| Objective:To explore the value of Combinational Elastography(Combi-Elasto)in the diagnosis of liver fibrosis and liver inflammation in patients with chronic hepatitis B(CHB)and to explore the diagnostic threshold of related indexes;To compare and analyze the diagnostic efficacy of Combi-Elasto,shear wave velocity measurement(SWM),real-time tissue elastography(RTE)and transient elastography(TE)in the diagnosis of hepatic fibrosis in patients with CHB,in order to find a more effective non-invasive method for evaluating hepatic fibrosis.Methods:A total of 92 CHB patients who were treated in Affiliated Hospital of Youjiang Medical University for Nationalities from January 2021 to July 2022 were selected as the pathology group,and all patients underwent ultrasound-guided liver biopsy to obtain the grades of pathological liver fibrosis(S)and liver inflammation(G).Results,pathological liver fibrosis was divided into 4 groups(S1～S4),and pathological liver inflammation was divided into 5 groups(G0～G4).At the same time,30 healthy volunteers were included as the control group.Both the pathology group and the control group underwent Combi-Elasto examination to measure liver fibrosis index(F Index)and liver inflammatory activity index(A Index).The above two indicators were used to evaluate liver fibrosis and liver inflammation.When the Combi-Elasto test was performed,the index of liver fibrosis shear wave velocity(Vs)which was evaluated by SWM technology and the index of liver fibrosis liver fibrosis index(LFI)which was evaluated by RTE technology could be obtained at the same time,and the liver stiffness measurement(LSM)was detected by TE to evaluate liver fibrosis.With pathological results as the diagnostic gold standard,the correlation between F Index and S,A Index and G was compared and analyzed,the value of Combi-Elasto in the diagnosis of liver fibrosis and liver inflammation was discussed,and the value of Combi-Elasto in the diagnosis of liver fibrosis was compared and analyzed with SWM,RTE and TE.Results:(1)There was a high positive correlation between F Index and the stage of pathological hepatic fibrosis(S),(r_s=0.863,P<0.001),and there was a high positive correlation between A Index and pathological grade of liver inflammation(G),(r_s=0.703,P<0.001);(2)Compared with the F Index of the pathological liver fibrosis group and the control group,F Index was not significantly increased in the normal group and S1 stage,but significantly increased in S2,S3,and S4;(3)A Index increases with the increase of inflammation grade;(4)For F Index,using 1.215,1.396,1.497 and 1.590 as the threshold for diagnosing≥S1,≥S2,≥S3 and=S4,the area under the curve(AUC)were 0.936,0.966,0.942 and 0.978;(5)For A Index,using 1.235,1.305,1.635 and 1.670 as the threshold for diagnosing≥G1,≥G2,≥G3 and=G4,the AUC were 0.747,0.813,0.835 and 0.823;(6)The AUC of LFI in the diagnosis of liver fibrosis stage≥S1,≥S2,≥S3 and=S4 were0.705,0.690,0.720 and 0.799;The AUC of Vs in the diagnosis of liver fibrosis stage≥S1,≥S2,≥S3,=S4 were 0.936,0.978,0.950,0.985;The AUC of TE in the diagnosis of liver fibrosis stage≥S1,≥S2,≥S3,=S4 were 0.878,0.950,0.937,0.960.As could be seen,the F Index of Combi-Elasto and Vs of SWM had high and similar diagnostic efficacy in the diagnosis of hepatic fibrosis≥S1 stage and above;The diagnostic efficiency of Combi-Elasto and SWM were significantly better than that of TE in diagnosis≥S1,slightly better than TE in≥S2 and=S4,and similar in diagnostic efficiency≥S3;The efficacy of Combi-Elasto,SWM and TE in the diagnosis of liver fibrosis≥S1 and above were better than that of RTE.Conclusion:As a new technique of ultrasound elastography for comprehensive quantitative evaluation of hepatic fibrosis and hepatic inflammation,F Index and A Index measured by Combi-Elasto can better reflect the degree of hepatic fibrosis and hepatic inflammation.Among them,FIndex has high diagnostic efficiency,while AIndex has moderate diagnostic efficacy,so it has important clinical application value.It is expected to become a new method for non-invasive evaluation of hepatic fibrosis and hepatic inflammation. |
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