二维超声剪切波弹性成像对慢性乙型肝炎患者肝纤维化程度的评估价值

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摘要目的探究二维超声剪切波弹性成像对慢性乙型肝炎患者肝纤维化的诊断价值。方法回顾性选取2021年1月至12月上海市东方医院吉安医院就诊的66 例慢性乙型肝炎患者为研究对象，所有患者经病理检查确诊，均行普通超声成像、二维超声剪切波弹性成像，以肝组织穿刺活检为检查金标准，并根据METAVIR 评分标准将患者的肝纤维化程度分为F0、F1、F2、F3、F4 期，根据病理分级情况对于患者进行分组，以F0＋F1 为非显著性肝纤维化（非显著组），以F2＋F3＋F4 为显著性肝纤维化（显著组）。收集患者的年龄、细胞、体重指数（BMI）、杨氏模量值、谷草转氨酶（AST）、谷氨酰转移酶（GGT）、谷丙转氨酶（ALT）等指标资料，并计算肝纤维化-4 因子指数（FIB-4）和谷草转氨酶/血小板比率指数（APRI）。采用单因素与多因素logistic 对患者的相关资料进行分析，并使用ROC 曲线评估杨氏模量值、FIB-4、APRI 对患者肝纤维化显著程度的诊断效能。结果患者穿刺活检结果显示，所选66 例慢性乙型肝炎患者中，肝纤维化F0 期5 例，F1 期为19 例，F2 期为23 例，F3 期为12 例，F4 期为7 例，故F0＋F1期肝非显著性肝纤维化（非显著组24 例），显著性肝纤维化（显著组42 例）。单因素分析显示，两组患者的性别、年龄、BMI、AST、GGT、ALT、碱性磷酸酶（ALP）、白蛋白、总胆红素（TBil）比较，差异无统计学意义（P＞0.05）；两组患者的杨氏模量值、血清肝纤维化指标[层黏连蛋白（LN）、透明质酸（HA）、Ⅳ型胶原（Ⅳ-C）、Ⅲ型前胶原肽（PⅢP）]、FIB-4、APRI 比较，差异有统计学意义（P＜0.05）。多因素logistic 分析结果显示，患者的杨氏模量值、LN、HA、Ⅳ-C、PⅢP、FIB-4 及APRI 均为影响患者肝纤维化的独立危险因素（P＜0.05）。ROC 结果显示，杨氏模量值的AUC 为0.864，诊断敏感度为82.6%，特异度为84.5%，FIB-4 的AUC 为0.789，诊断敏感度为80.7%，特异度为72.4%，APRI 的AUC 为0.857，诊断敏感度为81.5%，特异度为83.8%，三组指标联合的AUC 为0.935，诊断敏感度为92.8%，特异度为93.2%。结论运用二维剪切波弹性成像可对慢性乙型肝炎患者的肝纤维化显著程度进行无创性检查，且诊断效能较好。

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	刘小伟秦文羚陈敏陈雪梅▲ 顾文杨丽华

关键词 ：超声二维剪切波弹性成像, 慢性乙型肝炎, 诊断价值, 肝纤维化

Abstract：Objective To explore the diagnostic value of two-dimensional ultrasound shear-wave elastography for liver fibrosis in patients with chronic hepatitis B.Methods A total of 66 patients with chronic hepatitis B treated in Ji'an Hospital of Shanghai Oriental Hospital from January to December 2021 were retrospectively selected as the research objects.All patients were diagnosed by pathological examination,and underwent conventional ultrasound imaging and two-dimensional ultrasound shear wave elastography.Liver biopsy was taken as the gold standard.The degree of liver fibrosis of patients was divided into F0,F1,F2,F3 and F4 stages according to the METAVIR score standard.The patients were divided into groups according to the pathological grade,with F0＋F1 as non-significant liver fibrosis (nonsignificant group) and F2＋F3＋F4 as significant liver fibrosis (significant group).The age,cell,body mass index (BMI),Young's modulus,aspartate aminotransferase (AST),glutamyltransferase (GGT),alanine aminotransferase (ALT) and other indicators were collected,and liver fibrosis-4 factor index (FIB-4) and aspartate aminotransferase/platelet ratio index(APRI) were calculated.Univariate and multivariate logistic analysis were used to analyze the relevant data of patients,and ROC curve was used to evaluate the diagnostic efficacy of Young's modulus,FIB-4 and APRI in the significant degree of liver fibrosis in patients.Results The results of needle biopsy showed that among the selected 66 pa tients with chronic hepatitis B,5 cases were F0 stage,19 cases were F1 stage,23 cases were F2 stage,12 cases were F3 stage,and 7 cases were F4 stage.Therefore,F0＋F1 stage had non-significant liver fibrosis (non-significant group of 24 cases) and significant liver fibrosis (significant group of 42 cases).Univariate analysis showed that there were no significant differences in gender,age,BMI,AST,GGT,ALT,alkaline phosphatase (ALP),albumin and total bilirubin(TBil) between the two groups (P＞0.05).There were significant differences in Young's modulus,serum liver fibrosis indexes (laminin [LN],hyaluronic acid [HA],collagen Ⅳ[Ⅳ-C],pro-collagen Ⅲ[PⅢP]),FIB-4 and APRI between the two groups (P＜0.05).Multivariate logistic analysis showed that Young's modulus,LN,HA,Ⅳ-C,PⅢP,FIB-4 and APRI were independent risk factors for liver fibrosis (P＜0.05).ROC results showed that the AUC of Young's modulus value was 0.864,the diagnostic sensitivity was 82.6% and the specificity was 84.5%,the AUC of FIB-4 was 0.789,the diagnostic sensitivity was 80.7% and the specificity was 72.4%,and the AUC of APRI was 0.857 and the diagnostic sensitivity was 81.5%.The specificity was 83.8%,the combined AUC of the three groups of indicators was 0.935,the diagnostic sensitivity was 92.8%,and the specificity was 93.2%.Conclusion Two-dimensional shear wave elastography can be used to detect the significance of liver fibrosis in patients with chronic hepatitis B in a non-invasive manner,and the diagnostic efficiency is good.

Key words： Ultrasonic two-dimensional shear-wave elastic imaging Chronic hepatitis B Diagnostic value Liver fibrosis

基金资助:江西省卫生健康委科技计划项目（202212849）。

引用本文:

刘小伟秦文羚陈敏陈雪梅▲ 顾文杨丽华. 二维超声剪切波弹性成像对慢性乙型肝炎患者肝纤维化程度的评估价值[J]. 中国当代医药, 2022, 29(28): 143-147.
LIU Xiaowei QIN wenling CHEN Min CHEN Xuemei▲ GU Wen YANG Lihua. Evaluation of the degree of liver fibrosis in patients with chronic hepatitis B by two-dimensional ultrasonic shear-wave elastography. 中国当代医药, 2022, 29(28): 143-147.

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