瞬时弹性成像与实时组织弹性成像评估肝纤维化的比较

Comparative study of transient elastography versus real-time tissue elastography for assessment of liver fibrosis in patients with chronic liver disease

目的对比分析瞬时弹性成像和实时组织弹性成像评估慢性肝病肝纤维化的价值。方法对92例行肝组织学检查的慢性肝病患者同时行瞬时弹性成像和实时组织弹性成像检查，以肝组织病理学检查结果为金标准，比较瞬时弹性成像和实时组织弹性成像与肝纤维化病理分期的相关系数、诊断肝纤维化的受试者工作特征曲线下面积。结果瞬时弹性成像与肝纤维化病理分期的相关系数（r=0.755，95％CI0.651～0.831，P=0.000）高于实时组织弹性成像（r=0.481，95％CI0.306～0.624，P=0.000），Z=3.07，P=0.002。瞬时弹性成像和实时组织弹性成像诊断肝纤维化（S≥2）、肝硬化（S=4）的受试者工作特征曲线下面积分别为0.903和0.740、0.915和0.786，瞬时弹性成像高于实时组织弹性成像沪值分别为0.003和0.020）。结论瞬时弹性成像诊断幔性肝病肝纤维化效能优于实时组织弹性成像，但后者与二维超声图像融合，具有广泛的应用前景。

Objective To compare the abilities of transient elastography （TE） versus real-time tissue elastography （RTE） for assessing liver fibrosis in patients with chronic liver disease. Methods Ninety- two patients with chronic liver disease were enrolled in the study, and included 77 cases of chronic hepatitis B, 4 cases of chronic hepatitis C, 4 cases of autoimmune liver disease, 2 cases of primary biliary cirrhosis, 1 case of abnormal bile duct development, and 4 cases of unknown etiology. All patients were assessed by both TE and RTE in a single day. The correlation coefficient of liver fibrosis level and the receiver operating characteristic （ROC） curve of S 〉 2 and = 4 of TE and RTE were determined. The values were compared using findings from pathological analysis as reference. Results The correlation coefficient of liver fibrosis level was significantly higher for TE （r = 0.755, 95% CI： 0.651-0.831,P = 0.000） than for RTE （r = 0.481, 95% CI： 0.306-0.624,P = 0.000） （Z= 3.07,P = 0.002）. The areas under the ROC curves for S 〉 2 and = 4 were 0.903 and 0.740 for TE and 0.915 and 0.786 for RTE, respectively, indicating that the performance of TE was superior to that of RTE. Conclusion TE was superior to RTE for assessment of liver fibrosis.