实时剪切波弹性成像对慢性乙型肝炎肝纤维化程度的诊断价值研究

Diagnostic value of real-time shear wave elastrography for hepatic fibrosis degree in patients with chronic hepatitisB

目的 探讨实时剪切波弹性成像(SWE)对乙型肝炎肝纤维化程度的诊断价值。方法 选择62例慢性乙型肝炎肝纤维化病人,其中男性41例,女性21例;年龄35~68岁,平均年龄51.8岁;病程2~6年,平均病程3.1年。对其分别进行SWE检查及血清学指标检测,对肝进行活检;并与病理肝纤维化程度进行比较。结果 病理诊断S1期8例,S2期31例,S3期23例。随着慢性乙型肝炎病人肝纤维程度的升高,其S1期、S2期、S3期丙氨酸氨基转移酶(ALT)(59.4 U/L±1.6 U/L、73.6 U/L±1.9 U/L、95.6 U/L±2.5 U/L)、天冬氨酸转氨酶(AST)(51.5 U/L±1.2 U/L、65.6 U/L±1.7 U/L、80.9 U/L±2.8 U/L)及总胆红素(TBiL)(15.3μmol/L±3.8μmol/L、17.6μmol/L±4.5μmol/L、26.6μmol/L±4.9μmol/L)逐渐升高(P <0.05);SWE技术测量S1期、S2期、S3期弹性模量分别为(5.9±1.2) kPa、(8.5±2.6) kPa、(17.3±5.0) kPa,差异有统计学意义(F=3.928,P=0.035);弹性模量与肝纤维化病理分期、ALT、AST及TBiL均呈明显的正相关关系(均P <0.05);肝脏弹性模量诊断S1期、S2期、S3期曲线下面积分别为0.918、0.830、0.790。结论 SWE可精准地评估慢性乙型肝炎病人的肝纤维化程度,具有较高的灵敏度及特异度,值得临床推广应用。

Objective To evaluate the diagnostic value of real-time shear wave elastrography(SWE) for hepatic fibrosis degree in patients with chronic hepatitis B. Methods A total of 62 chronic hepatitis B patients with hepatic fibrosis were enrolled,which included 41 males and 21 females, aged 35-68 years old with mean age of 51.8 years old;disease duration was 2-6years with mean duration of 3.1 years. All patients performed hepatic biopsy, and SWE and serological index detection were respectively examined to compare with the degree of pathological hepatic fibrosis. Results The pathological diagnosis showed8 cases of stage S1, 31 of stage S2 and 23 of stage S3. With the increase of hepatic fibrosis in patients with chronic hepatitis B, the levels of alanine aminotransferase(ALT)(59.4 U/L ± 1.6 U/L, 73.6 U/L ± 1.9 U/L and 95.6 U/L ± 2.5 U/L), aspartate aminotransferase( AST)( 51. 5 U/L ± 1.2 U/L, 65.6 U/L ± 1.7 U/L and 80.9 U/L ± 2.8 U/L) and total bilirubin(TBiL)(15.3 μmol/L ± 3.8 μmol/L, 17.6 μmol/L ± 4.5 μmol/L and 26.6 μmol/L ± 4.9 μmol/L) in stage S1, S2 and S3 were gradually increased(P < 0.05). The elastic modulus values of SWE in stage S1, S2 and S3 of hepatic fibrosis were(5.9 ± 1.2) kPa,(8.5 ±2.6) kPa and(17.3 ± 5.0) kPa, and the difference was significant(F = 3.928, P = 0.035). The elastic modulus was significantly positively correlated with hepatic fibrosis stage, ALT, AST and TBiL(P < 0.05). The area under curve of elastic modulus in diagnosis of stage S1, S2 and S3 of hepatic fibrosis was 0.918, 0.830 and 0.790, respectively. Conclusion It is demonstrated that SWE could accurately assess the degree of hepatic fibrosis in chronic hepatitis B patients with high sensitivity and specificity,and is worthy of clinical application.