CAJ | 학술논문

目的：采用剪切波弹性成像（SWE）技术，探讨定量检测肝杨氏弹性模量值（EI）与肝脏病理的相关性。方法对231例CHB患者行SWE及在超声引导下肝穿刺活组织检查，并测量其 EI ，以肝脏病理学结果为金标准，分析肝硬度与病理学的相关性。组间比较采用单因素方差分析，两变量相关性检验用Spearman秩相关分析，受试者工作特征（ROC ）曲线用于分析EI对肝组织炎症活动度分级和纤维化分期的预测价值。结果不同肝脏炎症活动度分级的中位EI分别为6．78 kPa （G1）、7．30 kPa （G2）、9．93 kPa（G3）和14．93 kPa（G4），差异有统计学意义（H＝55．19，P＜0．01）。不同纤维化分期的中位EI分别为6．62 kPa（S0～S1）、7．15 kPa（S2）、9．78 kPa（S3）和14．62 kPa（S4），差异有统计学意义（ H＝62．14， P＜0．01）。EI与炎症活动度分级（ r＝0．4546， P＜0．01）及纤维化分期（ r＝0．5056， P＜0．01）均呈中度正相关。EI诊断 G≥2、G≥3、G＝4的ROC曲线下面积（95％ CI）分别为0．68（0．61～0．75）、0．77（0．70～0．84）和0．85（0．77～0．92），诊断S≥2、S≥3、S＝4的ROC曲线下面积（95％ CI）分别为0．73（0．66～0．79）、0．78（0．72～0．85）和0．83（0．75～0．91）。结论 SWE检测肝EI值与CHB患者肝脏病理学具有一定的相关性，有望成为动态监测肝纤维化进展的新方法。
목적：채용전절파탄성성상（SWE）기술，탐토정량검측간양씨탄성모량치（EI）여간장병리적상관성。방법대231례CHB환자행SWE급재초성인도하간천자활조직검사，병측량기 EI ，이간장병이학결과위금표준，분석간경도여병이학적상관성。조간비교채용단인소방차분석，량변량상관성검험용Spearman질상관분석，수시자공작특정（ROC ）곡선용우분석EI대간조직염증활동도분급화섬유화분기적예측개치。결과불동간장염증활동도분급적중위EI분별위6．78 kPa （G1）、7．30 kPa （G2）、9．93 kPa（G3）화14．93 kPa（G4），차이유통계학의의（H＝55．19，P＜0．01）。불동섬유화분기적중위EI분별위6．62 kPa（S0～S1）、7．15 kPa（S2）、9．78 kPa（S3）화14．62 kPa（S4），차이유통계학의의（ H＝62．14， P＜0．01）。EI여염증활동도분급（ r＝0．4546， P＜0．01）급섬유화분기（ r＝0．5056， P＜0．01）균정중도정상관。EI진단 G≥2、G≥3、G＝4적ROC곡선하면적（95％ CI）분별위0．68（0．61～0．75）、0．77（0．70～0．84）화0．85（0．77～0．92），진단S≥2、S≥3、S＝4적ROC곡선하면적（95％ CI）분별위0．73（0．66～0．79）、0．78（0．72～0．85）화0．83（0．75～0．91）。결론 SWE검측간EI치여CHB환자간장병이학구유일정적상관성，유망성위동태감측간섬유화진전적신방법。
Objective To investigate the correlation between Young′s elastic modulus (EI) using shear wave elastography (SWE) and liver pathology .Methods Liver biopsy was performed on 231 patients with chronic hepatitis B (CHB) under supersonic guidance ,and SWE with EI of liver was obtained concurrently .The correlation between measured liver stiffness and pathology was analyzed by using the liver pathology as golden standards .One‐way analysis of variance and Spearman rank correlation analysis were performed for the comparison between groups and correlation between two variables , respectively .Receiver operating characteristic (ROC) curve was used to explore the predictive value of shear modulus for the liver inflammation grades and fibrosis stages .Results The EI medians of different liver inflammation grades were 6 .78 kPa (G1) ,7 .30 kPa (G2) ,9 .93 kPa (G3) and 14 .93 kPa (G4) , respectively ,which were statistically different (H=55 .19 ,P<0 .01) .And EI medians of various fibrosis stages were 6 .62 kPa (S0 -S1) ,7 .15 kPa (S2) ,9 .78 kPa (S3) and 14 .62 kPa (S4) ,respectively , which were also significantly different (H=62 .14 ,P<0 .01) .EI was positively correlated with both liver inflammation grades (r=0 .454 6 ,P<0 .01) and liver fibrosis stages (r=0 .505 6 ,P<0 .01) .The areas under the ROC for G≥2 ,G≥3 and G=4 were 0 .68 (95% CI:0 .61 -0 .75) ,0 .77 (95% CI:0 .70 -0 .84) and 0 .85 (95% CI:0 .77-0 .92) ,respectively .The areas under the ROC for S≥2 ,S≥3 and S=4 w ere 0 .73 (95% C I:0 .66 -0 .79 ) ,0 .78 (95% C I:0 .72 -0 .85 ) and 0 .83 (95% C I:0 .75 -0 .91 ) , respectively .Conclusion The EI measured by SWE is correlated with liver pathology of CHB patients , which may be used to dynamically monitor the progress of liver fibrosis .