实时剪切波弹性成像与常规超声评估慢性乙型肝炎肝纤维化的比较

Comparative study of real-time shear wave elastography and ultrasonography in the assessment of liver fibrosis in chronic hepatitis B

目的对比分析实时剪切波弹性成像（real-time shear wave elastography，SWE）和常规超声检查评估慢性乙型肝炎肝纤维化的价值。方法对114例行肝组织学活检的慢性乙型肝炎患者同时行常规超声和SWE检查。常规超声对肝包膜、肝实质和脾大小进行半定量评分，评分相加为超声积分；SWE检测肝弹性模量。以肝组织病理学结果为金标准，比较SWE、常规超声与肝纤维化病理分期的相关系数、诊断肝纤维化各分期的ROC曲线下面积，以及不同操作者之间的组内相关系数（ICC）。结果SwE与肝纤维化病理分期的相关系数（r=0．799，95％CI0．413—0．670，P=0．000）高于常规超声（r=0．530，95％CI0．721—0．857，P=0．000）。常规超声和SWE诊断肝纤维化病理分期S≥2、S≥3和S=4的ROc曲线下面积分别为0．765和0．892、0．763和0．941、0．800和0．965，SWE高于常规超声（P=0．008、P〈0．001、P=0．005）。SWE的ICC（O．968，95％CI0．928—0．986）高于常规超声（0．886，95％CI0．834—0．921）。结论SWE简便易行，可重复性好，诊断肝纤维化准确性高，能弥补常规超声的不足。

Objective To compare real-time shear wave elastography （SWE） with conventional ultrasonography（US） in the assessment of liver fibrosis in patients with chronic hepatitis B. Methods One hundred and fourteen patients with chronic hepatitis B scheduled for liver biopsy were studied. Both SWE and US were performed on these patients in a single day. The SWE assessed the liver fibrosis with elasticity modulus,while US with a scoring system consisted of liver surface, parenchyma and splenic size. The correlation coefficient of liver fibrosis level,receiver operating characteristic （ROC） curve of S≥2,S≥3 and S = 4 and the interclass correlation coefficient （ICC） of SWE and US were compared. Results The correlation coefficient of liver fibrosis level for SWE （ r = 0. 799,95%CI 0. 413 - 0. 670, P = 0. 000） was higher than US scores （ r = 0. 530,95%CI 0. 721 - 0. 857, P = 0. 000）. The area under ROC curves for S≥2,S≥3 and S= 4 of US and SWE were 0. 765 and 0. 892,0. 763 and 0. 941,0. 800 and 0. 965,respectively, which indicated that SWE was better than US scores for the evaluation of liver fibrosis（ P = 0. 008, P 〈0. 001, P = 0. 005） ,respectively. The ICC of SWE （ICC= 0. 968,95%CI 0. 928 - 0. 986） was higer than US scores （ICC = 0. 886,95 %CI 0. 834 - 0. 921）. Conclusions SWE has high reproducibility and accuracy in the assessment of liver fibrosis in chronic hepotitis B,and was better than US.