声触诊组织量化技术评估慢性乙型肝炎肝纤维化分期的研究

Correlation study on virtual touch tissue quantification and the pathological stages of liver fibrosis in chronic hepatitis B

目的探讨声触诊组织量化（VTQ）技术评估慢性乙型肝炎肝纤维化分期的价值。方法应用VTQ测量40例正常对照组和64例经肝穿活检病理证实的慢性乙型肝炎肝剪切波速度（SWV），比较各组间差异及其与肝纤维化程度的相关性，通过ROC曲线确定界值。结果对照组肝SWV为（1．04±0．13）mjs，慢性乙型肝炎S0组的SWV为（1．17±0．08）m／s，S，组为（1．33±0．32）m／s，s，组为（1．53±0．32）m／s，S，组为（2．09±0．54）m／s，S4组为（2．18±0．70）m/s。正常组与慢性乙型肝炎组的SWV对比差异具有统计学意义（F=34，97，P=0．00），其中S0～S2与S3～S4组比较差异具有统计学意义（F=8．87，P=0．00）。肝SWV与肝纤维化分期呈正相关（r=0．67，P=0．00）。以SWV1．43m／s为截点诊断s≥s3的曲线下面积0．875，敏感性100％，特异性62．5％。结论SWV与肝纤维化分期具有良好的相关性，且其对s3～s4的纤维化能作出较准确评估，可作为慢性肝炎肝纤维化分期的无创性诊断指标。

Objective To investigate the correlation between virtual touch tissue quantification （VTQ） and the pathological grading of liver fibrosis in chronic hepatitis B. Methods 64 chronic hepatitis B patients （the chronic hepatitis group） and 40 healthy volunteers （the controlled group） were collected. The patients in the chronic hepatitis group were underwent liver biopsy. According to the hepatic fibrosis degree, the patients in the test group were classified into stage 0, 1 , 2,3 and 4. The liver shear wave velocities （SWV） of all the participant were measured by VTQ. The cut off values were determined by an analysis of receiver operating characteristic （ROC） curve. Results The mean SWV was （ 1.04 ± 0.13） m/s in the controlled group. The SWV in stages 0,1,2,3,and 4 were （1.17±0.08）m/s, （1.33 ± 0.32）m/s, （1.53 ± 0.32）m/s, （2.09 ± 0.54）m/s, （2.18 ± 0.70） m/s,respectively. There was a significantly difference in SWV between the controlled group and the chronic hepatitis group （ F = 34.97, P = 0.00）. The SWV were significantly different not only between stages 0 - 2, and 3, but also between 0 - 2 and 4 （ F = 8.87, P = 0.00）. A positive correlation was observed between the liver fibrosis and the SWV in the chronic hepatitis group （ r = 0.67, P = 0.00）. When a cut off value was set at 1.43 m/s,area under ROC curve was 0. 875. The sensitivity and specificity were 100% and 62.5%. Conclusions SWV has a better correlation with liver fibrosis. VTQ can make an accurate assessment for stage 3 and stage 4 of the chronic hepatitis B. Therefore, VTQ can be used as a noninvasive and reliable diagnostic indicator for chronic hepatitis B.