实时剪切波弹性成像在拉米夫定治疗乙肝纤维化过程中的疗效评估作用

Effect of real-time shear wave elastography in the evaluation of the efficacy of lamivudine in the treatment of hepatitis B fibrosis

目的探讨实时剪切波弹性成像在评估拉米夫定治疗乙肝纤维化临床疗效中的作用。方法选取2017年1月~2018年1月我院收治的80例乙肝纤维化患者,根据随机数字法分为对照组和观察组,每组40例。对照组采用常规治疗,观察组在对照组的基础上给予拉米夫定进行治疗,治疗6个月。比较两组治疗前后肝功能、肝纤维化指标,利用实时剪切波弹性成像评估两组治疗前后肝脏弹性模量值及肝穿刺活检情况,并进行比较。结果两组治疗后AST、ALT、TBIL水平均明显低于治疗前,差异有统计学意义(P<0.05);观察组治疗后AST、ALT、TBIL水平均明显低于对照组,差异有统计学意义(P<0.05);两组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于治疗前,差异有统计学意义(P<0.05);观察组治疗后HA、LN、PⅢPN-P、CL-Ⅳ水平及杨氏弹性模量值均显著低于对照组,差异有统计学意义(P<0.05);与治疗前相比,两组治疗后肝穿刺活检结果均有好转,尤其是汇管区、肝小叶内炎症及肝纤维化改善明显。结论实时剪切波弹性成像作为肝脏硬度定量检测的无创性技术,可用于拉米夫定治疗乙肝纤维化临床疗效评估的重要方法。

Objective To discuss the effect of real-time shear wave elastography in the evaluation of the clinical efficacy of lamivudine in the treatment of hepatitis B fibrosis.Methods 80 patients with hepatitis B fibrosis in our hospital from January 2017 to January 2018 were selected.According to the random number method,they were divided into the control group and the observation group,40 cases in each group.The control group was treated with routine treatment,and the observation group was treated with lamivudine on the basis of the control group.The two groups were treated for 6 months.The liver function and liver fibrosis indices before and after treatment were compared between the two groups.The real-time shear wave elastography was used to evaluate the liver elastic modulus and liver biopsy results before and after treatment between the two groups,and these indexes were compared.Results After treatment,the levels of AST,ALT and TBIL of the two groups were significantly lower than those before treatment,and the difference is statistically significant(P<0.05).The levels of AST,ALT and TBIL in the observation group were significantly lower than those in the control group,and the difference is statistically significant(P<0.05).After treatment,the levels of HA,LN,PⅢPN-P,CL-Ⅳand Young's elastic modulus of the two groups were significantly lower than those before treatment,and the difference is statistically significant(P<0.05).The levels of HA,LN,PⅢPN-P,CL-Ⅳand Young's elastic modulus in the observation group were significantly lower than those in the control group,and the difference is statistically significant(P<0.05).Compared with that before treatment,the liver biopsy of the two groups were improved after treatment.In particular,inflammations,liver fibrosis in the portal area and hepatic lobule were improved significantly.Conclusion Real-time shear wave elastography is a non-invasive technique for quantitative detection of liver hardness and can be used as an important method for the clinical evaluation of lamivudine in the treatment of hepatitis B fibrosis.