实时剪切波超声弹性成像对慢性乙型病毒性肝炎肝纤维化分期的定量分析

目的 探讨实时剪切波超声弹性成像(SWE)技术在慢性乙型病毒性肝炎肝纤维化分期诊断中的应用价值,同时建立诊断肝纤维化分期的杨氏模量值参考范围.方法 以48例慢性乙肝患者和58例健康成人作为研究对象,测量研究对象的肝脏S5、S6段杨氏模量值,并对48例慢性乙肝患者进行病理组织学检查,将病理结果与杨氏模量值进行比较分析,得出诊断肝纤维化分期的杨氏模量值参考范围.结果 肝S5、S6段的杨氏模量值在慢乙肝组及正常对照组间存在显著差异(P<0.05),慢乙肝组S5、S6段杨氏模量值分别为(11.7±2.9、12.1±3.2)k Pa,明显高于正常对照组(5.7±1.1、5.8±1.3)k Pa.肝杨氏模量值在各纤维化分期间均有差异(P<0.05),S0~S4期肝S5段杨氏模量值分别为(5.8±2.2、7.3±1.9、10.3±2.8、10.3±2.8、25.3±3.6)k Pa,肝S6段杨氏模量值分别为(5.7±2.3、9.2±2.1、10.5±2.1、14.7±4.5、26.1±2.1)k Pa,且随S分期的增加,肝脏杨氏模量值有所增加.结论 SWE技术可确立肝纤维化分期的杨氏模量值参考范围,且有较高的敏感性、特异性和准确性.

Quantitative Analysis on Staging of Chronic Viral Hepatitis B and Hepatic Fibrosis by Real-time Shear Wave Elastography

Objective To explore the application value of real-time shear wave elastography(SWE)technique in diagnosing and staging of chronic viral hepatitis B and hepatic fibrosis and to establish Young's modulus reference range for diagnosing and staging of hepatic fibrosis.Methods Forty-eight patients with chronic hepatitis B and fifty-eight healthy adults were enrolled and their Young's modulus values of S5 and S6 segments of liver were measured. Histopathologic examination was performed on 48 patients with chronic hepatitis B. Comparative analysis was conducted between the pathological findings and Young's modulus values, by means of which Young's modulus reference range for diagnosis and staging of hepatic fibrosis was obtained. Results There was significant difference in Young's modulus values of S5 and S6 segments of liver between chronic hepatitis B group and the normal control group(P <0.05). Young's modulus values of S5 and S6 segments of liver in chronic hepatitis B group were(11.7±2.9) k Pa and(12.1±3.2) k Pa respectively,which were significantly higher than those in the normal control group,(5.7 ±1.1) k Pa and(5.8 ±1.3) k Pa respectively. Significant differences of Young's modulus values were detected in every staging of hepatic fibrosis(P<0.05). S5 segment of liver Young's modulus values inS0-S4 stages were(5.8±2.2) k Pa,(7.3±1.9) k Pa,(10.3±2.8) k Pa,(10.3±2.8) k Pa,and(25.3±3.6) k Pa, respectively. S6 segment of liver Young's modulus values in S0-S4 stages were(5.7 ±2.3) k Pa,(9.2 ±2.1) k Pa,(10.5 ±2.1) k Pa,(14.7 ±4.5) k Pa, and(26.1 ±2.1) k Pa, respectively. Young's modulus value of the liver rose with the increase of S stage. Conclusion SWE technique can establish the Young's modulus reference range for hepatic fibrosis stage. Besides, it features high sensitivity, specificity and accuracy.