慢性乙型肝炎肝纤维化患者实时剪切波弹性成像的应用价值分析

Value of real-time shear wave elastography in assessing liver fibrosis in patients with chronic hepatitis B

目的探讨实时剪切波弹性成像技术(shear wave elastography,S W E)与常规超声检查在评估慢性乙型肝炎患者肝纤维化中的应用价值.方法回顾性分析唐山市传染病医院在2015-08/2017-06收治的慢性乙型肝炎患者87例,分别进行常规超声和S W E检查,以病理穿刺活检结果为金标准,分析常规超声、SWE与肝纤维化病理分期的相关性,评估常规超声、SWE诊断肝纤维化各分期的ROC曲线下面积,比较常规超声与SWE在诊断肝纤维化各分期的诊断效能.结果 (1)常规超声积分在肝纤维化相邻分期之间(S0-S1vs S2,S2 vs S3,S3 vs S4)比较差异无统计学意义(P=0.451,0.639,0.103);但不相邻分期(S0-S1 vs S3,S0-S1vs S4,S2 vs S4)之间常规超声评分比较差异具有统计学意义(P=0.001,0.000,0.000);SWE在不同肝纤维化分期的弹性模量值分别为(S0=5.625 kPa±1.221 kPa,S1=7.172 k Pa±1.818 k Pa,S2=10.295 kPa±3.122kPa,S3=15.541 kPa±4.340 kPa,S4=23.918 kPa±5.697 kPa),肝脏弹性模量在相邻及不相邻分期之间比较差异均具有统计学意义(P均<0.05);(2)Spearman相关性分析显示,常规超声积分、SWE弹性模量值与肝纤维化分期之间存在正相关(r=0.529,0.798,P均<0.001);SWE弹性模量值与肝纤维化之间相关系数高于常规超声积分;(3)常规超声积分在诊断肝纤维化S≥2、S≥3和S4期的ROC曲线下面积分别为0.766,0.891,0.764;SWE值在诊断肝纤维化S≥2、S≥3和S4期的ROC曲线下面积分别为0.941,0.948,0.952;SWE的诊断效能高于常规超声(P<0.05).结论相比于常规超声,SWE技术在评估慢性乙型肝炎患者肝纤维化程度方面具有更高的应用价值,可重复性好,具有较高的潜在临床价值.

AIM To evaluate the value of real-time shear wave elastography （SWE） and routine ultrasonography in the assessment of liver fibrosis in patients with chronic hepatitis B.METHODS A retrospective analysis was performed of 87 patients with chronic hepatitis B treated in Tangshan Infectious Disease Hospital from August 2015 to June 2017. All patients underwent routine ultrasound and SWE examinations. Using the pathological biopsy results as the gold standard, the results of routine ultrasound and SWE in staging and diagnosing liver fibrosis were compared by ROC curve analysis.RESULTS There was no significant difference in conventional ultrasound scores between adjacent stages of liver fibrosis （S0-S1 vs S2, S2 vs S3, and S3 vs S4）, but there were significant differences between non-adjacent stages （S0-S1 vs S3, SO-S1 vs S4, and S2 vs S4; P = 0.001, 0.00G and 0.000, respectively）. The elastic modulus values of SWE in different stages of liver fibrosis were 5.625 kPa ± 1.221 kPa （SO）, 7.172 kPa±1.818 kPa （S1）, 10.295 kPa ±3.122 kPa （S2）, 15.541 kPa ± 4.340 kPa （S3）, and 23.918 kPa ±5.697 kPa （S4）. There was a significant difference in the elastic modulus values between both adjacent and non-adjacent stages （P 〈 0.05 for all）. Spearman correlation analysis showed that there was a positive correlation between conventional ultrasound score or SWE elastic modulus and liver fibrosis stage （r = 0.529, 0.798, P 〈 0.001）. The areas under the ROC curve of conventional ultrasound score in diagnosing liver fibrosis S ≥ 2, S 3, and S4 were 0.766, 0.891, and 0.764, respectively; the corresponding values of SWE were 0.941, 0.948, and 0.952, respectively. The diagnostic efficiency of SWE was higher than that of conventional ultrasound （P 〈 0.05）.Compared with conventional ultrasound, SWE has higher value in assessing the degree of liver fibrosis in patients with chronic hepatitis B, with better reproducibility.