超声剪切波频散成像评估慢性乙肝炎症活动度的临床价值

Clinical value of ultrasound shear wave dispersion imaging for assessing the hepatic inflammation activity of chronic hepatitis B

目的:探讨超声剪切波频散成像评估慢性乙型肝炎患者肝炎症活动度的临床价值。方法:前瞻性纳入2020年12月至2021年12月于北京大学第三医院和首都医科大学附属北京地坛医院行肝脏穿刺活检的慢性乙型肝炎患者52例。对患者进行超声剪切波频散成像测量其肝硬度(LS)和剪切波频散斜率(SWDS),收集基线资料和肝功能指标。通过病理检查明确肝脏炎症分级(G0~G4)和纤维化分期(S0~S4)。通过单因素和多因素线性回归分析确定SWDS与各项指标之间的关系。根据肝脏炎症活动度的病理分级进行分组,比较三组间各项指标的差异,并分析SWDS、LS及肝功能指标与肝脏炎症活动度的相关性。采用ROC曲线评估不同指标对肝脏炎症活动度的诊断效能,通过Delong检验比较不同指标间的诊断效能。结果:炎症和纤维化为SWDS的独立影响因素(均P<0.05);不同炎症活动度组间丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、LS和SWDS差异有统计学意义(均P<0.05),两两比较显示,G2及G3组SWDS和LS显著高于G1组(均P<0.001),ALT仅在G1与G2组间差异有统计学意义(P<0.05),AST仅在G1与G3组间差异有统计学意义(P<0.05);SWDS和LS与肝脏炎症活动度之间分别呈正向强相关(r_(s)=0.728,P<0.001)和正向中等相关(r_(s)=0.679,P<0.001),ALT和AST与肝脏炎症活动程度之间相关性较弱(r_(s)=0.376,P<0.05;r_(s)=0.485,P<0.001);SWDS诊断肝脏炎症≥G2级的ROC曲线下面积、敏感性和特异性分别为0.965、0.933和0.865。结论:SWDS在评估慢性乙型肝炎患者≥G2级肝脏炎症活动度方面具有一定价值。

Objective To investigate the clinical value of ultrasound shear wave dispersion(SWD)imaging in assessing the hepatic inflammation activity in patients with chronic hepatitis B.Methods Fifty-two patients with chronic hepatitis B who underwent liver biopsy in Peking University Third Hospital and Beijing Ditan Hospital Affiliated to Capital Medical University from December 2020 to December 2021 were prospectively enrolled.Liver stiffness(LS)and shear wave dispersion slope(SWDS)were measured by SWD imaging in all participants.Baseline data and laboratory indexes of liver function were collected.Liver inflammation grading(G0-G4)and fibrosis staging(S0-S4)were determined by pathological examination.The relationship between SWDS and various indicators was analyzed by univariate and multivariate linear regression analysis.The participants were grouped according to the pathological grading of hepatic inflammatory activity.The differences of various indexes among three groups were compared,and the correlations between SWDS,LS and laboratory indicators and hepatic inflammatory activity were analyzed.The ROC curve was used to evaluate the diagnostic performances of ultrasound and laboratory indicators for hepatic inflammation activity,and the diagnostic accuracy of different indicators was compared by Delong test.Results Inflammation and fibrosis were both independent affecting factors of SWDS(all P<0.05);there were significant differences in alanine transaminase(ALT),aspartate aminotransferase(AST),LS and SWDS among groups with different inflammatory activities(all P<0.05).The SWDS and LS of the G3 and G2 groups were statistically higher than those of the G1 group(all P<0.001).ALT was only significantly different between G1 group and G2 group(P<0.05),and AST was only significantly different between G1 group and G3 group(P<0.05);The SWDS and LS showed strongly positive correlation(r_(s)=0.728,P<0.001)and moderately positive correlation(r_(s)=0.679,P<0.001)with hepatic inflammatory activity,respectively;while the correlations between ALT,AST and hepatic inflammatory activity were weaker(r_(s)=0.376,P<0.05;r_(s)=0.485,P<0.001).The area under the ROC curve,sensitivity and specificity of SWDS for diagnosing hepatic inflammation≥G2 grade were 0.965,0.933 and 0.865,respectively.Conclusions SWDS has certain value in evaluating the hepatic inflammatory activity of≥G2 grade in patients with chronic hepatitis B.