超声弹性成像声触诊组织成像量化指标评估肝血吸虫病患者肝纤维化价值临床研究*

目的 探讨应用超声弹性成像声触诊组织成像量化指标评估肝血吸虫病患者肝纤维化的临床价值。方法 2019年1月～2021年1月我院诊治的肝血吸虫病患者110例和同期体检健康人110例,均接受肝活检和行超声弹性成像声触诊组织成像量化检测肝右前叶、肝右后叶和肝左外叶剪切波速度(SWV)。应用ROC分析SWV值诊断肝纤维化的价值。结果 肝血吸虫病患者肝右前叶、肝右后叶和肝左外叶SWV值分别为(1.4±0.4)、(1.4±0.5)和(1.5±0.5),均显著高于健康人【分别为(1.1±0.2)、(1.2±0.3)和(1.1±0.3),P＜0.05】;13例S4期患者肝右前叶、肝右后叶和肝左外叶SWV值分别为(1.9±0.5)、(1.9±0.5)和(2.1±0.6),显著高于27例S3期【分别为(1.6±0.4)、(1.7±0.3)和(1.8±0.4),P<0.05】或33例S2期【分别为(1.4±0.4)、(1.5±0.2)和(1.6±0.3),P<0.05】或37例S1期【分别为(1.2±0.3)、(1.3±0.2)和(1.4±0.2),P<0.05】;经ROC分析发现,SWV_肝右前叶、SWV_肝右后叶和SWV_肝左外叶诊断肝纤维化>=S2的截断点分别为1.250、1.350和1.350,其曲线下面积分别为0.837、0.733和0.807,敏感度分别为0.673、0.545和0.636,特异度分别为0.909、0.945和0.818,均具有一定的应用价值。结论 使用超声检测肝血吸虫病患者肝脏SWV值诊断显著肝纤维化分期有一定的临床应用价值,值得进一步研究。

Quantitative evaluation of hepatic fibrosis in patients with schistosomiasis by acoustic palpation tissue imaging of ultrasound elastography

Objective The aim of this study was to explore the quantitative evaluation of hepatic fibrosis in patients with schistosomiasis by acoustic palpation tissue imaging of ultrasound elastography. Methods A total of 110 patients with hepatic schistosomiasis and 110 healthy volunteers were recruited in our hospital between January 2019 and January 2021, and all patients underwent liver biopsies. The shear wave velocities (SWV) of right anterior lobe, right posterior lobe and left lateral lobe of livers were detected by quantitative acoustic palpation tissue imaging of ultrasound elastography in all individuals. The diagnostic value of SWV in predicting significant liver fibrosis (>=S2) was evaluated by ROC analysis. Results The SWVs of right anterior lobe, right posterior lobe and left lateral lobe of livers in patients with hepatic schistosomiasis were (1.4±0.4), (1.4±0.5) and (1.5±0.5), all significantly higher than [(1.1±0.2), (1.2±0.3) and (1.1±0.3), respectively,P＜0.05] in healthy volunteers; the SWVs of right anterior lobe, right posterior lobe and left lateral lobe of livers in 13 patients with S4 liver fibrosis staging were (1.9±0.5), (1.9±0.5) and (2.1±0.6), all significantly higher than [(1.6±0.4), (1.7±0.3) and (1.8±0.4), respectively, P<0.05] in 27 patients with S3 or [(1.4±0.4), (1.5±0.2) and (1.6±0.3), respectively, P<0.05] in 33 patients with S2 or [(1.2±0.3), (1.3±0.2) and (1.4±0.2), respectively, P<0.05] in 37 patients with S1; the ROC analysis showed that the area under ROC of SWV_{right anterior lobe}, SWV _{right posterior lobe} and SWV _{left lateral lobe} in diagnosing significant liver fibrosis were 0.837, 0.733 and 0.807 when the optimal cut-off-values were set at 1.250, 1.350 and 1.350, with the sensitivities of 0.673, 0.545 and 0.636, and the specificities of 0.909, 0.945 and 0.818. Conclusion The detection of SWV by acoustic palpation tissue imaging quantification of ultrasound in patients with hepatic schistosomiasis could help predicting significant liver fibrosis, and warrants further clinical investigation.