肝脏瞬时弹性成像和门静脉血流动力学指标检测对慢性乙型肝炎患者肝纤维化的诊断意义

目的 探讨瞬时弹性成像（TE,Fibroscan®）技术测量肝脏硬度值（LSM） 和超声检测门静脉血流动力学参数对慢性乙型肝炎（CHB）患者肝脏纤维化分级的效能。方法 91例CHB患者和41例正常人经Fibroscan-502仪测定LSM;使用彩色多普勒超声诊断仪检测门静脉主干内径（PVD）、最大流速（PVVmax）和平均流速（PVVmean）;CHB患者在超声引导下行肝脏穿刺,对穿刺组织进行病理学检查。结果 CHB患者LSM、PVD、PVVmax和PVVmean分别为（9.40±0.95）kPa、（11.63±0.12）mm、（35.40±0.94）cm/s和（29.82±0.84）cm/s,均显著高于正常人[分别为（4.45±0.20）kPa、（10.85±0.12）mm、（26.10±1.07）cm/s和（21.94±0.73）cm/s,P<0.01];CHB患者肝组织纤维化病理分期为S0者LSM、PVD、PVVmax和PVVmean分别为（5.46±0.33）kPa、（11.36±0.24）mm、（40.99±1.46）cm/s和（34.42±1.29）cm/s,S1期者为（6.06±0.31）kPa、（11.33±0.16）mm、（34.09±1.43）cm/s和（28.90±1.31）cm/s,S2期者为（9.87±1.15）kPa、（12.14±0.31）mm、（33.51±1.59）cm/s和（27.78±1.73）cm/s,S3期者为（15.48±2.16）kPa、（12.42±0.26）mm、（33.01±2.11）cm/s和（28.48±2.05）cm/s,和S4期者为（31.85±8.38）kPa、（12.50±0.34）mm、（28.42±2.78）cm/s和（24.58±2.91）cm/s],差异有统计学意义（F=29.13、F=4.52、F=5.98和F=4.36,P均<0.01）;CHB患者LSM与PVD、PVVmax和PVVmean存在相关性（r=0.362、r=-0.364、r=-0.345,P<0.01）。结论 综合应用LSM及门静脉血流动力学指标对临床无创评估CHB患者肝纤维化有一定的诊断意义。

Application of transient elastography and portal hemodynamics indexes in diagnosis of hepatic fibrosis in patients with chronic hepatitis B

Objective To investigate the efficacy of hemodynamic indexes of portal vein and liver stiffness measure（LSM） in diagnosis of liver fibrosis in patients with chronic hepatitis B（CHB）. Methods A total of 91 patients with CHB and 41 healthy persons were recruited in this study. All subjects were examined by Fibroscan-502 to obtain the LSM,and color Doppler ultrasound were applied for the detection of inner diameters of portal vein（PVD）,max blood flow velocity of portal vein（PVVmax） and mean blood flow velocity of portal vein （PVVmean）. All CHB patients underwent liver biopsy for evaluation of liver fibrosis staging. Results The LSM, PVD, PVVmax and PVVmean in patients with CHB[（9.40±0.95） kPa,（11.63±0.12） mm,（35.40±0.94） cm/s and （29.82±0.84）cm/s] were much higher than those in healthy persons [（4.45±0.20） kPa,（10.85±0.12） mm, （26.10±1.07） cm/s and（21.94±0.73） cm/s,respectively,P<0.01];the LSM,PVD,PVVmax and PVVmean in patients with S0 fibrosis were（5.46±0.33） kPa,（11.36±0.24） mm,（40.99±1.46） cm/s and （34.42±1.29） cm/s, in patients with S1 were（6.06±0.31） kPa,（11.33±0.16） mm,（34.09±1.43） cm and（28.90±1.31） cm/s,in patients with S2 were （9.87±1.15） kPa,（12.14±0.31） mm,（33.51±1.59） cm/s and（27.78±1.73） cm/s,in patients with S3 were （15.48±2.16） kPa,（12.42±0.26） mm,（33.01±2.11） cm/s and（28.48±2.05） cm/s,and in patients with S4 were（31.85±8.38） kPa,（12.50±0.34） mm,（28.42±2.78） cm/s,and（24.58±2.91） cm/s,significantly different among the five groups（F=29.13,F=4.52,F=5.98 and F=4.36,P<0.01）;the correlations between LSM and PVD,PVVmax,and PVVmean in patients with CHB were statistically significant （r=0.362,r=-0.364,r=-0.345,P<0.01）. Conclusions The combination detection of hemodynamic indexes of portal vein and LSM of liver may be valuable in determining liver fibrosis in a noninvasive way in patients with CHB.