| Objective:Using real-time shear wave elastography (SWE) to evaluate and analyze elastic modulus of normal subjects and patients with chronic liver disease related to HBV infection and explored its value in the evaluation of liver fibrosis about patients with chronic liver disease related to HBV infection. Then testing elastic modulus of patients with chronic liver disease use SWE, and compared with the results of liver pathology stages to explore its feasibility and accuracy in assessment of liver fibrosis.Methods:With chronic HBV infection-related liver disease patients in this study,162patients were divided into recovery group of HBV infection, carriers of chronic hepatitis B, mild/moderate group chronic hepatitis B and liver cirrhosis group and choose another20healthy persons served as normal controls. Using AixPlorer type real time shear wave elastic ultrasonic diagnostic apparatus (SWE Technology) to detect liver elastic modulus of all subjects. And homochronous laboratory datas were collected what included patient blood biochemistry, HBV serological markers, serum HBV DNA value, then the elastic modulus of the patients and laboratory datas were gaved correlation analysis. Another38patients of chronic liver disease were undertaked liver biopsy in ultrasound guided and simultaneously detective liver elastic modulus, SWE measurement sampling location as far as possible consistent with liver puncture site,analyze the results of liver pathology and liver elastic modulus. Datas were statistically analyzed using SPSS17.0, with p<0.05was considered statistically significant difference.Results:1. SWE collection success rates in liver segments were significantly different (p<0.05),100%success rate of S5, S6segments were the highest, S3, S4segments followed, S2, S7, S8segments were low.2. Hepatic S3, S4, S5, S6segments elastic modulus in recovery of Hepatitis B infection, carriers of chronic hepatitis B, mild/moderate group chronic hepatitis B, liver cirrhosis and normal controls were significantly different (p<0.001), but within each group, the differences between measured values of S3, S4, S5, S6segments compared to each other were not statistically significant (p>0.05). Liver elastic modulus of Hepatic S5, S6segments were no statistical difference(p>0.05) in recovery group, carrier group, mild/moderate chronic hepatitis B, but there was significant difference between remaining groups (p<0.05). Hepatic S5, S6segments elasticity levels:normal controls<recovery group of Hepatitis B infection, carriers of chronic hepatitis B, mild/moderate chronic hepatitis B<liver cirrhosis.3. Hepatic portal vein diameters were no statistical difference (p>0.05) in recovery group, carrier group, mild/moderate chronic hepatitis B, but there was significant difference between remaining groups (p<0.05). Hepatic portal vein diameter levels:normal controls<recovery group of Hepatitis B infection, carriers of chronic hepatitis B, mild/moderate chronic hepatitis B<liver cirrhosis.4. Hepatic S5, S6segment’s elastic modulus of HBeAg(-) group was higher than HBeAg (+) group (p=0.02,0.01);The liver elastic modulus of not anti-virus/HBeAg(-) group was also higher than that not anti-virus/HBeAg (+) group (p=0.04,0.03).5. In not antiviral treatment and antiviral therapy group, HBV DNA (+)and HBV DNA(-) group,DNA negative after treatment and DNA is not negative after treatment, not antiviral therapy/HBV DNA(+) and not antiviral therapy group/HBV DNA(-) group, not antiviral therapy/HBV DNA(+) and antiviral therapy group/HBV DNA(+),hepatic S5, S6segment’s elastic modulus were not statistically significant diference(p>0.05). Serum HBV DNA levels of c were not correlated with hepatic S5, S6segment’s elastic modulus (p>0.05), and serum HBV DNA levels of patients who could not anti-viral therapy were also not correlated with hepatic elastic modulus (p>0.05), HBeAg (+)/(-) patients serum HBV DNA levels is also no correlation with liver elastic modulus (p>0.05).6. Hepatic S5,S6segment’s elastic modulus had positive correlation with age, portal vein diameter, ALT, AST, TB, DB, ALP, y-GT (p<0.05), had negative correlation with ALB (p<0.05), had no correlation with time that patients infected with HBV (p>0.05).7.The hepatic elastic modulus except liver fibrosis stage SO and S1was no significant difference between each outer (p=0.21), there was different between the rest fibrosis stages (p<0.05),liver fibrosis stage S0, S1<S2<S3<S4; Its levels were no statistically significant difference in inflammation G0+G1and G2grade (p=0.53), but G3stage liver elasticity values were higher than G0+G1and G2stage (p<0.05); And all the stage of liver fibrosis, and liver inflammation had positive correlation with hepatic elastic modulus (r=0.868, r=0.562); There also had positive correlation between liver inflammation and fibrosis grading (r=0.613, p<0.001).8.The threshold values of SWE diagnosis of liver fibrosis≥S1,≥S2,≥S3,=S4were5.85Kpa,8.7Kpa,11.8Kpa,14.2Kpa, and the corresponding area under ROC curve respectively was0.965,0.944,0.956,0.982, specificity was100%,91.7%,92.6%,90.9%, sensitivity was94.4%,84.6%,90.9%and100%.Conclusion:1. When SWE was applied to detect the hepatic elastic modulus of patients with diffuse liver disease,if S5, S6segments were the best test site, the detection efficiency can be improved.2. There was a difference of SWE measured values between the normal populations, liver cirrhosis crowd, the crowd in between the twos (recovery group, carriers, mild/moderate chronic hepatitis B), it suggested SWE can quantitative assess the degree of liver fibrosis.Portal vein diameter had a positive correlation with hepatic elastic modulus, this suggested it had a consistency with SWE in the evaluation of liver fibrosis.3. Patients with chronic HBV infection, the hepatic elastic modulus of HBeAg(-) group was higher than HBeAg(+) group, it indicated liver fibrosis level of patients with HBeAg(-) was higher than patients with HBeAg(+), patients with HBeAg(-) who may need anti-fibrotic therapy urgently. The hepatic elastic modulus had no correlation with serum HBV DNA,it indicated continuous replication of HBV DNA may be just a starting factor in liver fibrosis, it did not affect the measured values of SWE4. Hepatic elastic modulus that SWE measured are closely correlated with blood biochemical parameters, hepatic inflammatory activity and cholestasis may be affect the measured values of SWE in some extent, so when assess liver fibrosis use SWE, we should take into account the factors.5. SWE can distinguish liver fibrosis S1, S2, S3, S4period, but the identification of the SO and S1is poor. When the SWE thresholds values of liver fibrosis≥S1,≥S2,≥S3and=S4were5.85Kpa,8.7Kpa,11.8Kpa,14.2Kpa,there had high sensitivity, specificity and accuracy. So SWE had a high diagnostic value on liver fibrosis, and its clinical application of quantitative assessment of liver fibrosis is feasible. |
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