天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (12): 1258-1262.doi: 10.11958/20190015

• 临床研究 • 上一篇    下一篇

凸阵探头实时组织弹性成像、声辐射力脉冲弹性成像与瞬时弹性成像诊断慢性乙肝相关肝纤维化程度的比较

孟彦娜1，张娟娟1，陈英红1，李莹1，于艳艳1，李志艳2△   

  1. 1河南省开封市河南大学淮河医院超声科（邮编475000）；2北京市解放军第302医院超声科
  • 收稿日期:2019-01-04 修回日期:2019-02-21 出版日期:2019-12-15 发布日期:2019-12-15
  • 通讯作者: 孟彦娜 E-mail:shuaiwei0909@163.com
  • 基金资助:
    凸振探头实施弹性成像在肝纤维化中的临床应用与基础研究

Comparison convex probe real-time elastography, acoustic radiation force impulse imaging and transient elastography in the diagnosis of chronic hepatitis B-related liver fibrosis

MENG Yan-na1，ZHANG Juan-juan1，CHEN Ying-hong1，LI Ying1，YU Yan-yan1，LI Zhi-yan2△   

  1. 1 Department of Ultrasound, Huaihe Hospital of Henan University, Kaifeng 475000, China; 2 Department of Ultrasound, the 302nd Hospital of PLA
  • Received:2019-01-04 Revised:2019-02-21 Published:2019-12-15 Online:2019-12-15
  • Contact: Meng YanNa E-mail:shuaiwei0909@163.com
  • Supported by:
     

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摘要： 目的 比较凸振探头实时组织弹性成像（C-RTE）、声辐射力脉冲弹性成像（ARFI）及瞬时弹性成像（TE）评 估肝纤维化的诊断效能。方法 选取167例慢性乙肝（CHB）患者，分别进行C-RTE、ARFI及TE检查及肝穿刺活检， 以病理学结果为金标准。比较病理纤维化分期之间各弹性成像肝硬度检测指标差异，分析C-RTE、ARFI及TE与病 理纤维化分期的相关性，构建受试者工作特征（ROC）曲线分析3种成像方法的诊断效能，并采用DeLong法比较不同 检测方法的曲线下面积（AUC）。结果 除C-RTE及ARFI诊断S0/S1和S3/S4之间，TE诊断S0/S1和S0/S2之间差异 无统计学意义（P＞0.05），余各组间比较差异均有统计学意义；C-RTE、ARFI及TE与病理肝纤维化分期的相关系数 分别为 0.72、0.65、0.68（P＜0.001）；C-RTE、ARFI 及 TE 3 者诊断≥S1、≥S2、≥S3 及 S4 期的曲线下面积分别为 0.812、 0.917、0.848及0.785；0.824、0.818、0.858及0.822；0.858、0.833、0.876及0.884，最佳临界值分别为1.3、1.74、2及2.64； 5.3 kPa、7.2 kPa、8.9 kPa及19.4 kPa；1.29 m/s、1.71 m/s、1.89 m/s及2.02 m/s；且在≥S2时，C-RTE的诊断效能优于ARFI 及TE（Z分别为2.56和2.84，P＜0.01）。结论 C-RTE对各级肝纤维化具有较高的诊断价值，值得临床推广。

关键词: 诊断, 鉴别, 弹性成像技术, 肝硬化, 乙型肝炎, 慢性, 活组织检查, 针吸

Abstract:

Objective To compare the diagnostic efficacy of convex probe real-time elastography (C-RTE), acoustic
radiation force impulse imaging (ARFI) and transient elastography (TE) in evaluating liver fibrosis. Methods One hundred
and sixty-seven patients with chronic hepatitis B (CHB) were included in this study. All patients were assessed by C-RTE,
ARFI,TE and liver biopsy respectively. The pathological results were used as the gold standard. The correlation coefficient
between C-RTE, ARFI, TE and pathological fibrosis stage was analyzed
. The areas under receiver operating characteristic
curve (AUROC) between the three methods were compared.
Results Except for C-RTE and ARFI in the diagnosis of S
0/
S1, S3/ S4, TE in the diagnosis of S0/ S1, S0/ S2, there were significant differences between other groups
.
The correlation
coefficients between C-RTE, ARFI, TE and liver fibrosis were 0.72, 0.65 and 0.68, respectively (
P＜0.001).
The areas under
the curves (AUC) of C-RTE, ARFI and TE for diagnosing S≥1, S≥2, S≥3 and S=4 were 0.812, 0.917, 0.848 and 0.785;
0.824, 0.818, 0.858 and 0.822; 0.858, 0.833, 0.876 and 0.884, respectively. The optimal cut–off values were 1.3, 1.74, 2
and 2.64; 5.3 kPa, 7.2 kPa, 8.9 kPa and 19.4 kPa; 1.29 m/s, 1.71 m/s, 1.89
m/s and
2
.02
m/s
,
respectively
. The diagnostic
efficiency of C-RTE was better than that of ARFI and TE, when S≥2, (
Z
=2
.56,2.84,
P
＜0
.01
).
Conclusion
C-RTE has
higher diagnostic efficiency for liver fibrosis and is worthy of clinical promotion
.

Key words: diagnosis, differential, elasticity imaging techniques, liver cirrhosis, hepatitis B, chronic, biopsy, needle

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