三维显微定量超声在乙型肝炎肝硬化患者病情评价中的应用

Three-dimensional microscopic quantitative ultrasound for evaluating hepatitis B related liver cirrhosis

目的初步评估三维显微定量超声对于乙型肝炎肝硬化及肝功能失代偿的诊断价值。方法收集2016年1月至2017年12月青海省第四人民医院住院患者共270例,分为慢性乙型肝炎(CHB)组(102例)、代偿期肝硬化(LC)组(84例)和失代偿期LC组(84例)。入组患者均行三维显微定量超声检查、二维剪切波弹性成像检查及肝功能、血常规等检查。计算患者的天门冬氨酸氨基转移酶和血小板比率指数(APRI)评分。比较3组患者间三维显微定量超声、二维剪切波弹性成像(2D-SWE)和APRI评分差异。评价三维显微定量超声、2D-SWE和APRI评分指标对于LC以及LC相关肝功能失代偿的预测价值、灵敏度和特异度。结果3组患者三维显微定量超声和肝脏硬度差异均有统计学意义(F=313.52、173.36,P均<0.001)。三维显微定量超声预测LC的受试者操作曲线下面积为0.925(95%CI:0.885~0.965,P<0.001),取三维显微定量超声临界值为11.5分,其诊断LC的敏感度和特异度分别为85.7%和90.2%;三维显微定量超声预测LC相关肝功能失代偿的受试者操作曲线下面积为0.850(95%CI:0.795~0.905、P<0.001),取三维显微定量超声临界值为16.5分,其诊断肝功能失代偿的敏感度和特异度分别为60.7%和89.3%。结论本研究建立了基于三维显微超声技术的定量诊断标准,该标准可用于LC及失代偿LC的辅助诊断。

Objective To evaluate the diagnosis value of 3D microscopic ultrasound sonography for hepatitis B related liver cirrhosis(LC)and liver function decompensation.Methods Total of 270 patients were admitted to the Fourth People’s Hospital of Qinghai Province from January 2016 to December 2017,which were divided into chronic hepatitis B group(102 cases),compensatory LC group(84 cases)and decompensation LC group(84 cases).3D microscopic ultrasound sonography,2D shear waved elastography(2D-SWE)and blood routine examination were performed on each patient.Aspartate aminotransferase-toplatelet ratio index(APRI)were calculated.3D microscopic ultrasound sonography scores,2D-SWE scores and APRI were compared among the three groups,respectively.Receptor operation curves were built to compare the predictive values of 3D microscopic ultrasound sonography scores,2D-SWE scores and APRI for LC and for liver function decompensation of LC patients.Results The score of 3D microscopic ultrasound sonography and liver hardness among the three groups were significantly different(F=313.52,173.36;both P<0.001).The area under receptor operation curve(AUROC)of 3D microscopic ultrasound sonography for predicting cirrhosis was 0.925(95%CI:0.885-0.965,P<0.001);with the cut-off value of 11.5 scores,the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting cirrhosis were 85.7%and 90.2%,respectively.The AUROC of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis was 0.850(95%CI:0.795-0.905,P<0.001).With the cut-off value of 16.5 scores,the sensitivity and specificity of 3D microscopic ultrasound sonography for predicting decompensated cirrhosis were 60.7%and 89.3%,respectively.Conclusions A quantitative diagnostic standard based on 3D microscopic ultrasound sonography was established in this study,which could be used in the auxiliary diagnosis of LC and liver function decompensation.