瞬时弹性扫描对慢性乙型肝炎抗病毒治疗后肝脏纤维化的评价应用研究

A applied study on the evaluation of transient elastography for liver fibrosis after antiviral treatment of patients with chronic hepatitis B

目的:应用瞬时弹性成像(TE)技术,评价乙型肝炎患者经恩替卡韦抗病毒治疗后肝脏纤维化的疗效。方法:选取医院收治的60例乙型肝炎患者,根据乙型肝炎检查结果将其分成乙型肝炎E抗原(HBe Ag)阳性组(32例)和HBe Ag阴性组(28例),采用Fibro Scan瞬时弹性扫描设备,观察两组患者经恩替卡韦治疗前后肝脏弹性值和肝脏纤维化病理学的变化,同时观察谷丙转氨酶(ALT)的恢复情况、乙肝病毒的脱氧核糖核酸(HBV DNA)的变化情况。结果:HBe Ag阳性组和HBe Ag阴性组治疗前后的肝脏纤维化半定量计分值比较,差异均有统计学意义(t=5.524,t=5.389;P<0.05);HBe Ag阳性组和HBe Ag阴性组治疗前后的肝脏弹性值变化比较,差异均有统计学意义(t=5.235,t=5.171;P<0.05);肝脏弹性值与肝脏纤维化半定量计分值之间呈正相关关系(r=0.824,P<0.05);HBe Ag阳性组患者ALT恢复率为87.5%(28/32),HBe Ag阴性组患者ALT恢复率为82.1%(23/28),两组ALT恢复率比较,差异无统计学意义(x2=0.272,P>0.05)。结论:TE技术可以动态观察和评价抗病毒治疗的效果,实现无创、快速和可重复地对患者肝纤维化进行检测,具有临床应用价值。

Objective To apply transient elastography technique to evaluate the degree of liver fibrosis after patients with chronic hepatitis B virus received antiviral treatment of Entecavir. Methods： 60 patients with chronic hepatitis B were divided into HBeAg positive group（32 cases） and HBeAg negative group（28 cases） according to examination results. And the changes of elasticity value and pathology of liver fibrosis pre and post treatment of Entecavir were observed by adopting FibroScan transient elastography. At the same time, the recovery situation of glutamic-pyruvic transaminase （ALT） and the change of HBV DNA were observed. Results： The differences of the semi quantitative score of liver fibrosis between pre and post treatment in HBeAg positive group and HBeAg negative group were statistically significant （t=5.524, t=5.389, P〈0.05）, respectively. The differences of value of liver elasticity of HBeAg positive group and HBeAg negative group between pre and post treatment were significant （t=5.235, t=5.171, P〈0.05）. There was a positive correlativity existed in the value of liver elasticity and the semi quantitative score of liver fibrosis （r=0.824, P〈0.05）. The recovery rate of ALT in patients with HBeAg positive was 87.5%（28/32）, and it was 82.1% in patients with HBeAg negative （23/28）. And the difference of recovery rate of ALT between the two groups was no significant （x2=0.272, P〉0.05）. Conclusion： TE technique can dynamically observe and evaluate the effect of antiviral therapy, and can achieve noninvasively, fast and repeatedly detect liver fibrosis of patient with chronic hepatitis B. Therefore, it has application value in clinical practice.