| Objective Viral hepatitis B(HBV)is a worldwide disease caused by hepatitis B virus(HBV).According to statistics,there are more than 280 million asymptomatic infected persons in the world,accounting for about 130 million in China,among which 30% of the patients will appear hepatic damage leading to hepatic fibrosis(HF)and late decompensation cirrhosis.Early and accurate assessment of the degree of HF can guide effective clinical medication to reverse HF or even early cirrhosis.Therefore,the first part of this study aims to explore the value of real-time two-dimensional shear wave Elastrography(2D-SWE)and laboratory diagnosis of HF staging based on the wavenumber Domain attenuation coefficient(W-AC)of ultrasound,and conduct a comparative study on the diagnostic efficiency of the two.The second part aims to explore the application value of 2D-SWE combined WITH HF serological indicators in monitoring the follow-up after entecavir antiviral therapy.Method Selection Sixty-four hospitalized patients receiving treatment for HBV-related liver diseases in the infectious department of our hospital from October 2016 to January2018 were selected,and liver biopsy was performed during the period of hospitalization,including 37 males and 27 females,aged 22-69,with an average age of(42.10±11.58)years old.The pathology of METAVIR revealed 23 cases of F1,16 cases of F2,15 cases of F3 and 410 cases of F410,which were further divided into F1+F2 group for liver fibrosis and F3+F4 group for cirrhosis.Another 30 cases of F0 were selected as normal control group.Before the liver biopsy,the Aixplorer Shear Wave TM real-time Shear Wave elastic ultrasound diagnosis of France Surpersonic Imagine company was first adopted.The abdominal s-type probe with a central frequency of 1 ? 6mhz and 2d-swe mode was selected to measure elasticity values value at the lower edge of the liver envelope at 1 ?2cm.Meanwhile,VINNO70 color Doppler ultrasound diagnostic instrument and X4-12 L linear array probe are used,with the center frequency of 10 MHz,imaging depth of 6cm and focus at 3cm,which can output the post-beamforming radio frequency(PRF)data of all patients.Then PRF data is collected.According to the location of PRF data collection point,liver puncture biopsy was performed within 2 hours after ultrasound examination.The near-field echo of liver tissue was selected as the reference signal and the far-field liver was used as the area of interest to calculate the W-AC value of liver tissue.Correlation analysis was conducted between 2D-SWE measurements and PRF data W-AC values and liver biopsy METAVIR score results.The receiver operating characteristic Curve(ROC)was drawn to compare the diagnostic effectiveness of the two.Another 50 patients with CHB compensatory cirrhosis who received entecavir treatment in the Infection Department of the First Affiliated Hospital of Anhui Medical University from October 2016 to October 2018 were selected as the study group,including 32 males and 18 females,aged 25-69(43.10±11.48)years old.Average BMI was(24.07±3.38)kg/m2.The duration of HBV-associated liver disease was 6.8 years(6-15years).Meanwhile,50 CHB compensatory cirrhosis patients with matched gender,age and BMI who did not receive entecavir treatment during the same period were selected as the control group.Liver protection and basic antiviral therapy were given to both groups.Enticavir 0.5 mg once a day was given to the study group for 48 weeks as the end point.Liver function(ALT,AST,TBIL),HF serological indexes(LN,CIV,HA,P III)and Young's modulus of elasticity measured by 2D-SWE were compared between the two groups before and after treatment,and the correlation between Young's modulus of elasticity measured by 2D-SWE and HF serological indexes was analyzed.Results 1.With the progression of HF(Stage F0-F4),elasticity values and W-AC values of the liver increased.2.The overall Elasticity values and W-AC values of the normal control group were significantly lower than those of the HF group,with statistically significant differences(P < 0.05).There were statistically significant differences in elasticity values and W-AC values between the normal control group,the liver fibrosis group and the liver cirrhosis group(P < 0.05).3.Spearman rank correlation analysis showed that HF in different pathological stages was highly positively correlated with elasticity values and W-AC(R =0.867,P < 0.001).R=0.796,P < 0.001).4.ROC curve analysis of 2D-SWE in HF diagnosis showed that the area under receiver Operating Curve(AUC)of the subject was 0.960,with a cut-off value of 0.12253,the sensitivity and specificity were 0.806 and 0.930 respectively.ROC curve analysis of WAC technique in HF diagnosis showed that AUC was 0.890,sensitivity and specificity were 0.706 and 0.830 respectively when the cutoff value was 0.12212.Comparison of diagnostic efficiency between 2D-SWE and W-AC in HF diagnosis shows that the diagnostic efficiency of 2D-SWE in HF diagnosis is higher than that of W-AC,and the correlation between HF staging and Elasticity values is greater than that between HF staging and W-AC.5.After 48 weeks of antiretroviral therapy with entecavir,liver function,HF serological indicators and elasticity values in both groups were improved to varying degrees.HF serological indexes and elasticity values measured by 2D-SWE in the study group were lower than those in the control group(P < 0.05).Elasticity values was positively correlated with HF serological index level(R was 0.50,0.48,0.38,0.51,all P < 0.05).Conclusion: 1.Elasticity values measured by D-SWE have high sensitivity and specificity in HF diagnosis in each group.2D-SWE technology can be used to diagnose HF and has high clinical application value.2.PRF is a new method for laboratory in vivo experiments,namely wave number domain attenuation coefficient measurement method.In clinical practice,W-AC has the potential of noninvasive HF diagnosis in vivo.3.Elasticity values value measured by D-SWE and W-AC values were significantly correlated with the pathological stage of METAVIR of HF,but the diagnostic efficiency of elasticity values in HF group was better than that of W-AC.4.2D-SWE combined with HF serological index has important clinical application value in monitoring the follow-up after entecavir antiviral treatment. |
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