目的：应用肝脏实时剪切波弹性成像和超声量化评分评价恩替卡韦治疗慢性乙型肝炎（CHB）肝纤维化的疗效。方法：87例符合抗病毒治疗指征的CHB患者，根据治疗前肝脏病理分期进行分组。在治疗前肝脏实时剪切波弹性成像和超声量化评分与肝脏病理分期进行组间比较，应用恩替卡韦抗病毒治疗96周后，肝脏实时剪切波弹性成像与超声量化评分进行组内比较。结果：87例CHB患者分3组：A组（S0，S1）12例，B组（S2，S3）64例，C组（S4）11例。抗病毒治疗前，超声量化评分和肝硬度随着肝纤维化病理分期的增加而增大，组间差异均具有统计学意义。肝脏超声量化评分和肝硬度与纤维化病理分期均存在较好的相关性。肝硬度和超声量化评分的曲线下面积（AUC）是0.89和0.78。恩替卡韦抗病毒治疗96周后，肝脏实时剪切波弹性成像和超声量化评分治疗后均比治疗前有显著性的下降，组间差异均具有统计学意义。治疗前与治疗后超声量化评分和肝硬度均为A组＜B组＜C组。结论：肝脏实时剪切波弹性成像和超声量化指标可以用来对恩替卡韦治疗CHB肝纤维化疗效进行评估。
Abstract
Objective: To evaluate the efficacy of entecavir anti-fibrosis treatment in chronic hepatitis B(CHB) with real-time shear wave elastography and ultrasound quantitative score. Methods: Eighty-seven CHB patients with antiviral treatment indications were enrolled. They were grouped by liver pathological staging before treatment. Real-time shear wave elastography and ultrasound quantitative score were compared with pathological staging between groups before treatment. Real-time shear wave elastography was compared with ultrasound quantitative score within groups after 96 weeks entecavir treatment. Results: Eighty-seven CHB patients were divided into three groups: group A(S0, S1) 12 patients, group B(S2, S3) 64 patients, and group C(S4) 11 patients. The parameters of stiffness and ultrasound quantitative score increased gradually with liver fibrosis exacerbation． The parameters of stiffness and ultrasound quantitative score of each pathological stage had statistically significant difference between groups. Both of these parameters were well correlated with the pathological change on the liver fibrosis． The areas under the curve for stiffness and ultrasound quantitative score were 0.89 and 0.78, respectively． The parameters of stiffness and ultrasound quantitative score obviously decreased after 96 weeks treatment vs before. The parameters of stiffness and ultrasound quantitative score of each pathological stage had statistically significant difference within groups. The parameters of stiffness and ultrasound quantitative score in three groups were group A＜group B＜group C. Conclusion: Real-time shear wave elastography and ultrasound quantitative score could be used to evaluate the efficacy of entecavir anti-fibrosis treatment in CHB.
关键词
/
肝炎 /
乙型 /
慢性 /
肝硬化 /
超声检查 /
多普勒 /
彩色
Key words
Hepatitis B, chronic /
Liver cirrhosis /
Ultrasonography, Doppler, color
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基金
国家“十二五”传染病重大专项（2012ZX10002003）。辽宁省自然科学基金（2014021007）。
辽宁省临床能力建设项目（LNCCC-A02-2014）。中国医科大学附属盛京医院自由研究者基金项目（201102）。
辽宁省传染性疾病转化医学研究中心建设（2014225020）。
