MRI弹力成像技术联合血清学指标在乙型肝炎肝纤维化诊断中的应用价值

Value of MRI elastography combined with serological markers in diagnosis of hepatitis B liver fibrosis

目的 探讨乙型肝炎肝纤维化临床诊断中磁共振（MRI）弹力成像联合血清指标的临床价值.方法 选取2017年1月至2017年12月黑龙江省医院收治的乙型肝炎肝纤维化患者66例,均行肝脏穿刺活检确诊,分别使用透明质酸（HA）、Ⅲ型前胶原蛋白（PCⅢ）、IV型胶原蛋白（IV-C）及层粘连蛋白（LN）等血清指标及MRI弹力成像技术对患者进行检测,观察比较不同检查方法的诊断准确率.结果 HA、PCⅢ、IV-C及LN等血清指标诊断准确率为80.3％,MRI弹力成像检测准确率为81.8％,二者联合诊断准确率为93.9％.单纯MRI检查与单纯血清指标检查准确率比较差异未见统计学意义（P〉0.05）;MRI联合血清指标诊断准确率高于两种单独检测,差异有统计学意义（P〈0.05）.患者肝纤维化程度与MRI弹性值呈正相关（P〈0.05）,MRI检查结果与血清HA、LN、PCⅢ及IV-C指标呈负相关（P〈0.05）.结论 血清指标联合MRI弹力成像技术对乙型肝炎肝纤维化的诊断明显优于单一检查方法,值得于临床中进一步推广使用.

Objective To investigate the value of magnetic resonance imaging （MRI） elastography combined with serological markers in diagnosis of hepatitis B liver fibrosis. Methods Sixty-six patients with hepatitis B liver fibrosis treated in Heilongjiang Provincial Hospital from January 2017 to December 2017 were selected as research objects. All patients were determined by liver bispsy, and underwent hyaluronic acid （HA） test, procollagen Ⅲ （PC Ⅲ ） test, Ⅳ collagen （Ⅳ-C） test, laminin （LN） test and MRI elastography to compare diagnosis accuracy of these methods. Results The diagnoscant difference in diagnostic accuracy between single serological markers test and single MRI elastography （P 〉 0. 05 ）, but the diagnostic accuracy of MRI combined with serological markers was significantly higher than single tests （P 〈 0. 05 ）. Severity of liver fibrosis was positively correlated with MRI elasticity value （P 〈 0. 05 ） ; MRI result was negatively correlated with serological markers, such as HA, PC Ⅲ, Ⅳ-C and LN （P 〈 0. 05 ）. Conclusions Serological markers combined with MRI elastograohy is superior to single tests in the diagnosis of liver fibrosis, which is worthy of further promotion in clinical.