二维剪切波弹性成像评估病毒性肝炎与非病毒性肝炎肝纤维化的效能比较

Comparison of two-dimensional shear wave elastography on liver fibrosis of patients with viral and non-viral hepatitis

目的探讨二维剪切波弹性成像（2D-SWE）对病毒性肝炎与非病毒性肝炎肝纤维化程度的诊断效能,为2D-SWE的临床应用提供科学依据。方法将2D-SWE应用于2011年4月至2013年1月于中山大学附属第三医院就诊的73例病毒性肝炎与60例非病毒性肝炎患者,以肝穿刺活检病理结果为金标准,分别比较病毒性肝炎与非病毒性肝炎不同纤维化程度肝杨氏模量值及其与病理分期的相关性、2D-SWE诊断肝纤维化的受试者操作特性曲线（ROC曲线）下面积。结果病毒性肝炎患者S0-1期、S2-3、S4期肝脏杨氏模量值分别为6.1（4.8-6.6）、10.3（7.6-14.0）和24.7（17.4-32.1）k Pa;非病毒性肝炎患者S0-1期、S2-3、S4期肝脏杨氏模量值分别为7.4（6.0-8.4）、10.7（8.0-13.5）、26.8（16.5-31.7）k Pa。病毒性肝炎与非病毒性肝炎患者S0-1期肝脏杨氏模量值的差异有统计学意义（Z=-3.45,P=0.001）,而S2-3期和S4期的差异均无统计学意义（Z=-0.40、-0.06,P=0.686、0.956）。病毒性肝炎与非病毒性肝炎患者肝脏杨氏模量值与纤维化病理分期的Spearman相关系数分别0.864和0.705（P=0.000,0.000）,两者比较差异有统计学意义（Z=-2.42,P=0.015）。2D-SWE诊断病毒性肝炎与非病毒性肝炎患者显著肝纤维化（S≥2）的ROC曲线下面积为0.964和0.817,两者比较差异有统计学意义（Z=-2.47,P=0.014）;诊断肝硬化（S=4）的ROC曲线下面积为0.930和0.900,两者比较差异无统计学意义（Z=-0.502,P=0.616）。结论 2D-SWE诊断病毒性肝炎与非病毒性肝炎患者肝纤维化的效能在无/轻度纤维化阶段存在差异,在显著/严重纤维化和肝硬化阶段,两者诊断效能相当。

Objective To explore the clinical application and diagnostic efficiency of two-dimensional shear wave elastography （2D-SWE） in assessing liver fibrosis of patients with viral and non-viral hepatitis. Methood Seventy-three patients with viral hepatitis and sixty with non-viral hepatitis scheduled for liver biopsy in the third Affiliated Hospital, Sun Yat-Sen University from April, 2011 to January, 2013 were enrolled in this study. The Young＇s modulus in different fibrosis stages, correlation coefficients of liver fibrosis level and area under receiver operating characteristic curve （ROC） were compared between patients with viral and non-viral hepatitis respectively. Results The hepatic Young＇s modulus of patients with viral and non-viral hepatitis in S0-1, S2-3, S4 were 6.1（4.8-6.6）kPa,7.4（6.0-8.4）kPa,10.3（7.6-14.0）kPa, and 10.7（8.0-13.5）kPa,24.7（17.4-32.1）kPa,26.8（16.5-31.7）kPa, respectively. The difference of Young＇s modulus between viral and non-viral hepatitis in S0-1 were statistically significant （Z=-3.45, P=0.001）, while not in S2-3 and S=4 （Z=-0.40, -0.06, P=0.686, 0.956）. Correlation coefficients of liver fibrosis with 2D-SWE in viral and non-viral hepatitis are 0.964,0.817 （ both P=0.000 ） with statistically significant difference （Z=2.42, P=0.015）. The area under ROC for S≥2 and S=4 in viral and non-viral hepatitis were 0.964 and 0.930,0.817 and 0.906 respectively. The comparison was significantly different for S≥2 （Z=-2.47, P=0.014）, while not for S=4 （Z=-0.502, P=0.616）. Conclusion In liver fibrosis assessment, the diagnosis efficiency of 2D-SWE in patients with viral and non-viral hepatitis was different and dependent on fibrosis stage.