Liu Jing-Hua, Zou Yu, Chang Wei, Wu Jun, Zou Yu, Xie Yu-Chen, Lu Yong-Ping, Wei Jia
Department of Gastroenterology and Hepatology, the 4th Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Biostatistics, Kunming Medical University, Kunming, China.
Rev Invest Clin. 2017 Sep-Oct;69(5):254-261. doi: 10.24875/ric.17002215.
We assessed liver fibrosis using real-time shear-wave elastography (SWE) combined with liver biopsy (LB) for patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) and alanine transaminase < 2 times the upper limit of normal and hepatitis B virus DNA < 2000 IU/ml.
A total of 107 patients met the inclusion criteria. Real- ime SWE and ultrasoundassisted liver biopsies were consecutively performed. Fibrosis was staged according to the METAVIR scoring system. Analyses of receiver operating characteristic curve were performed to calculate the optimal area under the receiver operating characteristic curve for F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4 for real-time SWE.
The most concurrent liver fibrosis degrees were between F1 and F2 for these HBeAg-negative CHB patients. Liver stiffness increased in parallel with the degree of liver fibrosis using SWE measurements. The area under the receiver operating characteristic curves was 0.881 (95% confidence interval [CI]: 0.704-1.000) for SWE (p = 0.004); 0.912 (95% CI: 0.836-0.987) for SWE (p = 0.000); 0.981 (95% CI: 0.956-1.000) for SWE (p = 0.000); 0.974 (95% CI: 0.936-1.000) for SWE (p = 0.000) when comparing F0 versus F1-F4, F0-F1 versus F2-F4, F0-F2 versus F3-F4, and F0-F3 versus F4, respectively.
SWE has the advantage of providing an image of liver stiffness in real-time. As an alternative to LB, the development of all these noninvasive methods for dynamic evaluation of liver fibrosis will decrease the need for LB, making clinical care safer and more convenient for patients with liver diseases.
对于乙肝e抗原（HBeAg）阴性的慢性乙型肝炎（CHB）患者，且丙氨酸转氨酶低于正常上限2倍、乙肝病毒DNA低于2000 IU/ml，我们采用实时剪切波弹性成像（SWE）联合肝活检（LB）来评估肝纤维化情况。
共有107例患者符合纳入标准。连续进行实时SWE和超声引导下肝活检。根据METAVIR评分系统对纤维化进行分期。绘制受试者操作特征曲线进行分析，以计算实时SWE在F0 - F1与F2 - F4、F0 - F2与F3 - F4、F0 - F3与F4比较时的最佳受试者操作特征曲线下面积。
这些HBeAg阴性CHB患者中，最常见的肝纤维化程度在F1和F2之间。使用SWE测量时，肝脏硬度随肝纤维化程度平行增加。在比较F0与F1 - F4、F0 - F1与F2 - F4、F0 - F2与F3 - F4、F0 - F3与F4时，SWE的受试者操作特征曲线下面积分别为0.881（95%置信区间[CI]：0.704 - 1.000）（p = 0.004）；0.912（95% CI：0.836 - 0.987）（p = 0.000）；0.981（95% CI：0.956 - 1.000）（p = 0.000）；0.974（95% CI：0.936 - 1.000）（p = 0.000）。
SWE具有实时提供肝脏硬度图像的优势。作为LB的替代方法，所有这些用于动态评估肝纤维化的非侵入性方法的发展将减少对LB的需求，使肝病患者的临床护理更安全、更便捷。
