Value of SWE in the diagnosis of HBV liver fibrosis and its influencing factors
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摘要:
目的探讨实时剪切波弹性成像（SWE）诊断乙肝病毒（HBV）感染肝纤维化的价值及其影响因素。 方法选取我院既往确诊的HBV感染肝纤维化患者137例作为纤维化组，选取同期HBV感染未出现肝纤维化的患者60例作为对照组，对比两组患者的SWE测定的肝脏弹性模量值，并根据不同的病理学纤维化程度分期进行分层分析；采用受试者工作曲线（ROC）分析SWE检测鉴别诊断肝纤维化患者的临床价值；采用Logistic回归方法分析影响SWE检测诊断肝纤维化的影响因素。 结果纤维化组患者的肝脏弹性模量测定值高于对照组，差异具有统计学意义（P < 0.05）；不同病理学分期的肝纤维化患者肝脏弹性模量组间比较，差异具有统计学意义（P < 0.05），S1~S4期肝脏弹性模量测定值逐渐增大；SWE测定肝脏纤维化值诊断肝纤维化的灵敏度为86.13%，特异度为85.00%，漏诊率为13.87%，误诊率为15.00%，ROC曲线下面积AUC值为0.889；Logistic回归模型分析显示，肝纤维化病理学分期越高、炎症分级越高与肝脏弹性模量值正确诊断肝纤维化呈正相关（P < 0.05）。 结论SWE诊断HBV感染肝纤维化作为一种无创手段具有较高的灵敏度和特异度，但其诊断效能受到纤维化程度及炎症分级的影响。 Abstract:ObjectiveTo explore the value of real-time shear wave elastography (SWE) in the diagnosis of hepatitis B virus (HBV) infection and its influencing factors. MethodsA total of 137 patients with liver fibrosis diagnosed with HBV infection in our hospital were selected as the fibrosis group. Sixty patients with HBV infection without liver fibrosis during the same period were selected as the control group. The liver elastic modulus values measured by SWE of the two groups were compared. According to different pathological fibrosis stages, stratified analysis, receiver operating curve (ROC) was used to analyze the clinical value of SWE detection in differential diagnosis of liver fibrosis; logistic regression method was used to analyze the influence of SWE detection in diagnosis of liver fibrosis Influencing factors. ResultsThe measured value of hepatic elastic modulus of patients in the fibrosis group was higher than that of the control group (P < 0.05). The difference in liver elastic modulus of patients with different pathological stages of liver fibrosis was significant (P < 0.05). The measured values of hepatic elastic modulus from stage S1 to S4 gradually increased. The ROC curve was drawn and the sensitivity of SWE to determine the hepatic fibrosis value in the diagnosis of liver fibrosis was 86.13%, the specificity was 85.00%, and the missed diagnosis rate was 13.87%, the misdiagnosis rate was 15.00%. The area under the ROC curve AUC value was 0.889. Logistic regression model analysis showed the higher the pathological stage of liver fibrosis. The higher the inflammation grade was positively correlated with the correct diagnosis of hepatic elastic modulus (P < 0.05). ConclusionSWE diagnosis of HBV infection liver fibrosis as a non-invasive method has high sensitivity and specificity. Its diagnostic performance is affected by the degree of fibrosis and inflammation grade. -
图 1 两组患者SWE影像学示例
A: 对照组某患者SWE检测结果, 病理学分期S0期; B: 纤维化组某患者SWE检测结果，病理学分期S3期.
Figure 1. SWE results of the two groups.
图 2 SWE鉴别诊断肝纤维化的ROC曲线
Figure 2. SWE ROC curve for differential diagnosis of hepatic fibrosis.
表 1 不同病理学分期的肝纤维化患者肝脏弹性模量比较
Table 1. Comparison of liver elastic modulus in patients with different pathological stages (kPa, Mean±SD)
纤维化程度 肝脏弹性模量 F P S1期（n=26） 5.95±1.03 48.209 0.000 S2期（n=35） 8.85±1.58 S3期（n=56） 10.67±1.72 S4期（n=20） 14.31±1.98 
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表 2 SWE诊断肝纤维化患者的一般资料对比
Table 2. SWE Comparison of general data on diagnosis of hepatic fibrosis
因素 正确诊断（n=118） 漏诊（n=19） t/χ2 P 年龄（岁, Mean±SD） 58.8±7.7 57.6±7.8 0.629 0.530 BMI（kg/m2, Mean±SD） 23.8±2.2 24.5±2.4 -1.271 0.206 ALT（U/L, Mean±SD） 44.2±6.9 43.1±7.1 0.642 0.522 AST（U/L, Mean±SD） 55.4±9.8 53.7±10.2 0.698 0.486 性别[n(%)] 2.319 0.128 男 65 (55.08) 14(11.86) 女 53 (44.92) 5(4.24) 肝纤维化程度[n(%)] 25.596 0.000 S1 16 (13.56) 10 (8.47) S2 27 (22.88) 8(6.78) S3 55 (46.61) 1(0.85) S4 20 (16.95) 0(0.00) HBeAg[n(%)] 1.665 0.197 阳性 62 (52.54) 13(11.02) 阴性 56 (47.46) 6(5.08) 炎症分级[n(%)] 5.291 0.021 G1~G2 82 (69.49) 18(15.25) G3~G4 36 (30.51) 1(0.85) SWE: 剪切波弹性成像.
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表 3 SWE诊断肝纤维化患者的影响因素研究
Table 3. SWE Factors affecting the diagnosis of hepatic fibrosis
参数 β SE Walds P OR 95%CI 肝纤维化程度 0.884 0.304 8.456 0.000 2.421 1.334-4.392 炎症分级 0.775 0.315 6.053 0.002 2.171 1.171-4.024 常数项 1.048 0.487 4.631 0.045 2.852 1.098-7.408
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