摘要
目的探讨实时二维剪切波弹性成像(SWE)技术无创评价慢性乙型肝炎患者肝纤维化程度的诊断价值及其与病理分期的相关性。方法选取行经皮肝脏穿刺活检病理组织学检查确诊的慢性乙型肝炎患者213例作为病例组,另选取同期健康体检成人40例作为对照组,两组均应用SWE技术行肝脏弹性检测,获取肝脏弹性值(LSM),并与肝穿刺活检病理结果进行对照分析,探讨LSM与肝纤维化病理分期的相关性。以肝活检病理结果为金标准,绘制LSM预测不同肝纤维化病理分期的受试者工作特征(ROC)曲线,并计算其曲线下面积。结果病例组S1、S2、S3及S4期患者肝脏LSM与对照组比较,差异均有统计学差异(均P<0.05)。病例组患者中,除S0期与S1期、S3期与S4期患者肝脏LSM比较差异无统计学意义,余各分期两两比较差异均有统计学意义(均P<0.05)。相关性分析结果表明,LSM与肝纤维化病理分期呈正相关(r=0.53,P<0.05)。各病理分期肝纤维化患者LSM诊断肝纤维化的ROC曲线下面积分别为0.822、0.814、0.843及0.814;≥S1期阈值为9.56 k Pa,≥S2期阈值为9.64 k Pa,≥S3期阈值为11.64 k Pa,S4期阈值为13.43 k Pa。结论 SWE技术可以较好地判断慢性乙型肝炎患者肝纤维化程度,为临床治疗和疗效评定提供重要依据。
Objective To evaluate the value of real time two-dimensional shear wave elastography（SWE）in evaluating liver fibrosis in patients with chronic hepatitis B,and to explore the correlation between fibrosis and pathological staging.Methods A total of 213 patients with chronic hepatitis B infection underwent percutaneous liver biopsy for histopathological examination were selected as case group.At the same time,40 cases of healthy adults were selected as control group.Liver elasticity was detected by SWE technique in two groups,the liver stiffness of measurement（LSW） was taken as the SWE index,and the liver biopsy and pathological results were compared and analyzed.The correlation between LSM and liver fibrosis staging was analyzed. Taken liver biopsy results as the gold standard,the receiver operating characteristic（ROC）curve of LSM for predicting different liver fibrosis stages was plotted,and the area under the curve（AUC） was calculated.Results There were statistical differences of LSM between case group（S1,S2,S3,S4 stage） and control group（all P〈0. 05）. There were no statistical difference between S0 and S1,S3 and S4 in different stages of liver fibrosis,and there were statistically differences among the other groups（all P〈0.05）.LSM of case group was positively correlated with liver fibrosis staging（r=0.53,P〈0.05）.According to the difference of each LSM,the AUC were 0.822,0.814,0.843 and 0.814,the threshold of ≥S1 stage was 9.56 k Pa,the threshold of ≥S2 stage was 9.64 k Pa,the threshold of ≥S3 stage was 11.64 k Pa,and the threshold of S4 stage was 13.43 k Pa.Conclusion SWE can better distinguish the degree of liver fibrosis in chronic hepatitis,which can provide an important basis for clinical treatment and evaluation of curative effects.
作者
李昶玥
郑颖
张嫄
孟繁坤
LI Changyue;ZHENG Ying;ZHANG Yuan;MENG Fankun(Department of Ultrasound,Beijing You ＇an Hospital Affiliated to Capital Medical University,Beijing 100054,China)
出处
《临床超声医学杂志》
2018年第8期518-521,共4页
Journal of Clinical Ultrasound in Medicine
关键词
剪切波弹性成像
二维
实时
乙型肝炎
慢性
肝纤维化
Shear wave elastography
two-dimensional
real-time
Hepatitis B
chronic
Liver fibrosis
