Nr超声造影技术及血清学指标对慢性乙型肝炎肝纤维化评估的相关性研究

Correlation between ultrasound imaging and serum markers of liver fibrosis in patients with chronic hepatitis B

目的:探讨超声造影技术及血清学指标对慢性乙型肝炎肝纤维化评估临床价值。方法:分析我院20例行肝穿刺活检慢性乙型肝炎患者的临床资料,依肝纤维化程度的不同分为轻度肝纤维化组、中度肝纤维化组、重度肝纤维化组,另选取健康志愿者为对照组,采用彩色多普勒超声仪,运用血流显像技术及自动追踪增强定量分析,采用第二代微气泡造影剂声诺维进行造影,分析造影剂到达门静脉时间(PVAT)、肝动脉时间(HAAT)、肝静脉时间(HVVT),计算肝动静脉渡越时间(VAT)及肝-门静脉渡越时间(VVT),采用化学发光法检测血清肝纤维透明质酸(HA)、层粘连蛋白(LN)及Ⅳ型胶原(ⅣC)指标。结果:各组HAAT、PVAT指标相比,差异无统计学意义(P>0.05);随着纤维化程度的加重,HVAT、VAT、VVT时间逐渐缩短,轻度肝纤维化组与对照组相比,差异无统计学意义(P>0.05);轻度、中度、重度肝纤维化组间相比,差异有统计学意义(P<0.05);随着纤维化程度的加重,HA、ⅣC、LN水平逐渐升高,轻度肝纤维化组与对照组相比,差异无统计学意义(P>0.05);轻度、中度、重度肝纤维化组间相比,差异有统计学意义(P<0.05)。结论:肝纤维化血清学指标可指导肝纤维化程度的分级,超声造影可较准确地反映肝纤维化肝脏血流动力学的改变,对肝纤维化程度的评估、病情监测、临床治疗具有一定指导意义。

Objective： To investigate the clinical value of ultrasonic imaging in the assessment of liver fibrosis in patients with chronic hepatitis B. Methods： Clinical data of 20 patients underwent liver biopsy were analyzed, and they were divided into mild hepatic fibrosis group, moderate fibrosis group, severe fibrosis group according to the degree of hepatic fibrosis. Healthy volunteers were selected as control group. Color Doppler ultrasound, imaging technology and automatic tracking were applied to do strengthened quantitative analysis. The second generation of microhubhle contrast agent SonoVue was applied to analyzed the portal time （PVAT）, hepatic artery time （HAAT）, hepatic vein （HVVT）, the calculation time of hepatic arteriovenous transit time （VAT） and hepatic portal vein transit time （VVT）, using chemiluminescence detection to detect the serum liver fiber hyaluronic acid （HA）, laminin （LN） and collagen type IV （CIV） index. Results： There was no significant difference in HAAT, PVAT, VAT, VVT and HVAT among the three groups （P〉0.05）. With increase of severity, HVAT, VAT, VVT become shorter showing significant difference among the mild, moderate and severe fibrosis group （P〈0.05）. But no significant difference in HAAT, PVAT, VAT, VVT and HVAT was found between the control group and the mild group. Conclusion： Serum liver fibrosis indexes can be used for assessment of liver fibrosis severity. And the ultrasound contrast image can reflect the changes of liver blood flow dynamics indicating it can be used for assessment of liver fibrosis severity, monitoring and treatment of the disease.