声触诊弹性成像对慢性乙型病毒性肝炎肝纤维化的诊断效能研究

doi:10.19871/j.cnki.xfcrbzz.2024.05.010

摘要/Abstract

摘要： 目的探讨应用声触诊弹性成像（sound touch elastography,STE）评价慢性乙型病毒性肝炎（chronic hepatitis B,CHB）纤维化程度的价值,并分析基于STE验证纤维化的效能,为CHB肝纤维化程度分期提供依据。方法选取2022年2月至2023年3月深圳禾正医院和深圳市第三人民医院收治的264例CHB肝纤维化患者及59例健康志愿者,肝纤维化患者经肝穿刺后分为轻度肝纤维化组113例、中度肝纤维化组59例、重度肝纤维化组52例、肝硬化组40例,健康志愿者纳入正常对照组。对比各组一般资料及实验室检查指标、STE值有无差异,采用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）评价STE对肝纤维化不同程度的诊断价值。结果肝硬化组脾厚、脾长、脾静脉内径（splenic vein diameter,SPV）、总胆红素（total bilirubin,TB）、谷草转氨酶（aspartate aminotransferase,AST）、透明质酸（hyaluronic acid,HA）、前肽原Ⅲ肽（propeptide Ⅲ peptide,PⅢP）、Ⅳ型胶原（type Ⅳ collagen,CⅣ）均最高,而血小板计数（platelet count,PLT）最低。轻度肝纤维化组在脾长、谷丙转氨酶（alanine aminotransferase,ALT）、AST、HA、PⅢP、CⅣ与中度肝纤维化组差异无统计学意义（P<0.05）;脾厚、PLT两组间差异有统计学意义（P<0.05）。肝脏STE值、脾脏STE值均随着肝纤维化程度加重而升高（P<0.05）。STE诊断轻度肝纤维化、中度肝纤维化、重度肝纤维化的ROC曲线的曲线下面积AUC值分别为0.853、0.802、0.989。结论 STE评估CHB患者肝纤维化程度有显著效果,对肝纤维化分期有较好的诊断价值。

关键词: 乙型肝炎病毒, 肝纤维化程度, 肝硬化, 声触诊弹性成像, 诊断效能

Abstract: Objective To explore the value of sound touch elastography (STE) in evaluating the degree of fibrosis in chronic hepatitis B (CHB) and analyze the efficacy of STE in verifying fibrosis. To provide a new reference for staging the degree of liver fibrosis in patients with chronic hepatitis B. Method 264 patients with CHB liver fibrosis and 59 healthy volunteers were selected from February 2022 to March 2023. After liver puncture, the patients with liver fibrosis were divided into mild liver fibrosis group (113 cases), moderate liver fibrosis group (59 cases), severe liver fibrosis group (52 cases) and cirrhosis group (40 cases). The healthy volunteers were included in the normal control group. The general data and laboratory test indexes of each group were compared to evaluate the stage of liver fibrosis. Receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic value of STE in different degrees of liver fibrosis. Result In cirrhosis group, splenic vein diameter (SPV), total bilirubin (TB), aspartate aminotransferase (AST), hyaluronic acid (HA), propeptide Ⅲ peptide (PⅢP) and type Ⅳ collagen (CⅣ) were the highest, while platelet count（PLT) was lowest. There were no significant differences in spleen length, alanine aminotransferase (ALT), AST, HA, PⅢP, CⅣ between the mild hepatic fibrosis group and the moderate hepatic fibrosis group (P>0.05), while there were statistically significant differences in spleen thickness and PLT between the two groups (P<0.05). Both liver STE and spleen STE were increased with the aggravation of liver fibrosis (P<0.05). The AUC of the ROC of STE in diagnosing mild, moderate and severe liver fibrosis were 0.853, 0.802 and 0.989, respectively. Conclusion STE has a significant effect in evaluating the degree of liver fibrosis in patients with CHB, STE has good diagnostic efficacy for staging liver fibrosis.

Key words: Hepatitis B virus, Degree of liver fibrosis, Cirrhosis, Sound touch elastography, Diagnostic efficiency

中图分类号:

R451

袁丽, 戈娟, 袁宇峰, 冯旋, 董常峰. 声触诊弹性成像对慢性乙型病毒性肝炎肝纤维化的诊断效能研究[J]. 新发传染病电子杂志, 2024, 9(5): 53-58.

Yuan Li, Ge Juan, Yuan Yufeng, Feng Xuan, Dong Changfeng. To explore the diagnostic efficacy of sound touch elastography in chronic hepatitis B liver fibrosis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(5): 53-58.

参考文献

[1] 丁荣蓉, 陆伟, 王雁冰, 等. 采用瞬时弹性成像技术和血清标志物预测丙氨酸转氨酶轻度升高的慢性乙型肝炎患者肝纤维化程度[J].中华传染病杂志, 2019, 37(2):72-76.
[2] ZAYED N, DARWEESH SK, MOUSA S, et al.Liver stiffness measurement by acoustic radiation forced impulse and transient elastography in patients with intrahepatic cholestasis[J].Eur J Gastroen Hepat, 2019, 31(4):520-527.
[3] 董常峰, 冯程, 黄婷, 等. 弹性成像联合血生化指标评估慢性乙型肝炎肝纤维化程度[J].中国超声医学杂志, 2018, 34(7):623-626.
[4] ZHENG Y, XIA S, REN X, et al.A study of spleen shear-wave elastography in indirect prediction of liver fibrosis in patients with chronic hepatitis B[J]. Clin Hemorheol Micro, 2020, 76(1):1-10.
[5] 任浩, 徐辉, 杨大为, 等. 磁共振弹性成像评估非酒精性脂肪性肝病肝纤维化程度[J]. 中国医学影像学杂志, 2022, 30(2):106-110.
[6] 董丙田, 黄枢, 常建东, 等. 声触诊弹性成像与4项血清纤维化指标评估慢性乙型肝炎肝纤维化的效能比较[J]. 中华肝脏病杂志, 2020, 28(3):269-272.
[7] 赵雅琴, 李刚, 沈慧梅, 等. 超声半定量评分结合弹性成像诊断早期肝硬化及其与血清标记物比较[J].中国超声医学杂志, 2022, 38(6):665-668.
[8] XU B, ZHOU NM, CAO WT,et al.Evaluation of elastography combined with serological indexes for hepatic fibrosis in patients with chronic hepatitis B[J].World J Gastroen, 2018, 24(37):4272-4280.
[9] 刘春蕊, 孔文韬, 韩浩, 等. 基于VTQ和FIB-4的logistic回归模型诊断肝脏外科手术前肝脏储备功能明显受损的研究[J]. 中华肝胆外科杂志, 2021, 27(7):489-493.
[10] 曾伟梅, 董常峰, 黄琨, 等. 声触诊弹性成像线性结合超声评分细分慢性乙肝患者肝纤维化程度[J]. 中华超声影像学杂志, 2023, 32(2):129-135.
[11] 王春妍, 文君, 周永和, 等. 声脉冲辐射力弹性成像技术对乙型肝炎后肝硬化患者食管静脉曲张的预测价值[J]. 中华肝脏病杂志, 2018, 26(7):499-502.
[12] 李沁园,董常峰,姜伟. 超声弹性成像对肝纤维化的诊断及应用[J/CD]. 新发传染病电子杂志,2020,5(3):207-211.
[13] 黄秀玲,董常峰. 超声新技术诊断慢性乙型病毒性肝炎合并非酒精性脂肪性肝病新进展[J/CD]. 新发传染病电子杂志, 2022, 7(2):95-98.
[14] 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[J].中华传染病杂志, 2018, 36(6):363-366.
[15] 郑剑, 吴曼丽, 钟梅, 等.声触诊弹性成像和声触诊弹性测量检测肝,脾硬度可行性研究[J].中华超声影像学杂志, 2019, 28(7):617-620.