| Background and ObjectiveAccording to statistics, there are about30million chronic hepatitis B patients in China. If a timely and effective control for hepatitis progress of the patients with Hepatitis B, it would usually experienced three stages, HBV, cirrhosis and hepatic carcinoma. Liver fibrosis is a transition state between hepatitis and hepatic cirrhosis. And it is the early stage of a necessary progression to cirrhosis. The studies have shown that early diagnosis and active treatment of the disease could delay or reverse the development of cirrhosis. Thus early and accurate diagnosis and assessment of liver fibrosis play an important role in the prevention, treatment and prognosis of liver fibrosis. Cirrhosis is the development of liver fibrosis progressed to a certain extent. Once chronic hepatic disease developed to hepatic cirrhosis, it would affect the life quality and survival time of the patients. So accurate staging of the hepatic cirrhosis is very important for understanding the degree of severity. The staging will be a good reference for the doctor to make clinical diagnosis, choice of treatment and drug selection.The ultrasound is a noninvasive method commonly used in diagnosis of liver disease. Conventional two-dimensional ultrasound have diagnostic value for hepatic disease that have the morphological changes in liver disease, but the diagnostic value of diffuse liver disease which have no morphological changes are limited and a further study need to be done. With the development of ultrasound diagnostic techniques in recent years, ultrasound elastography in clinical diagnosis has been widely used. The concept of elastography was first mentioned by Ophir in1991. This technology is based on the basic properties of biological tissues that all tissues have the elasticity or hardness. Tissue elastic information was obtained objectively and the differences between the organizations were evaluated. Elastography is widely applied in clinical and it has been shown to have good application value in the diagnosis of superficial organs such as breast, thyroid and prostate. Especially in recent years it was used in the diagnosis of hepatic disease, such as hepatic cirrhosis, hepatic tumor, etc, however, to the cirrhosis stage there are rarely report. In this study, we chosen chronic hepatitis B patients as study objectives and used ultrasound elastography quantitative analysis combined with the pathological results to investigate the value of elastography in the diagnosis and classification of liver fibrosis and liver cirrhosis. Method1.,The diagnostic value of elastography in hepatic fibrosis. To explore the diagnostic value of elastography in the hepatic fibrosis and,132cases of hepatitis B with liver fibrosis and30cases without liver fibrosis were detected using elastography and the parameters of all patients were noted. At the same time, the degree of fibrosis was confirmed by pathology.2,The diagnostic value of elastography in hepatic cirrhosis.90cases of hepatitis B with liver fibrosis and20cases without cirrhosis were detected by ultrasonic elastography. All of the results all were confirmed by pathology.Result1,Bivariate correlation analysis and Spearman correlation analysis were used to analyze the parameters of different stages of hepatic fibrosis, including mean, standard deviation, complexity, and the blue area percentage. of The correlation coefficient between strain mean and liver fibrosis staging was-0.196(r=-0.916, p=0.000), there existed a significant negative correlation. The higher of hepatic fibrosis staging, the lower of the strain mean. The correlation coefficient between standard deviation and liver fibrosis staging was0.766(r=0.766, p=0.000).There is a significant positive correlation between them, the higher the liver fibrosis stage, the higher the standard deviation. At the same way, we calculated that the correlation between fibrosis and the percentage of the blue areas or and the complexity, both of them had a positive correlation and the correlation coefficient were r=0.914, p0.000; r=0.834, p=0.000respectively.With Wilcoxon rank sum test, there was statistically significant difference on strain mean between the groups with or without liver fibrosis. The mean average rank was108.51,46.2(Z=-8.772, P=0.000). And at the same way, we observed that there were statistically significant difference on standard deviation, the percentage of the blue areas and the complexity, the results were29.84,84.21, and Z=-7.655, P=0.000;24.36,86.86, Z=-8.798, P=0.000;28.56,84.83, Z=-7.922, P=0.000respectively. In summary, two sets of strain between the mean, standard deviation, the percentage of blue area and the complexity of the differences were statistically significant. Analysis of variance:a comprehensive comparison MEAN, SD, the AREA and COMP, there were significant differences (P=0.000), and thus a further multiple comparisons was done. Multiple comparisons:LSD (Least-significant Difference) shows nosignificant difference (P=0.174) in the standard deviation between the S3and S4, and no significant difference on the complexity of S1and S2(P=0.898). The remaining stages of liver fibrosis on mean, standard deviation, the percentage of blue area and complexity, they all have a significant differences (P <0.05).2,The strain mean of the groups with hepatic cirrhosis and without cirrhosis were96.8±9.4and125.0±5.6respectively. The SD of the groups with hepatic cirrhosis and without cirrhosis were67.5±7.4and49.4±2.6respectively. The%AREA of the groups with hepatic cirrhosis and without cirrhosis were35.0±8.3and10.6±2.2respectively. The COMP of the groups with hepatic cirrhosis and without cirrhosis were33.5±9.4and20.0±2.8respectively. The difference is statistically significant (P <0.05). Compared with the large nodules and mixed nodular cirrhosis groups, the strain mean of small nodular cirrhosis of the liver were statistically significant (P <0.05). Although the stain mean between large nodular cirrhosis and mixed nodular cirrhosis has a changing trend, but the difference was no statistically significant (P>0.05); Compared with the small nodules and mixed nodular cirrhosis groups, the SD of large nodular cirrhosis of the liver were statistically significant (P <0.05). Although the SD between small nodular cirrhosis and mixed nodular cirrhosis has a changing trend, but the difference was no statistically significant (P>0.05); Compared with the small nodules and mixed nodular cirrhosis groups, the%AREA of large nodular cirrhosis of the liver were statistically significant (P <0.05). Although the%AREA between small nodular cirrhosis and mixed nodular cirrhosis has a changing trend, but the difference was no statistically significant (P>0.05); Compared with the large nodules and mixed nodular cirrhosis groups, the COMP of small nodular cirrhosis of the liver were statistically significant (P <0.05).Conclusion:1,Ultrasonic elastography can provide an objective, accurate data and images. And it can analyze the data comprehensively. It might have an promising application prospect in determining the degree of hepatic fibrosis with non-invasive methods.2,As a new diagnostic technique, ultrasonic elastography is a preliminary exploration and provides a more effective mean of clinical judgment for liver cirrhosis. It also has a positive mean for treatment and prognosis of hepatic cirrhosis. This technique is worthy of further study and application. |
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