瞬时弹性成像技术定量评估CHB病人肝脏炎症程度

QUANTITATIVE ASSESSMENT OF LIVER INFLAMMATION IN PATIENTS WITH CHRONIC HEPATITIS B USING TRANSIENT ELASTOGRAPHY

目的探讨超声瞬时弹性成像(FibroScan)受控衰减参数(CAP)无创定量评估慢性乙型病毒性肝炎(CHB)病人肝脏炎症的阈值。方法选取2013年9月—2015年1月入住我院的CHB病人80例,同时行FibroScan测量CAP值及肝穿刺活检,分析CAP值评估肝损伤方法的灵敏度和特异度。结果 CHB病人CAP值与肝组织炎症分级和纤维化分期呈显著负相关(r=-0.340、-0.347,P<0.05),CAP值与肝脏脂肪变程度分级呈明显正相关(r=0.419,P<0.01)。轻度和中重度炎症、肝脂肪变CHB病人的CAP值之间差异有显著性(t=2.409,P<0.05)。以分级指数≥2作为诊断中重度炎症、纤维化和脂肪化的标准,CAP值与炎症指数、纤维化指数、脂肪变指数的ROC曲线下面积(AUC)分别为0.840 5、0.820 5、0.910 1。阈值分析表明,区分肝组织轻度和中重度炎症的CAP值为194dB/m,方法的灵敏度和特异度分别为81%和89%;以CAP值236dB/m为诊断阈值,能将肝组织轻度和中重度纤维化区分开,灵敏度和特异度分别为79%和85%;CAP阈值为267dB/m能将肝组织轻度和中重度脂肪病变区分开,灵敏度和特异度分别为85%和91%。结论 FibroScan CAP值能准确区分CHB病人肝组织轻度和中重度炎症、纤维化和肝脂肪变程度,可用于无创定量评价CHB病人肝脏病损程度。

Objective To investigate the threshold value of liver inflammation in patients with chronic hepatitis B（CHB）using FibroScan Controlled Attenuation Parameters（CAP）. Methods FibroScan and liver biopsy were performed in 80 patients with CHB hospitalized between September 2013 and January 2015.The sensitivity and specificity of CAP value for evaluating liver lesions were analyzed. Results The CAP value in CHB patients was negatively correlated with inflammation grade and fibrosis stage of the liver（r=-0.340,-0.347;P 〈0.05）.There was a positive correlation between CAP value and degree of hepatic steatosis（r=0.419,P〈0.01）.The differences in CAP values between mild and moderate-severe inflammation and fatty liver were significant（P〈0.05）.Taking classification index of≥2as a standard for diagnosing moderate-severe inflammation,fibrosis and pimelosis of liver,the area under ROC curve of CAP values of inflammation,fibrosis and fatty degradation were 0.840 5,0.820 5and 0.910 1,respectively.Threshold analysis indicated that the CAP value to classify between mild and moderate-severe hepatic inflammation was 194dB/m and its sensitivity and specificity were 81% and 89%,respectively.Taking CAP value of 236dB/m as diagnostic threshold,mild fibrosis and moderate-severe fibrosis of liver tissue could be differentiated,with sensitivity and specificity of 79% and 85%,respectively,and when the CAP threshold value was 267dB/m,the mild and moderate-severe fatty lesion area of liver could be identified,with a sensitivity of 85% and specificity of 91%. Conclusion FibraoScan CAP value can accurately distinguish between mild and moderate-severe inflammation,fibrosis and fatty degradation in liver,which can be used for a quantitative evaluation of liver lesions in patients with chronic hepatitis B.