超声造影与剪切波弹性成像评估慢性乙型肝炎肝纤维化的对比研究

目的探讨超声造影与剪切波弹性成像(SWE)在慢性乙型肝炎(CHB)肝纤维化评估中的应用价值。方法选取我院行肝穿刺活检的CHB患者120例,根据活检结果分为无纤维化组(S0期)18例、肝纤维化组(S1~S3期)73例、肝硬化组(S4期)29例。应用超声造影获取各组肝动静脉渡越时间(HAVTT1和HAVTT2)值,SWE检查获得肝脏弹性测值;应用受试者工作特征(ROC)曲线分析各检测指标预测肝纤维化及肝硬化的诊断效能。结果随着肝纤维化分期提高,HAVTT1、HAVTT2逐渐缩短,肝脏弹性测值逐渐增大;HAVTT1、HAVTT2及肝脏弹性测值在无纤维化组、肝纤维化组及肝硬化组之间两两比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,HAVTT1、HAVTT2诊断肝纤维化及肝硬化的曲线下面积分别为0.870、0.851和0.889、0.856,肝脏弹性测值诊断肝纤维化及肝硬化的曲线下面积为分别为0.953、0.898;肝脏弹性测值的诊断效能明显优于HAVTT1及HAVTT2,差异均有统计学意义(均P<0.05)。结论应用SWE技术获取的肝脏弹性值对CHB患者肝纤维化及肝硬化的诊断优于超声造影。

Evaluation on liver fibrosis in patients with chronic hepatitis B by contrastenhanced ultrasound and shear wave elastography:a comparison study

Objective To explore the application value of contrast-enhanced ultrasound(CEUS)and shear waveelastography(SWE)in evaluating liver fibrosis for chronic hepatitis B(CHB)patients.MethodsA total of 120 CHB patientsunderwent liver needle biopsy were enrolled in this study.According to biopsy results,they were divided into non-fibrosisgroup(S0 stage,18 cases),liver fibrosis group(S1~S3 stage,73 cases)and cirrhosis group(S4 stage,29 cases).The hepaticarteriovenous transit time(HAVTT1 and HAVTT2)and liver elasticity measurement value in each group were obtained by CEUSand SWE.ResultsWith the degree of liver fibrosis increasing,HAVTT1 and HAVTT2 were gradually shortened,and liverelasticity measurement value was gradually increased. There were significant differences in HAVTT1,HAVTT2 and liverelasticity between the non-fibrosis group,fibrosis group and cirrhosis group(all P<0.05).ROC curve analysis showed that areasunder the curve(AUC)of HAVTT1 and HAVTT2 in diagnosis of liver fibrosis and cirrhosis were 0.870,0.851 and 0.889,0.856,respectively.The areas under the curve for liver fibrosis and liver cirrhosis measured by liver elasticity values were 0.953 and0.898,respectively.The diagnostic efficiency of liver elasticity measurement value was significantly better than that of HAVTT1 and HAVTT2(both P<0.05).ConclusionThe liver elasticity value obtained by SWE is superior to CEUS in the diagnosis of liverfibrosis and cirrhosis in patients with CHB.