实时组织超声弹性成像及瞬时弹性成像相关参数在评价慢性乙型肝炎肝纤维化的应用价值
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摘要
目的探讨实时组织超声弹性成像(RTE)与瞬时弹性成像(FS)评价慢性乙型肝炎肝纤维化程度的应用效果。方法选择2015年1月-2016年12月于医院诊断治疗的乙型肝炎患者250例为肝炎组,80名健康志愿者为对照组,肝炎组均经穿刺活检明确肝纤维化程度。所有研究对象均行RTE以及FS检查,比较对照组以及不同肝纤维化程度患者肝纤维化指数以及肝脏硬度值,并分析肝纤维化指数以及肝脏硬度值与肝纤维化程度的相关性。结果肝纤维化指数中MEAN随着肝纤维化程度的增加而下降,应变值标准差(SD)、解析区蓝色面积百分比(%AREA)、蓝色区域复杂度(COMP)、偏度(SKEW)、对比度(CONT)随着肝纤维化程度的升高而升高(P<0.05);实时组织RTE检测与肝纤维化指数中MEAN肝纤维化程度呈负相关(P=-0.833,P<0.001),SD、%AREA、COMP、SKEW、CONT与肝纤维化程度呈正相关(P<0.05);肝脏硬度值随着肝纤维化程度的增加而增加(P<0.05);LSM与肝纤维化程度呈正相关(ρ=0.566,P=0.016)。结论实时组织RTE与FS对乙型肝炎肝纤维化程度的评估均具有较好的效果,两种方法均具有无创、快速等优点。
OBJECTIVE To discuss the efficacy of real-time tissue elastography and transient elastography in the evaluation of liver fibrosis in patients with chronic hepatitis B.METHODS A total of 250 cases with chronic hepatitis B diagnosed in our hospital from Jan.2015 to Dec.2016 were selected as the hepatitis group,and 80 cases of healthy volunteers were selected as the control group.The degree of liver fibrosis of the hepatitis group was determined by aspiration biopsy.All subjects underwent RTE and transient elastography.Hepatic fibrosis indexes and liver stiffness in the control group and patients with different degree of liver fibrosis were compared.Correlation of hepatic fibrosis index and liver stiffness with the degree of liver fibrosis was analyzed.RESULTS In the hepatic fibrosis indexes,MEAN decreased with the increase of liver fibrosis degree,SD,%AREA,COMP,SKEW and CONT increased with the increase of liver fibrosis degree,which showed significant difference(P<0.05).According to real-time tissue elastography,MEAN showed negative correlation with the degree of liver fibrosis(ρ=-0.833),whereas SD,%AREA,COMP,SKEW and CONT showed positive correlation with the degree of liver fibrosis(ρ=0.642,0.861,0.628,0.603,0.712,P<0.05).Liver stiffness increased with the increase of liver fibrosis,which showed significant difference(P<0.05).Liver stiffness showed positive correlation with the degree of liver fibrosis(ρ=0.566,P<0.05).CONCLUSION Real-time tissue elastography and transient elastography have good application efficacy in the evaluation of liver fibrosis in patients with chronic hepatitis B,and both methods have advantages of being non-invasive and fast.
OBJECTIVE To discuss the efficacy of real-time tissue elastography and transient elastography in the evaluation of liver fibrosis in patients with chronic hepatitis B.METHODS A total of 250 cases with chronic hepatitis B diagnosed in our hospital from Jan.2015 to Dec.2016 were selected as the hepatitis group,and 80 cases of healthy volunteers were selected as the control group.The degree of liver fibrosis of the hepatitis group was determined by aspiration biopsy.All subjects underwent RTE and transient elastography.Hepatic fibrosis indexes and liver stiffness in the control group and patients with different degree of liver fibrosis were compared.Correlation of hepatic fibrosis index and liver stiffness with the degree of liver fibrosis was analyzed.RESULTS In the hepatic fibrosis indexes,MEAN decreased with the increase of liver fibrosis degree,SD,%AREA,COMP,SKEW and CONT increased with the increase of liver fibrosis degree,which showed significant difference(P<0.05).According to real-time tissue elastography,MEAN showed negative correlation with the degree of liver fibrosis(ρ=-0.833),whereas SD,%AREA,COMP,SKEW and CONT showed positive correlation with the degree of liver fibrosis(ρ=0.642,0.861,0.628,0.603,0.712,P<0.05).Liver stiffness increased with the increase of liver fibrosis,which showed significant difference(P<0.05).Liver stiffness showed positive correlation with the degree of liver fibrosis(ρ=0.566,P<0.05).CONCLUSION Real-time tissue elastography and transient elastography have good application efficacy in the evaluation of liver fibrosis in patients with chronic hepatitis B,and both methods have advantages of being non-invasive and fast.
引文
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[2]沈涛,周淑清,耿洁恩,等.实时组织弹性成像弹性相关参数诊断肝纤维化的价值[J].临床超声医学杂志,2014,16(12):852-854.
[3]中华医学会传染病与寄生虫病学分会.病毒性肝炎防治方案[J].中华传染病杂志,2001,19(1):56-62.
[4]Bataller R,Brenner DA.Liver fibrosis[J].J Clin Invest,2005,115(2):209-218.
[5]余明杰,王萍,韩媛媛,等.肝功能指标及肝纤维化标志物在乙型肝炎患者中的测定意义研究[J].中华医院感染学杂志,2017,27(13):2912-2915.
[6]吴猛,吴蓉,吴剑,等.超声造影和经直肠实时组织超声弹性成像及磁共振成像对前列腺癌诊断价值研究[J].中国全科医学,2015,18(18):2228-2232.
[7]陈刚,余正军,夏良华,等.实时组织弹性超声成像对甲状腺乳头状癌伴颈部淋巴结转移的预估评价[J].中国基层医药,2015,22(22):3388-3391.
[8]Cournane S,Browne JE,Fagan AJ.The effects of fatty deposits on the accuracy of the Fibroscan liver transient elastography ultrasound system[J].Phys Med Biol,2012,57(12):3901-3914.
[9]Wong GL.Update of liver fibrosis and steatosis with transient elastography(Fibroscan)[J].Gastroenterol Rep(Oxf),2013,1(1):19-26.
[10]谭有娟,纪冬,牛小霞,等.瞬时弹性成像检测肝硬度失败的因素及分析[J].医学研究杂志,2012,41(11):30-33.
[11]Shen F,Xu ZJ,Pan Q,et al.Influencing factors and reproducibility of controlled attenuation parameters in the evaluation of fatty liver disease using Fibroscan[J].J Clin Hepatol,2013,16(11):59-62.
[12]Mohamed Y,Aisha E,Mohammad EB,et al.Use of ultrasonic transient elastography(Fibroscan)in the assessment of hepatic focal lesion stiffness[J].Open J Gastroenterol,2013,3(2):107-112.