慢性肝病肝纤维化的肝静脉血流频谱分析

目的 探讨慢性肝病肝静脉多普勒频谱改变与肝组织病理肝纤维化程度的关系。方法 超声引导下肝穿对70例慢性肝病进行肝组织病理分析，并运用多普勒技术对70例慢肝患者和70例正常人进行肝静脉频谱测定。结果 慢性肝病肝静脉多普勒波形改变与肝纤维化病理分期之间具有一定相关性。结论 肝静脉多普勒对肝纤维化具有明显诊断意义。     

肝静脉管径及多普勒频谱与慢性病毒性肝炎肝纤维化的相关性研究

目的：探讨慢性病毒性肝炎肝静脉管径及多普勒频谱改变与肝组织病理纤维化程度的关系。方法：应用彩色多普勒超声观测了１１３例慢性病毒性肝炎患者肝中静脉直径（ＨＶＤ）及多普勒频谱改变,并与肝组织病理纤维化分期（Ｓ）进行相关性分析。结果：ＨＶＤ随肝纤维化程度的加重而变窄,与Ｓ呈显著性负相关关系;肝静脉多普勒频谱改变与肝纤维化分期有关,亦与肝静脉管径有关。分别将Ｓ０－１、Ｓ２－３、Ｓ４归为轻度、中度、重度纤维化,不同程度纤维化之间肝中静脉管径及多普勒频谱的差异均有显著性。结论：肝静脉管径及多普勒频谱的变化在判别慢性病毒性肝炎肝纤维化的程度方面有重要诊断价值。     

肝硬化患者肝静脉多普勒波形的观察

本文对２０例健康体检者和１５例肝硬化患者的肝静脉（ＨＶ）多普勒图像作了对比性观察。探讨了正常组与肝硬化组之间ＨＶ波可能出现的差异，以及ＨＶ波形的改变与疾病严重程度的关系。ＨＶ波分为三型：ＨＶ０ＨＶ＿１和ＨＶ＿２。所有正常组ＨＶ波形为ＨＶ＿０；肝硬化组，ＨＶ＿０７例（４７％），ＨＶ＿１６例（４０％），ＨＶ＿２２例（１３％）。肝功损害程度在ＨＶ＿２组最重，ＨＶ＿０组最轻。     

肝静脉频谱波形分析对肝纤维化的临床价值研究

目的 利用脉冲多普勒评估肝静脉(HV)频谱波形对肝纤维化临床应用中的价值.方法 利用脉冲多普勒超声评估30例正常人和150例慢性乙型肝炎后肝纤维化患者肝静脉频谱波形,将肝静脉频谱波形分为0型、I型和II型.结果 随纤维化程度加重(HV)I型和II型明显增多,组间差异显著(P＜0.01).结论 脉冲多普勒超声肝静脉频谱波形分析有望成为无创伤性诊断肝纤维化的一种简单实用的指标.     

超声量化指标与肝静脉波形分型在评价乙肝患者肝纤维化程度中的临床意义

目的探讨超声量化指标与肝静脉波形分型在评价乙肝患者肝纤维化程度中的临床意义。方法回顾性分析本院110例乙肝患者的临床资料,作为研究组;选取同期到本院体检的25例健康人,作为对照组。研究组入院确诊时、对照组体检时均分别行超声检查,评估超声量化指标、肝静脉波形分型。以肝穿刺病理结果为金标准,判断超声量化指标、肝静脉波形分型对肝纤维化程度诊断价值。结果研究组S1、S2、S3、S4期患者超声量化指标评分高于对照组(P<0.05);随着肝纤维化分期增加,研究组超声量化指标评分呈增高趋势(P<0.05);研究组S4期HVⅠ型+HVⅡ型率高于S0、S1、S2期及对照组,S3期HVⅠ型+HVⅡ型率高于S0、S1、S2期及对照组(P<0.05);ROC曲线显示肝静脉波形分型灵敏度、特异度较超声量化指标评分高。结论乙肝患者肝纤维化程度评估中超声量化指标与肝静脉波形分型均具有一定价值,且后者灵敏度、特异度更高。     

Hepatic Elastometry and Glissonian Line in the Assessment of Liver Fibrosis

The aim of this study was to identify a method for staging hepatic fibrosis using a non-invasive, rapid and inexpensive technique based on ultrasound morphologic hepatic features. A total of 215 patients with different liver diseases underwent B-mode (2-D brightness mode) ultrasonography, vibration-controlled transient elastography, 2-D shear wave elastography and measurement of the controlled attenuation parameter with transient elastography. B-Mode images of the anterior margin of the left lobe were obtained and processed with automatic Genoa Line Quantification (GLQ) software based on a neural network for staging liver fibrosis. The accuracy of GLQ was 90.6% during model training and 78.9% in 38 different patients with concordant elastometric measures. Receiver operating characteristic curve analysis of GLQ performance using vibration-controlled transient elastography as a reference yielded areas under the curves of 0.851 for F ≥ F1, 0.793 for F ≥ F2, 0.784 for F ≥ F3 and 0.789 for F ≥ F4. GLQ has the potential to be a rapid, easy-to-perform and tolerable method in the staging of liver fibrosis.     

肝静脉多普勒超声及血清标志物测定诊断肝纤维化的对比研究

目的：比较肝静脉多普勒超声和血清标志物检测诊断肝纤维化的价值。方法：用上述二种方法同时对７０例慢性肝病患者和４０例正常人进行检测。结果：慢性肝病患者肝静脉多普勒波形改变具有相对恒定的特征变化;血清透明质酸（ＨＡ）,Ⅲ型前胶原（ＰＣⅢ）和层粘蛋白（ＬＮ）水平比正常对照组显著增高。结论;肝静脉多普勒法诊断肝纤维化明显优于血清法,是诊断肝纤维化较可靠的无创伤性方法。     

Point Shear Wave Elastography for Non-invasive Assessment of Liver Fibrosis in Patients with Viral Hepatitis

Elastography point quantification (ElastPQ) is a new ultrasound-based shear wave elastography method for non-invasive assessment of liver fibrosis. We evaluated the diagnostic accuracy of ElastPQ in patients with chronic viral hepatitis. Fibrosis stage (F) was determined by transient elastography (F0/F1: <7.1 kPa, F2: 7.1–9.4 kPa, F3: 9.5–12.4 kPa, F4: ≥12.5 kPa). Area under the receiver operator characteristics curve (AUROC) analysis was performed to assess ElastPQ cutoffs for significant fibrosis (≥F2) and cirrhosis (F4). Paired transient elastography and ElastPQ measurements were obtained from 217 patients (mean age ± SEM: 49 ± 0.79 years, 68.2% male, F0/F1: n?=?98 [45.0%], F2: 47 [21.6%], F3: 22 [10.1%], F4: 50 [22.9%]). AUROC for ≥F2 was 0.843 (95% confidence interval: 0.791–0.895), and for F4, 0.933 (95% confidence interval: 0.894–0.972). The optimal ElastPQ cutoff for F2 was 6.68 kPa (sensitivity: 80.7%, specificity: 70.4%, positive predictive value: 78.5%, negative predictive value: 72.3%), and for F4 11.28 kPa (sensitivity: 86.0%, specificity: 85.6%, positive predictive value: 60.52%, negative predictive value: 97.16%). In conclusion, ElastPQ represents an accurate tool for non-invasive staging of liver fibrosis in patients with viral hepatitis.     

慢性肝炎患者血清纤维化指标与肝组织纤维化之间的关系

目的：研究血清纤维化指标透明质酸(HA)，Ⅲ型前胶原肽(PⅢP)及IV型胶原(IVC)与慢性肝炎患者组织炎症程度与纤维化分期之间的关系。方法：用放射免疫法测定176例慢性肝炎患者血清HA、IVC、PⅢP水平，同时行肝组织活检，对肝组织炎症分级及纤维化分期，分析上述指标与肝纤维化及炎症之间的关系。结果：上述3项指标随着肝脏炎症及纤维化程度的加重而上升，有一定的相关性，尤其是随着肝脏纤维化分期的上升而升高，呈正相关。结论：血清HA、PⅢP、IVC可做为反映肝脏炎症和纤维化程度的参考指标。     

阻断肝右静脉对肝硬化小猪肝脏血流动力学的影响

目的：探索肝硬化条件下合理的肝静脉阻断方式。方法：分别缝扎或间歇断肝硬化小猪各6头，动态观察肝脏组织病理学，肝功能，肝动脉造影，核素扫描和肝脏血流动力学的改变。结果：缝扎组早期肝损害明显，6周后恢复，早期肝右叶肿胀淤血，晚期有萎缩，左叶横径纵径增加；术后门静脉压力或高，门静脉血流减慢，流量减少，肝动脉血流加快，血流量增加，肝动脉－门静脉瘘，右肝门静脉分支与左肝静脉分支交通支形成。间歇阻断组肝损害较轻但持久，阻断期肝右叶肿胀，放松后改善，6周后左右略增大，右叶减小不明显，阻断期PVP，门静脉，肝动脉血流速度，血流量改变与结扎组相似，间歇期恢复；未见血管瘘形成。结论：肝硬化情况下缝扎RHV致肝右叶萎缩，左叶代偿增生较间歇阻断组明显；缝扎RHV致肝功能损害早期较明显，可自行恢复，间歇阻断致肝功能损害较轻但持久，缝扎RHV对肝脏血流动力学的影响较明显，肝内侧支循环较完善。     

Improved Ultrasound Attenuation Measurement Method for the Non-invasive Evaluation of Hepatic Steatosis Using FibroScan

Controlled attenuation parameter (CAP) is a measurement of ultrasound attenuation used to assess liver steatosis non-invasively. However, the standard method has some limitations. This study assessed the performance of a new CAP method by ex vivo and in vivo assessments. The major difference with the new method is that it uses ultrasound data continuously acquired during the imaging phase of the FibroScan examination. Seven reference tissue-mimicking phantoms were used to test the performance. In vivo performance was assessed in two cohorts (in total 195 patients) of patients using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as a reference. The precision of CAP was improved by more than 50% on tissue-mimicking phantoms and 22%–41% in the in vivo cohort studies. The agreement between both methods was excellent, and the correlation between CAP and MRI-PDFF improved in both studies (0.71 to 0.74; 0.70 to 0.76). Using MRI-PDFF as a reference, the diagnostic performance of the new method was at least equal or superior (area under the receiver operating curve 0.889–0.900, 0.835–0.873). This study suggests that the new continuous CAP method can significantly improve the precision of CAP measurements ex vivo and in vivo.     

四氯化碳诱导性肝纤维化大鼠肝组织白细胞介素4表达的研究

目的通过观察四氯化碳（CCl4）致大鼠肝纤维化过程中的白细胞介素4（IL-4）在肝组织中的表达情况，探讨肝纤维化机制。方法建立（CCl4）诱导的大鼠肝纤维化动物模型。19只Wistar大鼠分为对照组4只和肝纤维化组15只（肝纤维化组按照CCl4的作用时间又分为2、4、6、8周组）。对各组大鼠肝组织进行苏木精-伊红染色和SP法免疫组织化学染色，观察肝组织病理变化及IL-4的表达情况。结果免疫组织化学染色显示，IL-4在正常肝脏组织几乎没有表达，肝纤维化组注射CCl4诱导后，大鼠肝组织中IL-4的表达强度较对照组明显增强，主要分布在肝组织纤维化增生的汇管区。IL-4表达随CCl4作用时间延长而增强，4、6周后变化尤其明显。结论IL-4可能在肝纤维化过程中发挥着重要作用。     

Ultrasound Detection of Liver Fibrosis in Individuals with Hepatic Steatosis Using the Homodyned K Distribution

Acoustic structure quantification (ASQ) based on the analysis of ultrasound backscattered statistics has been reported to detect liver fibrosis without significant hepatic steatosis. This study proposed using ultrasound parametric imaging based on the parameter α of the homodyned K (HK) distribution for staging liver fibrosis in patients with significant hepatic steatosis. Raw ultrasound image data were acquired from patients (n = 237) to construct B-mode and HK α parametric images, which were compared with the focal disturbance (FD) ratio obtained from ASQ on the basis of histologic evidence (METAVIR fibrosis score and hepatic steatosis severity). The data were divided into group I (n = 173; normal to mild hepatic steatosis) and group II (n = 64; with moderate to severe hepatic steatosis) for statistical analysis through one-way analysis of variance and receiver operating characteristic (ROC) curve analysis. The results showed that the HK α parameter monotonically decreased as the liver fibrosis stage increased (p < .05); concurrently, the FD ratio increased (p < .05). For group I, the areas under the ROC (AUROCs) obtained using the FD ratio and the α parameter (AUROC_FD and AUROC_α) were, respectively, 0.56 and 0.55, 0.68 and 0.68, 0.64 and 0.64 and 0.62 and 0.62 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. The values of AUROC_FD and AUROC_α for group II were, respectively, 0.88 and 0.91, 0.81 and 0.81, 0.77 and 0.76 and 0.78 and 0.73 for diagnosing liver fibrosis ≥F1, ≥F2, ≥F3 and ≥F4. As opposed to previous studies, ASQ was found to fail in characterizing liver fibrosis in group I; however, it was workable for identifying liver fibrosis in patients with significant hepatic steatosis (group II). Compared with ASQ, HK imaging provided improved diagnostic performance in the early detection of liver fibrosis coexisting with moderate to severe hepatic steatosis. Ultrasound HK imaging is recommended as a strategy to evaluate early fibrosis risk in patients with significant hepatic steatosis.     

Quantification of Liver Viscoelasticity with Acoustic Radiation Force: A Study of Hepatic Fibrosis in a Rat Model

Ultrasound elastography, based on shear wave propagation, enables the quantitative and non-invasive assessment of liver mechanical properties such as stiffness and has been found to be feasible for and useful in the diagnosis of hepatic fibrosis. Most ultrasound elastographic methods use a purely elastic model to describe liver mechanical properties. However, to describe tissue that is dispersive and to obtain an accurate measure of tissue elasticity, the viscoelasticity of the tissue should be examined. The objective of this study was to investigate the shear viscoelastic characteristics, as measured by ultrasound elastography, of liver fibrosis in a rat model and to evaluate the diagnostic accuracy of viscoelasticity for staging liver fibrosis. Liver fibrosis was induced in 37 rats using carbon tetrachloride (CCl₄); 6 rats served as controls. Liver viscoelasticity was measured in vitro using shear waves induced by acoustic radiation force. The measured mean values of liver elasticity and viscosity ranged from 0.84 to 3.45 kPa and from 1.12 to 2.06 Pa·s for fibrosis stages F0–F4, respectively. Spearman correlation coefficients indicated that stage of fibrosis was well correlated with elasticity (0.88) and moderately correlated with viscosity (0.66). The areas under receiver operating characteristic curves were 0.97 (≥F2), 0.91 (≥F3) and 1.00 (F4) for elasticity and 0.91 (≥F2), 0.79 (≥F3) and 0.74 (F4) for viscosity, respectively. The results confirmed that shear wave velocity was dispersive in frequency, suggesting a viscoelastic model to describe liver fibrosis. The study finds that although viscosity is not as good as elasticity for staging fibrosis, it is important to consider viscosity to make an accurate estimation of elasticity; it may also provide other mechanical insights into liver tissues.     

Assessing Hepatic Fibrosis Using 2-D Shear Wave Elastography in Patients with Liver Tumors: A Prospective Single-Center Study

The purpose of this study was to investigate the diagnostic performance of 2-D shear wave elastography (2-D-SWE) in evaluations of liver stiffness in patients with liver tumors before resection. A total of 121 consecutive patients with hepatocellular carcinoma (HCC) (n = 93), intra-hepatic cholangiocarcinoma (n = 6), mixed hepatocellular carcinoma and intra-hepatic cholangiocarcinoma (n = 6), liver metastases (n = 10) and benign tumors (n = 6) were prospectively enrolled in this study from June 2015 to March 2016. Three valid 2-D-SWE measurements for each patient and median liver stiffness values were calculated. Fibrosis staging was evaluated according to the METAVIR scoring system. A receiver operating characteristic curve analysis was used to assess diagnostic performance. In this study, we found that median liver stiffness values were significantly higher in patients with primary liver tumors than in those with liver metastases and benign tumors (11.80 kPa vs. 5.85 kPa, p < 0.001). In addition, liver stiffness, assessed using 2-D-SWE, was highly correlated with pathologically confirmed liver fibrosis stage. Liver fibrosis stage and liver stiffness values were analyzed using Spearman's correlation (0.708, p < 0.001). The median liver stiffness values were as follows: F1, 6.7 kPa; F2, 6.33 kPa; F3, 9.2 kPa; F4, 13.7 kPa. The area under the receiver operating characteristic curves of the liver stiffness values that predicted significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 83.5%, 91.6% and 88.1%, respectively. According to the Youden index, the optimal cutoff values for predicting significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4) were 7.05 kPa (sensitivity = 74.6%, specificity = 100.0%), 9.45 kPa (sensitivity = 78.8%, specificity = 100.0%) and 11.1 kPa (sensitivity = 83.1%, specificity = 89.3%), respectively. We conclude that 2-D-SWE is a useful, accurate and non-invasive method for evaluating hepatic fibrosis in patients with liver tumors adapted to hepatectomy (ClinicalTrials.gov ID: NCT02958592).     

彩色多普勒观察门静脉癌栓及肝硬化对原发性肝癌血供的影响

目的：探讨门静脉癌栓及肝硬化对肿瘤血供的影响。方法：本研究回顾性分析１０８例原发性肝癌的彩色多普勒超声图像,所有病例分为三组。Ⅰ组：单纯性肝癌,５４例;Ⅱ组：肝癌合并门静脉癌栓,２７例;Ⅲ组：肝癌合并肝硬化,２７例。结果：肿瘤动脉收缩期峰值流速（ＰＳＶ）均值以Ⅱ组最高,阻力指数（ＲＩ）均值以Ⅲ组最高。当肿瘤≤１０ｃｍ时,各组间ＰＳＶ、ＲＩ均值差异具显著性（ｐ＜０．０１～０．０５）。结论：门静脉癌栓及肝硬化对肝癌动脉ＰＳＶ和ＲＩ具有一定影响。     

Comparison of Acoustic Radiation Force Impulse Imaging and Transient Elastography for Non-invasive Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B

The aims of this study were to compare the performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis in patients with chronic hepatitis B and to evaluate the impact of elevated alanine transaminase levels on liver stiffness assessment using ARFI elastography. One hundred eighty consecutive patients with chronic hepatitis B were enrolled in this study and evaluated with respect to histologic and biochemical features. All patients underwent ARFI elastography and TE. ARFI elastography and TE correlated significantly with histologically assessed fibrosis (r = 0.599, p < 0.001, for ARFI elastography; r = 0.628, p < 0.001, for TE) and necro-inflammatory activity (r = 0.591, p < 0.001, for ARFI elastography; r = 0.616, p < 0.001, for TE). Areas under the receiver operating characteristic curves for ARFI elastography and TE were 0.764 and 0.813 (p = 0.302, ≥stage 2), 0.852 and 0.852 (p = 1.000, ≥stage 3) and 0.825 and 0.799 (p = 0.655, S = 4), respectively. The optimum cutoff values for ARFI elastography were 1.63 m/s for stage ≥2, 1.74 m/s for stage ≥3 and 2.00 m/s for stage 4 in patients for whom alanine transaminase levels were evaluated. The cutoff values decreased to 1.24 m/s for ≥ stage 2, 1.32 m/s for ≥ stage 3 and 1.41 m/s for stage 4 in patients with normal alanine transaminase levels. ARFI elastography may be a reliable method for diagnosing the stage of liver fibrosis with diagnostic performance similar to that of TE in patients with chronic hepatitis B. In addition, liver stiffness values obtained with ARFI elastography, like those obtained with TE, may be influenced by alanine transaminase levels.     

苦味酸-天狼猩红偏振光法在肝纤维化研究中的应用

目的探讨苦味酸-天狼猩红偏振光法在肝纤维化研究中的应用。方法取肝穿组织石蜡切片分别进行苦味酸-天狼猩红染色和Masson三色染色,检测肝组织中的胶原纤维,比较二者的差异性。结果苦味酸-天狼猩红染色的切片其纤维化部位颜色鲜明,四型胶原呈不同色彩;苦味酸-天狼猩红染色和Masson三色染色对纤维化部位的定位一致,对纤维化面积的检测无显著差异性(P<0.05)。结论应用苦味酸-天狼猩红染色处理的切片能区分四种类型的胶原纤维,且可结合图像分析系统测定肝纤维化面积,评估肝纤维化组织的修复程度,为临床诊断及治疗提供帮助。