声辐射力脉冲成像技术定量评价慢性丙型肝炎肝纤维化的临床研究

Clinical value of acoustic radiation force impulse imaging for quantitative evaluation of degree of liver fibrosis in chronic hepatitis C patients

目的探讨声脉冲辐射力成像技术（ARFI）在评价慢性丙型肝炎肝纤维化程度上的临床价值。方法对108例慢性丙型肝炎患者应用ARFI技术对肝脏的实时超声弹性进行测量，患者均进行肝活组织检查，以病理检查结果与肝脏的实时超声弹性测值进行比较，计算ARFI技术诊断肝纤维化的灵敏度，特异度，取敏感度和特异度之和最大时为最佳界限值。应用SPSS10．0统计学软件进行统计学处理，多组间比较根据数据是否正态分布及方差齐性来选择采用参数或非参数检验分析，相关性分析采用spearman相关分析。结果慢性丙型肝炎患者肝纤维化分期S1～S4期的ARFI平均值分别为（1．26±0．27）m／s（n=36）、（1．45±0．51）m／s（n=31）、（2．01±0．54）m／s（n=27）和（2．28±0．82）m／s（n=14），组间比较，秩和检验KW=42．307，P〈0．01。肝脏ARFI测值与肝纤维化分期相关，相关系数为0．61，P〈0．01。ARFI技术诊断慢性丙型肝炎肝纤维化S≥2，S≥3和S=4的受试者工作特征曲线下面积分别为0．779，0．863和0．880。结论ARFI可较准确的定量评价慢性丙型肝炎肝纤维化程度，具有良好的临床应用前景。

Objective To investigate the diagnostic value of acoustic radiation force impulse （ARFI） imaging technology for the assessment of liver fibrosis in chronic hepatitis C （CHC） patients. Methods One-hundred-and-eight CHC patients were examined by real-time ultrasound elastography using the Acuson S2000 ARFI instrument （Siemens Healthcare） and underwent liver biopsy for pathohistological analysis. The correlation between liver fibrosis grades determined by the two approaches was analyzed. The cut-off values for diagnosis by ARFI （S 〉 2, S 〉 3 and S = 4） were determined by generating a receiver operating characteristic （ROC） curve. Results The spectrum of liver stiffness detected by ARFI sonoelastography included S1 at （1.26 ± 0.27） m/s （n = 36）, S2 at （1.45 ± 0.51） m/s （n = 31）, S3 at （2.01 ±0.54） m/s （n = 27）, and S4 at （2.28 ± 0.82） m/s （n = 14）. The ARFI values were significantly different among the four different stages of liver fibrosis （P 〈 0.001）. The liver stiffness detected by ARFI sonoelastography was significantly correlated with the liver fibrosis stage determined by the gold standard pathohistological analysis （Spearman＇s rank coefficient： 0.61, P 〈 0.001）. Using the ARFI technology for assessment of liver fibrosis gave areas under the ROC curve of 0.779 for S 〉 2 patients,of 0.863 for S 〉 3 patients, and of 0.0880 for S = 4 patients. Conclusion The real-time ultrasound elastographic ARFI technology can show the elasticity modulus of liver, and its data values positively correlate with the patho-histology grade of liver fibrosis in CHC patients. ARFI technology is easy to operate, non-invasive, and quantitative, and has potential clinical value for assessing liver fibrosis in CHC.