Diagnosis Of Hepatic Fibrosis In Patients With Chronic Hepatitis B By Real-time Tissue Elastography

ObjectiveLiver fibrosis is a necessary process for patients with chronic hepatitis B to develop liver cirrhosis.If the liver fibrosis is not controlled,it will eventually lead to liver failure,hepatic encephalopathy and hepatocellular carcinoma.Therefore,it is very important to evaluate the degree of liver fibrosis in the early stage.The purpose of this study was to investigate the correlation between the quantitative diagnosis of liver fibrosis and the accuracy of real-time tissue elastography combined with serum markers in the diagnosis of liver fibrosis.In order to find a noninvasive diagnostic method for evaluating the degree of liver fibrosis.MethodsPart 1:During the January 2015-2015 year in August,were collected in our hospital underwent liver resection or liver biopsy in patients with chronic hepatitis B and 180 cases as experimental group subjects,another 34 healthy volunteers were selected as the subjects of the control group.All subjects were examined with real-time tissue elasticity imaging,and the tissue dispersion quantitative analysis software for average relative strain value(MEAN),standardd eviation of relative strain value(SD),area ratio of low-strain region(%AREA),complexity(COMP),kurtosis(KURT)and skewness(SKEW)and contrast(CONT),equality(ENT),inverse difference moment(IDM),angular second moment(ASM),correlation(CORR)and calculated by the software of the hepatic fibrosis index(LFI).Then compare the difference between the 11 elastic characteristics and LFI in the experimental group and the control group.The statistical analysis of the correlation between the experimental group and the control group and the pathological stage of chronic hepatitis B liver fibrosis.Then,the degree of liver fibrosis was assessed by using a relatively large amount of elasticity,and the ROC curve was used to evaluate the diagnostic efficacy of liver fibrosis.Part 2:During the September 2015-2016 year in August,were collected in our hospital underwent liver resection or liver biopsy in patients with chronic hepatitis B and 211 cases as subjects.All subjects were examined with real-time tissue elasticity imaging,the index of liver fibrosis(LFI)was calculated according to the quantitative analysis software.At the same time,serum biochemical indicators were collected: aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamyl transferase(GGT),total bilirubin(TBIL),platelet count(PLT),the APRI value and FIB-4 value were calculated.Based on the pathological results as the gold standard,the ROC curve was constructed to compare the diagnostic efficacy of RTE and serum biochemical parameters in the evaluation of liver fibrosis(? S2),severe hepatic fibrosis(?S3)and early cirrhosis(S4).Results 1 Quantitative analysis of the correlation between real time tissue dispersion and liver fibrosis1.1 In addition to kurtosis(KURT)and contrast(CONT),there were statistically significant differences of other elastic properties in the experimental group and control group(P<0.05).1.2 In correlation analysis,except the correlation(CORR),the other elastic characteristics were correlated with the pathological stage of liver fibrosis.The average relative strain value(MEAN)and equality(ENT)were negatively correlated with the stage of liver fibrosis,and the correlation coefficient(R)was-0.674,-0.571,respectively.The standard deviation(SD),area ratio of low-strain region(%AREA),complexity(COMP),skewness(SKEW),inverse difference moment(IDM),angular second moment(ASM)and liver fibrosis index(LFI)was positively correlated with liver fibrosis staging,correlation coefficient(R)were respectively 0.245,0.724,0.755,0.655 0.657,0.432,0.758.1.3 The average relative strain value(MEAN),area ratio of low-strain region(%AREA),complexity(COMP),skewness(SKEW),inverse difference moment(IDM),hepatic fibrosis index(LFI)ROC curve area under the diagnosis of liver fibrosis(AUC)were 0.796,0.819,0.832,0.785,0.797,0.832,respectively;accuracy were 71.67%,72.78%,73.33%,75%,73.89%,71.11% respectively;the sensitivity were 68.66%,67.16%,69.40%,73.13%,73.88%,64.93% respectively;the specificity were 80.43%,89.13%,84.78%,80.43%,73.91%,89.13% respectively.2 Comparison of real time tissue elastography and serum biochemical indexes in evaluating the degree of liver fibrosis 2.1 LFI value,APRI value,FIB-4 value for diagnosis of significant fibrosis(S2~S4)area under the ROC curve(AUC),sensitivity and specificity were respectively 0.963,94.20%,86.30%;0.862,80.43%,79.45%;0.820,80.43%,68.49%;the diagnosis of severe fibrosis(S3~S4)area under ROC curve(AUC),sensitivity and specificity were respectively 0.938,83.54%,89.39%;0.733,93.67%,47.73%;0.701,94.94%,40.15%;the diagnosis of early liver cirrhosis(S4)area under ROC curve(AUC),sensitivity and specificity were respectively 0.981,98%,91.30%;0.731,74%,68.94%;0.764,94.00%,45.96%.2.2 The accuracy of RTE combined with APRI or FIB-4in the diagnosis of significant hepatic fibrosis(? S2)was 96.21% and 95.73%,respectively,the accuracy of diagnosis of severe hepatic fibrosis(?S3)was 94.31% and 93.84% respectively,the diagnosis of early liver cirrhosis(S4)were 95.26% and 94.31%,respectively.ConclusionReal time tissue elastography quantitative analysis of tissue diffusion has a high correlation with the stage of liver fibrosis in patients with chronic hepatitis B,the correlation coefficient of liver fibrosis index(LFI)was the highest.However,the use of a single elastic characteristic to assess the degree of liver fibrosis,low sensitivity.Although the APRI and FIB-4 indices were more sensitive in the diagnosis of severe fibrosis and early cirrhosis,specificity and accuracy were low.Real time tissue elastography combined with serum biochemical indicators can greatly improve the accuracy of diagnosis of liver fibrosis,is of great significance for the assessment of liver fibrosis in chronic hepatitis B,and can be used to assess the degree of liver fibrosis in patients with chronic hepatitis B is a noninvasive diagnostic method.