应用超声评分联合STE/STQ定量检测肝脏硬度评估慢性乙型肝炎患者肝纤维化程度价值研究*

doi:10.3969/j.issn.1672-5069.2024.03.007

摘要/Abstract

摘要： 目的探讨应用声触诊弹性成像(STE)和声触诊弹性测量(STQ)参数联合超声评分评估慢性乙型肝炎(CHB)患者肝纤维化程度的价值。方法 2020年1月～2022年12月我院诊治的106例CHB患者,均行肝活检病理学检查,以肝组织肝纤维化Metavir分期为F2及以上为显著性肝纤维化。分别使用STE和STQ行肝脏硬度测量(LSM),使用二维超声图像评估肝纤维化超声评分。应用受试者工作特征(ROC)曲线评估指标诊断显著性肝纤维化的效能。结果在106例CHB患者中,肝组织病理学检查≥F2期肝纤维化者62例,＜F2期者44例;显著性肝纤维化者LSM_STE、LSM_STQ和LSM_超声分别为(12.7±2.2)kPa、(13.3±2.3)kPa和(10.5±2.2)分,均显著大于无显著性肝纤维化者【分别为(9.2±2.1)kPa、(8.9±1.7)kPa和(7.2±1.3)分,均P<0.05】;ROC曲线分析显示,LSM_STE、LSM_STQ和LSM_超声诊断CHB患者显著性肝纤维化的AUC分别为0.869(95%CI为0.803～0.935)、0.809(95%CI为0.728～0.891)和0.767(95%CI为0.679～0.855),其截断点分别为11.6 kPa、11.9 kPa和8.7分,而三者联合诊断的效能显著优于单一指标诊断(其AUC为0.949,95%CI为0.912～0.986,P<0.05)。结论应用LSM联合诊断CHB患者显著性肝纤维化的效能较高,作为无创诊断方法,值得临床进一步验证。

关键词: 慢性乙型肝炎, 肝纤维化, 超声, 声触诊弹性成像, 声触诊弹性测量, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic performance of sound touch elastography (STE) and sound touch quantify (STQ) combined with ultrasound (US) score for assessment of liver fibrosis in patients with chronic hepatitis B (CHB). Methods 106 patients with CHB were enrolled in our hospital between January 2020 and December 2022, and they all underwent liver biopsies for the assessment of liver fibrosis Metavir staging (≥F2 as significant liver fibrosis). The liver stiffness measurement (LSM) was obtained by STE and STQ. The ultrasound score for liver fibrosis was calculated according to the two-dimensional ultrasonography. The receiver operating characteristic (ROC) curve was applied to assess the diagnostic efficacy of US parameters. Results Among the 106 patients with CHB, the ≥F2 liver fibrosis were found in 62 cases and <F2 (no significant liver fibrosis) in 44 cases; the LSM_STE, LSM_STQ and LSM_U_S in patients with significant liver fibrosis were (12.7±2.2)kPa, (13.3±2.3)kPa and (10.5±2.2), all significantly greater than [(9.2±2.1)kPa, (8.9±1.7)kPa and (7.2±1.3), respectively, all P<0.05] in patients without significant liver fibrosis; the ROC analysis showed that the AUCs were 0.869(95%CI:0.803-0.935), 0.809(95%CI:0.728-0.891) and 0.767(95%CI:0.679-0.855), when the LSM_STE, LSM_STQ and LSM_U_S were applied for predicting the significant liver fibrosis, and the diagnostic performance of the three parameter combination was much superior to any one of them(the AUC was 0.949, with the 95%CI of 0.912-0.986, P<0.05). Conclusion The combination of LSM_STE, LSM_STQ and LSM_USis greatly efficacious in predicting significant liver fibrosis in patients with CHB, and as a non-invasive diagnosis, it is worthy of further clinical verification.

Key words: Hepatitis B, Liver fibrosis, Ultrasonography, Sound touch elastography, Sound touch quantify, Diagnosis

彭玉静, 郭航, 陈俊光. 应用超声评分联合STE/STQ定量检测肝脏硬度评估慢性乙型肝炎患者肝纤维化程度价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 345-348.

Peng Yujing, Guo Hang, Chen Junguang. Liver fibrosis assessment by US elastography in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2024, 27(3): 345-348.

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应用超声评分联合STE/STQ定量检测肝脏硬度评估慢性乙型肝炎患者肝纤维化程度价值研究^*

Liver fibrosis assessment by US elastography in patients with chronic hepatitis B

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