肝脏弹性测量值对慢性乙型肝炎肝纤维化的诊断意义

Diagnostic significance of LSM in patients with chronic hepatitis B

目的 评价肝脏弹性测量值（LSM）对慢性乙型肝炎肝纤维化的诊断意义.方法 选择185例慢性乙型肝炎患者为研究对象,均行肝穿刺活检和应用超声实时剪切波成像技术检测LSM,比较两者的肝纤维化程度并进行相关性分析,评价LSM对慢性乙型肝炎肝纤维化分期的诊断价值.以肝组织病理为标准对肝纤维化程度进行分期,比较不同肝纤维化分期间LSM的差异,分析LSM与肝脏病理纤维化分期间的相关性.结果 两种肝脏病理纤维化分期与LSM之间的差异有统计学意义（F=85.145,P ＜0.001）,且相邻分期间LSM比较差异均有统计学意义（P＜0.01）.Spearman等级相关分析显示,LSM与肝纤维化分期呈正相关（r=0.846,P＜0.01）,绘制ROC曲线发现,诊断S0-S4期肝纤维化的ROC曲线下面积（AUROC）为0.92,灵敏度为0.96,特异度为0.82,临界值为14.65 kPa.结论 LSM对慢性乙型肝炎肝纤维化具有较好的诊断价值,为无创性检查方法之一,尤其对于有禁忌证或拒绝进行肝穿刺活检的慢性乙型肝炎患者进行LSM检查是协助诊断慢性乙型肝炎肝纤维化程度的又一选择,值得临床推广应用.

Objective To investigate the diagnostic significance of LSM in patients with chronic hepatitis B（CHB）.Methods One hundred and eighty five CHB Patients were inrolled in this study totally.All of them underwent liver stiffness measurement （LSM） by Ultrasonic shear wave imaging in real time before one week of Liver biopsy.With liver biopsy as the standard,the liver fibrosis was staged,the results of Liver biopsy and Ultrasonic shear wave imaging in real time was compared,and the correlation between fibrosis stage and LSM were analyzed,and the receive operating characteristic （ROC） was adopted to analyze the accuracy of Ultrasonic shear wave imaging in real time for diagnosing liver fibrosis.Results LSM showed significant difference among patients with different fibrosis stages（F =85.145,P 〈 0.001）,meanwhile significant differences were also noted between the adjaced groups （P 〈 0.01）.Spearman correlation showed positive correlation（r =0.846,P 〈 0.01）.When Ultrasonic shear wave imaging in real time were applied for the assessment of liver fibrosis,the ROC area under the curve,sensitivity,specificity,and cut-off value were 0.92,0.96,0.82 and 14.65kpa for the patients with S0-S4.Conclusions As one of noninvasive approaches,LSM is valuable for the diagnosis of liver fibrosis in CHB patients.