CAJ | 학술논문

目的：探讨声辐射力脉冲成像（ARFI）技术定量评价慢性乙型肝炎肝纤维化分期的临床价值。方法对373例慢性乙型肝炎患者肝右叶不同检测位置分组进行ARFI检测，并行肝脏穿刺活检病理分期，比较各纤维化分级与各组间 ARFI测值之间的关系。结果肝右前叶及右后叶检测位置均显示ARFI测值在不同肝纤维化分级间的差异具有统计学意义（ P ＜00．01）；右前叶中、深部与右后叶相同深度比较ARFI测值差异均具有统计学意义（ P ＜00．1）；右前叶浅部ARFI测值与右前叶中、深部ARFI测值差异有统计学意义（ P ＜00．5）。ROC曲线分析显示肝右前叶中部ARFI测值的曲线下面积08．18，为各检测位置中最大，可作为最适宜检测位置。此位置数据显示肝脏ARFI测值与肝纤维化分期存在正相关，相关系数为05．30（ P ＜00．01），ARFI技术诊断重度肝纤维化（≥S3）和早期肝硬化（＝S4）的ROC曲线下面积分别为08．18和08．60。结论声辐射力脉冲成像技术可无创性定量评估慢性乙型肝炎肝纤维化程度，具有潜在的临床应用价值。
목적：탐토성복사력맥충성상（ARFI）기술정량평개만성을형간염간섬유화분기적림상개치。방법대373례만성을형간염환자간우협불동검측위치분조진행ARFI검측，병행간장천자활검병리분기，비교각섬유화분급여각조간 ARFI측치지간적관계。결과간우전협급우후협검측위치균현시ARFI측치재불동간섬유화분급간적차이구유통계학의의（ P ＜00．01）；우전협중、심부여우후협상동심도비교ARFI측치차이균구유통계학의의（ P ＜00．1）；우전협천부ARFI측치여우전협중、심부ARFI측치차이유통계학의의（ P ＜00．5）。ROC곡선분석현시간우전협중부ARFI측치적곡선하면적08．18，위각검측위치중최대，가작위최괄의검측위치。차위치수거현시간장ARFI측치여간섬유화분기존재정상관，상관계수위05．30（ P ＜00．01），ARFI기술진단중도간섬유화（≥S3）화조기간경화（＝S4）적ROC곡선하면적분별위08．18화08．60。결론성복사력맥충성상기술가무창성정량평고만성을형간염간섬유화정도，구유잠재적림상응용개치。
Objective To investigate the clinical value of the acoustic radiation force impulse imaging (ARFI) in the quantitative evaluation of fibrosis staging in chronic hepatitis B .Methods A total of 373 patients with chronic hepatitis B were grouped in accordance with the depth of the right anterior lobe and posterior lobe of the liver and underwent ARFI to measure ARFI values .Liver biopsy was performed in all patients to investigate the relationship between liver fibrosis stages and ARFI values in different groups . Results The ARFI values in different pathological grades with the same depth of the right anterior and right posterior lobe of the liver were statistically significant ( P < 0 0.01);the ARFI values between the middle and deep parts of the right anterior lobe and the same location of the right posterior lobe were statistically significant ( P <0 0.1);for the right anterior lobe ,the ARFI value of the shallow part showed statistical significance from that of the middle and the deep part ( P < 0 0.5 ) .Receiver operating characteristic (ROC) curve analysis for different sampling locations showed that the largest area under the ROC curve ,which was 0 8.18 ,existed in the middle part of the right anterior lobe ,indicating that it could be the optimal sampling location for the measurement of ARFI values .Liver stiffness at ARFI imaging was significantly correlated with liver fibrosis stage in chronic hepatitis B and spearman coefficient of correlation was 0 5.30 ( P <0 0.01) .The areas under the ROC curves for the chronic hepatitis B patients with severe liver fibrosis (≥ S3) and early cirrhosis (= S4) were 0 8.18 and 0 8.60 ,respectively .Conclusions ARFI imaging was promising for clinical application and could be utilized as a noninvasive method for the quantitative evaluation of fibrosis staging in chronic hepatitis B .