声触诊组织量化技术——肝脏剪切波速度无创评估乙型肝炎肝纤维化程度的研究

摘要

目的 研究声触诊组织量化技术(virtual touch quantification,VTQ)测量肝脏剪切波速度无创评估乙型肝炎患者肝纤维化程度的临床价值.方法 运用VTQ技术对246例受试者测量肝脏剪切波速度(shear wave velocity,SWV),包括60例健康志愿者(归为S0期)、53例慢性乙型肝炎患者(按肝穿病检结果分为S0～S4期)及133例临床诊断的乙型肝炎肝硬化患者(归为S4期)；将所得的SWV值按纤维化分级进行分析.结果 肝脏剪切波速度值与肝纤维化分级的相关系数为0.87 (P＜0.001),肝脏剪切波速度值随着肝纤维化的进展而增加.诊断S≥3和S=4期的受试者工作特征曲线下面积(area under the receiver operating characteristic curve,AUROC)分别为0.99、0.98,诊断的临界值分别为1.69 m/s、1.88 m/s,对应的灵敏度分别为0.93、0.96,特异度分别为0.96、0.94.结论 基于VTQ技术的肝脏剪切波速度在无创诊断乙型肝炎肝纤维化程度方面有重要的临床应用价值.%Objective To explore the clinical value of liver shear wave velocity (SWV) measured by virtual touch tissue quantification (VTQ) in noninvasive assessment of liver fibrosis in chronic HBV-infected patients. Methods 246 subjects were enrolled in the study, including 60 healthy volunteers, 53 patients with chronic hepatitis B who had undergone liver biopsy and 133 cirrhotic patients after hepatitis B were diagnosed by imaging or history. Liver shear wave velocity were measured using virtual touch tissue quantification (VTQ). The values of SWV were compared according to the stage of fibrosis. Results A significant, direct, linear correlation (Spearman rho = 0. 87, P<0. 001) was found between SWV and the stage of fibrosis. The values of SWV increased as liver fibrosis progressed in chronic HBV-infected patients. The area under the receiver operating characteristic curve for the diagnosis of S≥3 and S = 4 were 0. 99 and 0. 98, for the cutoff values of 1. 69 m/s and 1. 88 m/s, with sensitivity of 0. 93 and 0. 96, specificity of 0. 96 and 0. 94. Conclusions VTQ technique has important clinical value in noninvasive assessment of liver fibrosis.