两种超声弹性成像技术诊断慢性乙型肝炎患者肝纤维化价值比较*

doi:10.3969/j.issn.1672-5069.2020.01.007

摘要/Abstract

摘要： 目的探讨瞬时弹性成像和二维剪切波弹性成像用于CHB患者肝纤维化诊断的临床价值。方法 2016年3月～2018年12月我院收治的CHB患者164例,均行瞬时弹性成像和二维剪切波弹性成像检查及肝穿刺活检,采用受试者工作特性(ROC)曲线下面积比较两种超声弹性成像检查诊断不同肝纤维化分期的效能。结果经肝穿刺活检,在164例CHB患者中,诊断肝组织S₁期50例,S₂期42例,S₃期39例,S₄期33例;瞬时弹性成像检查S₁～S₄期肝纤维化分期的弹性值分别为(6.5±1.1)kPa、(8.6±1.4)kPa、(11.7±1.8)kPa和(16.3±1.8)kPa,二维剪切波弹性成像检查弹性值分别为(5.9±0.8) kPa、(8.1±1.2)kPa、(10.9±1.5)kPa和(16.7±1.9) kPa,两种超声弹性成像检查不同肝纤维化分期弹性值差异无统计学意义(P >0.05);二维剪切波弹性成像检查诊断肝纤维化S₂、S₃和S₄期的ROC曲线下面积(AUC)分别为0.971、0.979和0.973,显著高于瞬时弹性成像检查的0.902、0.906和0.904(P <0.05),其诊断的敏感性分别为90.3%、90.6%和100.0%,特异性分别为95.8%、90.6%和84.5%,而瞬时弹性成像检查诊断则分别为78. 5%、81.3%和73.1%,和93.3%、87.9%和91.0%。结论二维剪切波弹性成像和瞬时弹性成像检查均可用于慢性乙型肝炎患者的肝纤维化诊断,其临床价值均需要进一步探讨。

关键词: 慢性乙型肝炎, 肝纤维化, 瞬时弹性成像, 二维剪切波弹性成像, 诊断

Abstract: Objective The purpose of this study was to investigate the clinical value of transient elastography (TE) and two-dimensional shear wave elastography (SWE) in the diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB). Methods 164 patients with CHB B were enrolled in our hospital between March 2016 and December 2018, and all patients underwent HE and SWE. The liver biopsy was also performed. The area under ROC curve (AUC) was applied to analyze the diagnostic performance. Results The liver histopathological examination showed liver fibrosis S₁ in 50, S₂ in 42, S₃ in 39 and S₄ in 33 in our series; the liver stiffness measurement (LSM) of patients with S₁, S₂,S₃ and S₄ by TE were (6.5±1.1)kPa, (8.6±1.4)kPa, (11.7±1.8)kPa and (16.3±1.8)kPa, and by SWE were (5.9±0.8) kPa, (8.1±1.2)kPa, (10.9±1.5)kPa and (16.7±1.9) kPa(P >0.05); the AUC of SWE in diagnosing S₂, S₃ and S₄ were 0.971, 0.979 and 0.973, much higher than 0.902, 0.906 and 0.904(P <0.05) by TE, and the sensitivities were 90.3%, 90.6% and 100.0%, and the specificities were 95.8%, 90.6% and 84.5%, while they were 78. 5%, 81.3% and 73.1%, and 93.3%, 87.9% and 91.0%, respectively, by TE. Conclusion The application of TE and SWE in the diagnosis of liver fibrosis in patients with CHB might possess a efficient performance in clinical practice.

Key words: Hepatitis B, Transient elastography, Two-dimensional shear wave elastography, Hepatic fibrosis, Diagnosis

叶细容, 吕志红, 江峰, 解育新. 两种超声弹性成像技术诊断慢性乙型肝炎患者肝纤维化价值比较^*[J]. 实用肝脏病杂志, 2020, 23(1): 18-21.

Ye Xirong, Lyu Zhihong, Jiang Feng, et al. Clinical value of transient elastography and two-dimensional shear wave elastography in the diagnosis of liver fibrosis in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2020, 23(1): 18-21.

参考文献 27

[1]	Kim BK, Kim H, Yoo EJ, et al. Risk assessment of clinical outcomes in Asian patients with chronic hepatitis B using enhanced liver fibrosis test. Hepatology, 2015, 60(6): 1911-1919.
[2]	Huang Y, Wang Z, Liao B, et al. Assessment of liver fibrosis in chronic hepatitis B using acoustic structure quantification: quantitative morphological ultrasound. Eur Radiol, 2016, 26(7): 2344-2351.
[3]	Sporea I, Bota S, Gradinaru-Tascǎu O, et al. Which are the cut-off values of 2D-shear wave elastography(2D -SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering transient elastography(TE)as the reference method? Eur J Radiol, 2014, 83(3): 118-122.
[4]	中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2015年版).实用肝脏病杂志,2016,19(3):V-XXIII.
[5]	朱玲斐, 马苏亚, 邹桂兰. 实时组织超声弹性成像及瞬时弹性成像相关参数在评价CHB肝纤维化的应用价值. 中华医院感染学杂志, 2018, 28(16): 43-46.
[6]	Xu B, Zhou NM, Cao WT, et al. Evaluation of elastography combined with serological indexes for hepatic fibrosis in patients with chronic hepatitis B. World J Gastroenterol, 2018, 24(37): 4272-4280.
[7]	石俊英, 张斯佳, 史景璐, 等.经量化扩散加权成像与超声剪切波弹性成像对乙型肝炎相关性肝纤维化比较分析. 中国临床医学影像杂志, 2017, 28(6): 447-449.
[8]	Huang Y, Wang Z, Liao B, et al. Assessment of liver fibrosis in chronic hepatitis B using acoustic structure quantification: quantitative morphological ultrasound. Eur Radiol, 2016, 26(7): 2344-2351.
[9]	Schmillevitch J, Chammas MC, Pugliese V, et al. Acoustic radiation force impulse (ARFI) elastography compared with biopsy for evaluating hepatic fibrosis after liver transplantation: a cross-sectional diagnostic study. Sao Paulo Med J, 2016, 134(6): 513-518.
[10]	谢双双,李清,程悦,等. MR扩散峰度成像与超声弹性成像对肝纤维化诊断价值的对比研究. 中华放射学杂志,2018,52(11):847-851.
[11]	郑颖,孟繁坤, 徐晓鸾,等. 实时组织弹性成像定量分析技术检测病毒性乙型肝炎肝纤维化分期的初步研究.北京医学,2018,30(4):338-341.
[12]	Pfeifer L, Adler W, Zopf S, et al. Acoustic radiation force impulse elastography: comparison and combination with other noninvasive tests for the diagnosis of compensated liver cirrhosis. Eur J Gastroenterol Hepatol, 2017, 29(5): 524-530.
[13]	Karlas T, Dietrich A, Peter V, et al. Evaluation oftransient elastography, acoustic radiation force impulse imaging (ARFI), and enhanced liver function (ELF) score for detection of fibrosis in morbidly obese patients. Plos One, 2015, 10(11): e0141649.
[14]	Zhang D, Li P, Chen M, et al. Non-invasive assessment of liver fibrosis in patients with alcoholic liver disease using acoustic radiation force impulse elastography. Abdom Imaging, 2015, 40(4): 723-729.
[15]	Dong DR, Hao MN, Li C, et al. Acoustic radiation force impulse elastography, FibroScan©, Forns' index and their combination in the assessment of liver fibrosis in patients with chronic hepatitis B, and the impact of inflammatory activity and steatosis on these diagnostic methods. Mol Med Rep, 2015, 11(6): 4174-4182.
[16]	李秀茹,朱江,赵博文,等. 超声实时组织弹性成像与磁共振扩散加权成像对慢性乙型肝炎肝纤维化的诊断价值.中华传染病杂志,2018,36(6):363-366.
[17]	张芹,吴意赟,殷立平,等.剪切波弹性成像评估正常成人及慢性肝病患者肝脏硬度稳定性的研究.医学影像学杂志,2018,28(4):608-610.
[18]	Ragazzo TG, Paranaguavezozzo D, Lima FR, et al. Accuracy of transient elastography-FibroScan©, acoustic radiation force impulse (ARFI) imaging, the enhanced liver fibrosis (ELF) test, APRI, and the FIB-4 index compared with liver biopsy in patients with chronic hepatitis C. Clinics, 2017, 72(9): 516-525.
[20]	Liu H, Fu J, Hong R, et al. Acoustic radiation force impulse elastography for the non-invasive evaluation of hepatic fibrosis in non-alcoholic fatty liver disease patients: a systematic review & Meta-analysis. Plos One, 2015, 10(7): e0127782.
[21]	Chang W, Lee JM, Yoon JH, et al. Liver fibrosis staging with MR elastography: comparison of diagnostic performance between patients with chronic hepatitis B and those with other etiologic causes. Radiology, 2016, 280(1): 88-97.
[22]	Wang K, Lu X, Zhou H, et al. Deep learning radiomics of shear wave elastography significantly improved diagnostic performance for assessing liver fibrosis in chronic hepatitis B: a prospective multicentre study. Gut, 2019, 68(4): 729-741.
[23]	Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsy-proven liver fibrosis by 2D-shear wave elastography: An individual patient data based meta-analysis. Hepatology, 2017, 67(1): 260-272.
[24]	Voutilainen S, Kivisaari R, Lohi J, et al. A prospective comparison of noninvasive methods in the assessment of liver fibrosis and esophageal varices in pediatric chronic liver diseases. J Clin Gastroenterol, 2016, 50(8): 658-663.
[25]	Rms S, Liau J, Kaffas AE, et al. Ultrasound elastography: review of techniques and clinical applications. Theranostics, 2017, 7(5): 1303-1329.
[26]	Sporea I. The new EFSUMB guidelines on liver elastography 2017: why and for whom? Med Ultrason, 2017, 19(1): 5-6.
[27]	Dietrich CF, Bamber J, BerzigottiA, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (long version). Ultraschall Med, 2017, 38(4): 377-394.

两种超声弹性成像技术诊断慢性乙型肝炎患者肝纤维化价值比较^*

Clinical value of transient elastography and two-dimensional shear wave elastography in the diagnosis of liver fibrosis in patients with chronic hepatitis B

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 27

相关文章 15

编辑推荐

Metrics

本文评价

[1]	杨可芷, 陆伟, 黄丹, 李秀芬, 王雁冰, 周新兰, 丁蓉蓉, 张占卿. γ-谷氨酰转肽酶/胆碱酯酶比值预测慢性乙型肝炎患者肝纤维化程度的效能评价^*[J]. 实用肝脏病杂志, 2020, 23(1): 14-17.
[2]	李永华, 孙延芬, 王佳佳, 李艳颖, 于收. 恩替卡韦联合苦参素治疗慢性乙型肝炎患者疗效及其对外周血辅助性T淋巴细胞的影响^*[J]. 实用肝脏病杂志, 2020, 23(1): 22-25.
[3]	丁俊琪, 张偲, 张彬. 聚乙二醇干扰素α-2a治疗HBeAg阳性慢性乙型肝炎部分应答患者序贯替比夫定治疗疗效观察^*[J]. 实用肝脏病杂志, 2020, 23(1): 26-29.
[4]	陈丽丽, 符茂雄, 蒙绪标, 方其超. 空腹C肽评估NAFLD合并T2DM患者肝纤维化进展价值分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 38-41.
[5]	柳健, 朱峰发, 唐娟. 非均匀性脂肪肝患者腹部超声表现和血脂变化特点^*[J]. 实用肝脏病杂志, 2020, 23(1): 42-45.
[6]	毛重山, 殷辉, 肖二辉, 张英英. 非诺贝特对非酒精性脂肪性肝病合并2型糖尿病患者血脂、血管内皮功能和肝纤维化指标的影响^*[J]. 实用肝脏病杂志, 2020, 23(1): 50-53.
[7]	孙红菊, 王衍颜, 徐丛聪, 赵红. 硫普罗宁联合美他多辛治疗酒精性肝病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2020, 23(1): 54-57.
[8]	王晶晶, 李春涛, 周卫真. 失代偿期乙型肝炎肝硬化患者尿液视黄醇结合蛋白水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2020, 23(1): 74-77.
[9]	刘潇, 何年安, 叶显俊, 刘力, 付文学, 陈姣姣. 超声造影对肝细胞癌与肝转移癌的鉴别诊断价值分析[J]. 实用肝脏病杂志, 2020, 23(1): 94-97.
[10]	石莹莹, 王元喜. 应用肝脏影像报告与数据管理系统诊断肝细胞癌的价值研究^*[J]. 实用肝脏病杂志, 2020, 23(1): 98-101.
[11]	高莉, 高屹, 尹秋萍. CT灌注成像联合彩色多普勒超声造影辨别肝脏结节性病变性质临床价值探讨^*[J]. 实用肝脏病杂志, 2020, 23(1): 106-109.
[12]	王秀清, 马燕君, 詹晋莉. 微泡性多囊肝影像学检查表现比较^*[J]. 实用肝脏病杂志, 2020, 23(1): 114-117.
[13]	黄汉军, 鲁凤荣, 张灿. MRI联合血清维生素D预测慢性丙型肝炎患者肝纤维化临床价值探讨^*[J]. 实用肝脏病杂志, 2020, 23(1): 143-144.
[14]	王纯, 陈东风. Fitz-Hugh-Curtis综合征研究进展^*[J]. 实用肝脏病杂志, 2020, 23(1): 149-152.
[15]	陈慧婷, 周永健. 妊娠期肝内胆汁淤积症诊断与管理[J]. 实用肝脏病杂志, 2020, 23(1): 153-155.