实时剪切波弹性成像技术评估肝纤维化程度及其分期的临床意义

The clinical significance of real-time shear wave elastography in evaluating the degree and staging of liver fibrosis

目的探讨实时剪切波弹性成像(SWE)评估肝纤维化程度及其分期的临床意义。方法在我院肝病科就诊的108例慢性肝病患者,行常规血清学检查、病理学检查以及SWE技术检查,以病理检查为金标准,判断SWE技术的诊断价值,并比较各期肝纤维化指标和肝脏弹性模量水平,分析肝脏弹性模量与肝纤维化指标的相关性。结果S0/S1期(20例)的透明质酸(HA)、血清III型前胶原肽(PCⅢ)、Ⅳ型胶原(ⅣC)、层粘连蛋白(LN)、弹性模量水平分别为(30.22.5)ng/ml、(31.52.6)μg/ml、(64.85.8)ng/ml、(57.14.9)ng/ml、(5.31.2)kPa;S2期(61例)的HA、PCⅢ、IVC、LN、弹性模量分别为(51.45.0)ng/ml、(44.84.1)μg/ml、(75.97.2)ng/ml、(70.26.5)ng/ml、(6.81.7)kPa;S3期(19例)的HA、PCⅢ、IVC、LN、弹性模量分别为(64.86.7)ng/ml、(55.95.2)μg/ml、(93.08.6)ng/ml、(121.111.2)ng/ml、(9.72.5)kPa;S4期(8例)的HA、PCⅢ、IVC、LN、弹性模量水平分别为(78.97.5)ng/ml、(61.66.4)μg/ml、(111.510.8)ng/ml、(204.418.4)ng/ml、(14.33.6)kPa;各期的HA、PCⅢ、IVC、LN、弹性模量水平比较,差异均有统计学意义,且随着分期的增加,HA、PCⅢ、IVC、LN、弹性模量水平均逐渐增加(P<0.05)。肝脏弹性模量与HA、PCⅢ、IVC、LN水平均呈正相关(P<0.05)。≥S2分期的临界值为8.8 kPa,对应的敏感度、特异度分别为75.0%、95.0%;≥S3分期的临界值为10.9 kPa,对应的敏感度、特异度分别为85.2%、87.7%;S4分期的临界值为17.0 kPa,对应的敏感度、特异度分别为87.5%、91.0%。结论采用SWE技术对慢性肝病肝纤维化患者进行定量检测可较好的反映其肝脏纤维化程度及分期,且其弹性模量水平变化与HA、PCⅢ、IVC、LN水平均呈正相关,对肝纤维化程度具有较高的诊断效能,临床应用前景较好。

Objective To explore the clinical significance of real-time shear wave elastography(SWE)in evaluating the degree and staging of liver fibrosis.Methods One hundred and eight patients with chronic liver diseases in our hospital were examined by using routine serological examination,pathological examination and SWE technique.The diagnostic value of SWE technique was judged by taking pathological results as the gold standard,and the liver fibrosis index and liver elastic modulus level in different stages were compared.The correlation between liver elastic modulus and liver fibrosis index was analyzed.Results The levels of hyaluronic acid(HA),serum type III procollagen peptide(PIII),type IV collagen(IV-C),laminin(LN)and elastic modulus in S0/S1 phase(n=20)were(30.22.5)ng/ml,(31.52.6)μg/ml,(64.85.8)ng/ml,(57.14.9)ng/ml,and(5.31.2)kPa,respectively.The levels of HA,PCⅢ,IVC,LN and elastic modulus in S2 phase(n=61)were(51.45.0)ng/ml,(44.84.1)μg/ml,(75.97.2)ng/ml,(70.26.5)ng/ml and(6.81.7)kPa,respectively.The levels of HA,PCⅢ,IVC,LN and elastic modulus in S3 phase(n=19)were(64.86.7)ng/ml,(55.95.2)μg/ml,(93.08.6)ng/ml,(121.111.2)ng/ml,and(9.72.5)kPa,respectively.The levels of HA,PCⅢ,IVC,LN and elastic modulus in S4 phase(n=8)were(78.97.5)ng/ml,(61.66.4)μg/ml,(111.510.8)ng/ml,(204.418.4)ng/ml,and(14.33.6)kPa,respectively.The levels of HA,PCⅢ,IVC,LN and elastic modulus in different stages were significantly different.With the increase of stages,the levels of HA,PCⅢ,IVC,LN and elastic modulus were gradually increase(P<0.05).The elastic modulus of liver was positively correlated with the levels of HA,PCⅢ,IVC and LN(P<0.05).The critical value of≥S2 stage was 8.8kPa,and the corresponding sensitivity and specificity were 75.0%and 95.0%,respectively.The critical value of≥S3 stage was 10.9kPa,and the corresponding sensitivity and specificity were 85.2%and 87.7%,respectively.The critical value of S4 stage was 17.0kPa,and the corresponding sensitivity and specificity were 87.5%and 91.0%,respectively.Conclusion The quantitative detection of liver fibrosis patients by SWE technology can better reflect the degree and stage of liver fibrosis,and the change level of elastic modulus is positively correlated with levels of HA,PCⅢ,IVC and LN.It has higher diagnostic efficiency for liver fibrosis degree and better clinical application prospect.