高频超声联合声触诊弹性成像诊断肝硬化不同时期的价值分析

摘要/Abstract

摘要： 目的分析高频超声联合声触诊弹性成像(STE)诊断肝硬化不同时期的价值。方法选取2022年10月—2024年10月我院收治的乙型肝炎肝硬化患者100例,利用高频超声参照超声半定量评分标准对肝实质回声、肝被膜、肝静脉清晰度、边缘形态及脾脏厚度分别评价,STE检测肝脏硬度值(LSM)及脾脏硬度值(SSM),根据临床检测结果计算APRI、FIB-4。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估不同时期乙型肝炎肝硬化的效能表现。结果代偿期、失代偿期乙型肝炎肝硬化患者分别为61例、39例。代偿期组PLT、Alb、APRI、FIB-4、LSM及SSM为(94.5±22.4)×10⁹/L、(31.4±3.5)g/L、(0.47±0.08)、(0.63±0.13)、(15.3±3.2)kPa及(18.9±6.9)kPa,与失代偿组[(74.0±14.1)×10⁹/L、(29.8±2.5)g/L、(0.54±0.12)、(0.80±0.21)、(18.4±4.1)kPa及(23.5±9.3)kPa]比,差异具有统计学意义(P<0.05)。比较两组超声半定量评分,代偿期组肝实质回声、肝被膜、肝静脉清晰度、边缘形态、脾脏厚度等各项评分及总分为(2.6±0.4)分、(2.0±0.4)分、(2.0±0.3)分、(2.5±0.4)分、(2.1±0.3)分及(11.3±1.3)分,均显著高于失代偿期组[(2.9±0.7)分、(2.4±0.6)分、(2.3±0.5)分、(2.8±0.6)分、(2.5±0.5)分及(13.2±2.8)分,P<0.05]。APRI+FIB-4+LSM+SSM+半定量评分、LSM+SSM+半定量评分诊断失代偿期肝硬化诊断AUC值(0.89、0.87)分别显著高于单独诊断AUC值(P<0.05),而前二者诊断模式诊断AUC值差异不具有统计学意义(P>0.05)。结论利用高频超声联合STE诊断乙型肝炎肝硬化能够帮助判别不同时期肝硬化状态,值得临床进一步验证。

关键词: 乙型肝炎肝硬化, 超声弹性成像, 高频超声

Abstract: Objective To analyze the value of high frequency ultrasound combined with sound touch elastography (STE) in the diagnosis of liver cirrhosis at different stages. Methods 100 patients with hepatitis B cirrhosis admitted between October 2022 and October 2024 were selected. The echo of liver parenchyma, the clarity of liver capsule and hepatic vein, the border shape and the thickness of spleen were evaluated by high-frequency ultrasound with reference to the ultrasonic semi-quantitative scoring standard. STE detected the liver hardness (LSM) and spleen hardness (SSM), and calculated APRI and FIB-4 according to the clinical test results. Receiver operating characteristic curve (ROC) and area under curve (AUC) were used to evaluate the efficacy of hepatitis B cirrhosis at compemsated and decompendated stages. Results There were 61 patients with compensated and 39 patients with decompensated hepatitis B-related cirrhosis. In the decompensated group, platelet (PLT) count, albumin (Alb) level, values of aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 Index (FIB-4), LSM and SSM were (94.5±22.4) ×10⁹/L, (31.4±3.5) g/L, (0.47±0.08), (0.63±0.13), (15.3±3.2) kPa and (18.9±6.9) kPa, respectively, compared with those of (74.0±14.1) ×10⁹/L, (29.8±2.5) g/L, (0.54±0.12), (0.80±0.21), (18.4±4.1) kPa and (23.5±9.3) kPa in the compensatory group [P<0.05]. Comparing the two groups′ ultrasonic semi-quantitative scores, in the decompensated group, the scores of liver parenchyma echo, liver capsule, hepatic vein clarity, border shape and spleen thickness were (2.6±0.4) points, (2.0±0.4) points, (2.0±0.3) points, (2.5±0.4) points, (2.1±0.3) points, (2.1±0.3) points and (11.3±1.3) points, respectively, which were significantly higher than those of (2.9±0.7) points, (2.4±0.6) points, (2.3±0.5) points, (2.8±0.6) points, (2.5±0.5) points and (13.2±2.8) points in the compensatory group (P<0.05). The AUC values of APRI+FIB-4+LSM+SSM+ semi-quantitative score and LSM+SSM+ semi-quantitative score in the diagnosis of decompensated cirrhosis were 0.89 and 0.87, respectively, which were significantly higher than those of single diagnosis (P<0.05), but there was no significant difference in the AUC values of the first two diagnosis modes (P>0.05). Conclusion High-frequency ultrasound combined with STE in the diagnosis of hepatitis B-related cirrhosis can help to distinguish the compensate or decompensate status of cirrhosis, which is worthy of further clinical verification.

Key words: Liver cirrhosis, Sound touch elastography, High frequency ultrasound

周秀梅, 刘慧, 王时军. 高频超声联合声触诊弹性成像诊断肝硬化不同时期的价值分析[J]. 肝脏, 2025, 30(5): 609-612.

ZHOU Xiu-mei, LIU Hui, WANG Shi-jun. An analysis on the value of high frequency ultrasound combined with STE in the diagnosis of liver cirrhosis at different stages[J]. Chinese Hepatolgy, 2025, 30(5): 609-612.

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