声触诊组织量化技术无创评价慢性肝病肝纤维化程度的初步研究

Preliminary study on non-invasive evaluation of liver fibrosis stage in chronic liver disease by virtual tough tissues quantification technology

目的探讨声触诊组织量化（VTQ）技术无创评价慢性肝病患者肝纤维化程度的可靠性及肝脏的剪切波速（SWV）与肝病患者其他指标的相关性。方法利用VTQ技术测定165例慢性肝病患者（研究组）和161例健康体检者（NC组）肝脏Swv。研究组中131例慢性肝病患者行肝组织活检，分析SwV与体重指数（BMI）、肝功能、AST与血小板比值（APRI）、PLT、凝血酶原国际标准化比值（INR）、血清学肝纤维化指标、肝脏炎症程度（G）及纤维化程度（S）的相关性。结果纤维化分级S0、S1的慢性肝病患者的swv无明显差异（P=0．145），其他分级差异均有统计学意义：S4组〉s3组〉S2组〉S1组〉NC组（P均〈0．05），而纤维化（S0组）的慢性肝病患者与NC组的SWV无明显差异（P=1．972）。轻度纤维化（S0组、S1组、S2组）、重度纤维化（S，组）和肝硬化（S4组）组间比较，差异均有统计学意义（p均〈0．05），三组与NC组比较差异均有统计学意义（P均〈0．05）。当S≥S，时，ROC曲线下面积为0．988（95％C10．976～1．000）；ROC曲线下面积为0．989（95％C10．978～1．000）；以1．570m／s为界值，诊断S≥S，的敏感度为93．1％，特异度为92．5％；当S=s。时，以1．870m／s为界值，诊断S=s。的敏感度为97．7％，特异度为91．7％。INR、APRI、LN、HA、IV．C、PⅢP、TBil、G、S与swV均呈正相关（P均〈0．05），其中S与SwV高度相关；PLT与swv呈负相关（P=0．000），PLT值越低，测得swv越高，而年龄、性别和BMI与swv无相关性（P均〉0．05）。结论Swv与肝脏病理纤维化分级及血清肝纤维化指标之间存在一定的相关性，可用来评价慢性肝病患者的肝纤维化程度，VTQ技术具有广阔的应用前景。

Objective To approach the reliability of virtual tough tissues quantification （VTQ） technology by detecting the quantitative liver shear wave velocity （SWV） in estimating the liver fibrosis and the correlation between the liver shear wave velocity and the other indicators of liver disease. Methods SWV of I65 patients with chronic liver disease and 161 patients of normal controls （NC group） were assayed by VTQ technology. Liver biopsy of 131 patients was carried out. The correlation was analyzed between the SWV and other factors, such as body mass index （BMI）, liver function, aspartate aminotransferase to platelet ratio （APRI）, platelet （PLT）, international normalized ratio of prothrombin （INR）, serologic index of liver fibrosis, the grade of liver inflammation （G）, and fibrosis stage （S）. Results SWV among the pathological stage of S0, S1 in chronic liver disease patients had no significant difference （P = 0.145）, Other stages have statistically significant differences： S4 〉 S3 〉 S2 〉 S1 〉 NC （P 〈 0.05）. SWV between the fibrosis stage of So in chronic liver disease patients and NC had no significant difference （P = 1.972）. Among the mild fibrosis （So, S1, S2）, severe fibrosis （$3） and cirrhosis （S4） have statistically significant differences （P 〈 0.05）, and they all have statistically significant differences when compared with NC group. The areas under ROC curves were 0.988 （95%CI 0.976-1.000） for S≥S3, and 0.989 （95%CI 0.976-1.000） for S = S4. In our study, the optimal cut off value was 1.570 m/s for S ≥ S3, with a sensitivity of 93.1%, specificity of 92.5%; and. 1.870 m/s for S = S4, with a sensitivity of 97.7%, specificity of 91.7%. 1NR, APRI, LN, HA, IV.C, PⅢP, TBil, G and S positively correlated with SWV （P 〈 0.05）, among them, S is highest correlated with SWV; Platelet negatively correlated with SWV （P = 0.000）. The lower the platelet level, the higher SWV. While age, gender and BMI had no correlation with SWV （P 〉 0.05）. Conclusions There is a correlation between SWV and liver fibrosis pathology stage and serum index of liver fibrosis, which suggest that SWV might be used for evaluating the liver fibrosis stage of patients with chronic liver diseases, and VTQ technology promising have a board in assessment of liver fibrosis.