty -nine patients with chronic hepatitis, 27 patients with cirrhosis and 25 who took physical examinations were enrolled. RTE was performed and indicators of hepatic fibrosis were measured by ELISA. Results：Thirty - six patients were RTE positive, 20 were RTE negative. The sensitivity, specificity and the accuracy rate of RTE for diagnosing hepatic fibrosis was 96. 30% （ 26/27 ）, 65. 52% （ 19/29 ）, 80.36% （ 45/56 ） respectively, the indicators of hepatic fibrosis （HA, LN and IV -C） were apparently increased in both chronic hepatitis group and cirrhosis group （ P 〈 0.01 ） compared with normal controls group. With the development of hepatic disease, the levels of HA and IV - C in cirrhosis group were apparently increased than that of in hepatitis group （ P 〈 0.05 ）. Conclusion：RTE is a new and promising sonography - based noninvasive method for the assessment of hepatic fibrosis in patients with chronic hepatitis B. The combined detection of RTE and indicators of hepatic fibrosis （ HA, LN and IV -C） have great clinical significance in diagnosing hepatic fibrosis in chronic hepatitis patients, which can prognosticate the development of hepatic pathological change.