肝动静脉渡越时间及剪切波速评估肝纤维化程度的对比研究

摘要

目的：探讨超声造影测量肝动静脉渡越时间（HAVTT）及声脉冲辐射力技术测量剪切波速（SWV）在评估慢性乙型肝炎患者肝纤维化程度中的应用价值。方法83例S0～S4期慢性乙型肝炎肝病患者，对其肝脏行超声造影及弹性超声检查。超声造影采用目测法测量并计算HAVTT1和HAVTT2；利用声脉冲辐射力技术测量SWV。结果运用ROC曲线得到≥S1期、≥S2期、≥S3期和S4期的SWV参考阈值分别为1．41 m/s、1．81 m/s、2．14 m/s、2．40 m/s，HAVTT1参考阈值分别为11．6 s、10．5 s、9．5 s、7．4 s，HAVTT2参考阈值分别为14．1 s、12．4 s、11．6 s、9．4 s。SWV、HAVTT1、HAVTT2对肝纤维化分期诊断正确率分别为89．2％、72．3％、77．1％，前者高于后两者（P<0.05）。结论超声造影测量HAVTT可反映肝脏微循环的变化，可用于对S2期和S3期肝纤维化的鉴别诊断。超声弹性成像测量SWV能够反映肝纤维化分期的弹性硬度差异，较超声造影使用更方便、更无创，可作为评判肝纤维化程度及治疗疗效的一种新方法。%Objective To explore the application value of the hepatic artery to vein transit time (HAVTT) measured by contrast-enhanced ultrasonography and liver shear wave velocity(SWV) measured by acoustic radiation force impulse(ARFI) technology in hepatic fibrosis caused by chronic hepatitis B. Methods The measurement of liver HAVTT and SWV were performed on 83 patients with chronic hepatitis B in stage0~stage4. HAVTT was measured using contrast-enhanced ultrasonography. SWV was measured using ARFI technology. Results Values of 11.6 s,10.5 s,9.5 s,7.4 s;14.1 s,12.4 s,11.6 s,9.4 s and 1.41 m/s,1.81 m/s,2.14 m/s,2.40 m/s were acquired for diagnosis of ≥S1,≥S2,≥S3 and S4 of HAVTT1,HAVTT2 and SWV using ROC curve method. The accuracy of SWV,HAVTT1 and HAVTT2 values for diagnosing hepatic fibrosis stage was 89.2%,72.3% and 77.1%, respectively, in which the accuracy of SWV was higher than that of HAVTT1 and HAVTT2(P<0.05). Conclusion HAVTT can reflects changes in hepatic microcirculation and be used as identification for S2, S3 of hepatic fibrosis. SWV can reflects hardness difference among every S stage and is more effective, convenient and non-invasive compared with contrast-enhanced ultrasonography, which can be a new method to judge hepatic fibrosis degree and therapeutic effect.