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目的探讨超声实时组织弹性成像(RTE)中的组织弥散定量参数判定乙型肝炎不同程度肝纤维化的价值。方法 2012年7月-2014年11月期间,以肝穿刺活体组织检查(活检)病理结果为金标准,对112例乙型肝炎患者行RTE检查得到弹性图像,并进行组织弥散定量分析,获得右肝实质的肝脏纤维化指数(LFI)值,然后将LFI值与肝穿刺活检病理结果的纤维化分期对照,采用单因素方差分析对不同程度肝纤维化的LFI值进行比较,组间存在差异者再用最小显著差值法进行组间两两比较,最后用受试者工作特征(ROC)曲线确定诊断不同程度肝纤维化LFI值的临界值。结果慢性肝病肝纤维化分为S0、S1、S2、S3、S4期的LFI值分别为2.36±0.46、2.38±0.45、2.84±0.54、3.16±0.59、3.69±0.55,不同程度肝纤维化组间的LFI值差异有统计学意义(F=29.959,P<0.001),S0、S1组间差异无统计学意义(P=0.920),S2、S3期组间差异无统计学意义(P=0.076),其余各组间差异均有统计学意义(P<0.05)。区分S0~S1期与S2~S3期、S2~S3期与S4期ROC曲线下面积分别为0.784、0.799,其LFI值的临界值分别为2.83、3.69。结论 RTE是无创评价乙型肝炎肝纤维化的可行方法,LFI值对区分肝纤维化的程度具有较好的诊断价值。
Objective To investigate the quantitative value of tissue diffusion in ultrasound real-time tissue elastography (RTE) to determine the value of different degrees of hepatic fibrosis in hepatitis B patients. Methods From July 2012 to November 2014, biopsies from liver biopsies were taken as the gold standard for biopsy specimens. Elastic images were obtained from 112 patients with hepatitis B by RTE and quantitatively analyzed by tissue diffusion to obtain the right Liver fibrosis index (LFI) value of liver, and then LFI value and liver biopsy pathological results of fibrosis staging, using one-way ANOVA analysis of different degrees of liver fibrosis LFI values were compared between the two groups were different Then the least significant difference method was used to compare the two groups. Finally, the receiver operating characteristic (ROC) curve was used to determine the critical value of diagnosing LFI of different degrees of liver fibrosis. Results The values of LFI for chronic liver disease with liver fibrosis were S0, S1, S2, S3 and S4 were 2.36 ± 0.46, 2.38 ± 0.45, 2.84 ± 0.54, 3.16 ± 0.59 and 3.69 ± 0.55 respectively, with different degrees of liver fibrosis (P = 0.001). There was no significant difference between S0 and S1 (P = 0.920), but there was no significant difference between S2 and S3 (P = 0.076) , The rest of the differences between groups were statistically significant (P <0.05). The area under the ROC curve of S0-S1 and S2-S3 was 0.784 and 0.799 respectively, and the critical values of LFI were 2.83 and 3.69, respectively. Conclusion RTE is a feasible method for non-invasive evaluation of hepatitis B liver fibrosis. The value of LFI has a good diagnostic value in distinguishing liver fibrosis.