超声弹性成像及超声造影技术评估慢性乙肝肝纤维化程度的临床研究

目的　探讨声触诊组织量化（VTQ）及超声造影（CEUS）技术对慢性乙肝肝纤维化程度的诊断价值。方法　65例慢性乙肝患者分别进行VTQ、CEUS技术检查及肝穿刺活检，获取剪切波速度（SWV）及造影参数：门静脉到达时间（PVAT）、肝动脉到达时间（HAAT）、肝静脉到达时间（HVAT）、肝实质达峰时间（TTP）、肝动脉-肝静脉渡越时间（HV-HAAT）、肝动脉-门静脉渡越时间（PV-HAAT）。根据病理结果分为轻度组12例、中度组23例和重度组30例，比较各组SWV和CEUS参数差异，分析SWV、CEUS参数与肝纤维化程度的相关性，绘制受试者工作特征（ROC）曲线，寻找SWV、CEUS参数诊断重度肝纤维化的截断值，计算曲线下面积（AUC），评价SWV、CEUS参数对重度肝纤维化的诊断效能，采用DeLong法比较不同检测方法的AUC差异。结果　与轻度组比较，中度组和重度组SWV增大，重度组HVAT、HV-HAAT减小（P＜0.05）；与中度组比较，重度组SWV增大，HVAT、HV-HAAT减小（P＜0.05）。SWV与肝纤维化严重程度呈正相关（rs=0.713，P＜0.05），HVAT、HV-HAAT与肝纤维化严重程度呈负相关（rs分别为 -0.437、-0.620，P＜0.05）；SWV、HVAT、HV-HAAT诊断重度组肝纤维化（肝硬化）的AUC（95%CI）分别为0.925（0.832~0.976）、0.734（0.610~0.836）、0.804（0.687~0.892），截断值分别为1.92 m/s、21.02 s、8.23 s；SWV的诊断效能优于HVAT、HV-HAAT（Z分别为2.817和1.987，均P＜0.05）。结论　与CEUS相比，VTQ技术对慢性乙肝肝纤维化程度的诊断效能更佳。

Clinical study of ultrasound elastography and contrast-enhanced ultrasound in evaluating chronic hepatitis B liver fibrosis

Objective To investigate the diagnostic value of virtual touch tissue quantitfication (VTQ) and contrast-enhanced ultrasound (CEUS) in evaluating the chronic hepatitis B liver fibrosis. Methods Sixty-five patients with chronic hepatitis B were assessed by VTQ, CEUS and liver biopsy respectively to obtain the shear wave velocity (SWV) and contrast parameters of the liver，including portal vein arrival time (PVAT), hepatic artery time of arrival (HAAT), hepatic vein arrival time (HVAT), time to peak liver parenchyma (TTP), hepatic artery-hepatic vein transit time (HV-HAAT) and hepatic artery-portal vein transit time (PV-HAAT). According to the pathological results, sixty-five chronic hepatitis B patients were divided into mild group (n=12), moderate group (n=23) and severe group (n=30). The differences of SWV and CEUS parameters were compared between different groups. The correlation between SWV and CEUS parameters and the degree of liver fibrosis was analyzed. The receiver operating characteristic (ROC) curve was drawn to find the cut-off values of SWV and CEUS parameters for the diagnosis of severe liver fibrosis. The area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of SWV and CEUS parameters for severe liver fibrosis. Delong method was used to compare the differences of different AUC detection methods. Results Compared with the mild group, SWV increased in the moderate group and severe group, and HVAT and HV-HAAT decreased in the severe group (P＜0.05). Compared with the moderate group, SWV increased and HVAT and HV-HAAT decreased in the severe group (P＜0.05). There was a positive correlation between SWV and the severity of liver fibrosis (rs=0.713, P＜0.05). There was a negative correlation between HVAT, HV-HAAT and the severity of liver fibrosis (rs = -0.437 and -0.620, respectively, P＜0.05). In the severe group, the areas under the curve for the diagnosis of liver fibrosis (cirrhosis) by SWV, HVAT and HV-HAAT were 0.925 (0.832-0.976), 0.734 (0.610-0.836) and 0.804 (0.687-0.892), and the cut off values were 1.92 m/s, 21.02 s and 8.23 s, respectively. The diagnostic efficiency of SWV in severe liver fibrosis (cirrhosis) was better than that of HVAT and HV-HAAT (Z=2.817 and 1.987, P＜0.05). Conclusion Compared with CEUS, VTQ technique has better diagnostic efficacy in assessing the degree of chronic hepatitis liver fibrosis.