超声组织结构声学定量分析评估慢性乙型肝炎患者肝纤维化严重程度的价值

摘要/Abstract

摘要： 目的探讨超声组织声学结构定量(ASQ)技术在慢性乙型肝炎(CHB)肝纤维化分期及中重度肝纤维化预测中的价值。方法选取2021年1月至2024年6月在本院经肝穿刺活检证实为CHB并合并不同程度肝纤维化的患者139例,按METAVIR分期分为轻度组(F0-F2,61例)和中重度组(F3-F4,78例)。比较两组ASQ参数[红色曲线均值(RA)、红色曲线众数(RM)、蓝色曲线众数(BM)、蓝色曲线标准差(BSD)、红蓝曲线下面积比(FD比值)]差异,采用Spearman秩相关分析其与肝纤维化分期的关系,并以中重度肝纤维化为因变量行logistic回归及ROC曲线分析。结果与轻度组相比,中重度组RA、RM、BM及FD比值分别为124.55±6.98、123.68±4.98、136.99±6.15和0.65±0.15,高于轻度组的117.15±7.65、111.26±5.54、128.44±8.44和0.26±0.14。Spearman分析显示,BM、RA、RM、FD比值与肝纤维化分期呈显著正相关。Logistic回归结果显示,FD比值是中重度肝纤维化的独立危险因素,经ROC曲线分析,FD比值诊断中重度肝纤维化的AUC值为0.967(0.939～0.995),当取截断值为0.520时,灵敏度为0.872,特异度为0.984。结论 ASQ技术能够定量反映CHB患者肝实质回声随纤维化加重而发生的结构性改变,其中FD比值与病理分期相关性最强,是预测中重度肝纤维化的独立危险因素,对中重度肝纤维化具有较高的诊断效能。

关键词: 声学结构定量, 慢性乙型肝炎, 肝纤维化, 诊断效能

Abstract: Objective To assess the value of ultrasound acoustic structure quantification (ASQ) in staging liver fibrosis and identifying moderate-to-severe fibrosis in chronic hepatitis B. Methods A total of 139 patients with chronic hepatitis B and biopsy-confirmed liver fibrosis treated in our hospital from January 2021 to June 2024 were enrolled. According to the METAVIR stage, 61 patients with F0-F2 fibrosis were assigned to the mild group, and 78 patients with F3-F4 fibrosis were assigned to the moderate-to-severe group. ASQ parameters, including the mean of the red curve (RA), mode of the red curve (RM), mode of the blue curve (BM), standard deviation of the blue curve (BSD), and the red-to-blue area under the curve ratio (FD ratio), were compared between groups. Spearman rank correlation was used to analyze their associations with fibrosis stage. Logistic regression and receiver operating characteristic (ROC) analysis were performed with moderate-to-severe fibrosis as the dependent variable. Results Compared with the mild group, the moderate-to-severe group showed higher RA, RM, BM, and FD ratio values: 124.55±6.98 vs. 117.15±7.65, 123.68±4.98 vs. 111.26±5.54, 136.99±6.15 vs. 128.44±8.44, and 0.65±0.15 vs. 0.26±0.14, respectively. Spearman analysis showed that BM, RA, RM, and FD ratio were positively correlated with fibrosis stage. Logistic regression identified the FD ratio as an independent risk factor for moderate-to-severe fibrosis. ROC analysis showed that the FD ratio had an AUC of 0.967[95% CI: 0.939~0.995]; at a cutoff of 0.520, the sensitivity was 0.872 and the specificity was 0.984. Conclusion ASQ can quantitatively reflect fibrosis-related alterations in liver parenchymal echotexture in patients with chronic hepatitis B. The FD ratio showed the strongest association with pathological stage,was an independent predictor of moderate-to-severe fibrosis, and had high diagnostic efficacy.

Key words: Acoustic structure quantification, Chronic hepatitis B, Liver fibrosis, Diagnostic efficacy

张雪棉, 刘文钏, 武云慧. 超声组织结构声学定量分析评估慢性乙型肝炎患者肝纤维化严重程度的价值[J]. 肝脏, 2026, 31(6): 857-862.

Zhang Xuemian, Liu Wenchuan, Wu Yunhui. Value of ultrasound acoustic structure quantification for assessing the severity of liver fibrosis in patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2026, 31(6): 857-862.

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