Clinical study on noninvasive quantitative evaluation of hepatic fibrosis in chronic liver disease by ultrasound E imaging
Objective To detect and analyze clinical application value of ultrasound E-imaging(shear wave elastography,SWE)technique in patients with chronic liver disease,and explore the clinical application value of SWE for non-invasive quantitative evaluation of liver fibrosis in patient with chronic liver disease.Methods From August 2019 to July 2021,a to-tal of 148 patients with chronic liver disease were enrolled,which included 56 males and 92 females,aged 17-75 years old with mean age of 48.9 years old;height was 1.47-1.87 meters with mean height of 1.65 meters;body mass was 44-106 kg with mean body mass of 65.50 kg;body mass index(BMI)was 17.51-35.85 kg/m2 with mean BMI of 24.00 kg/m2.There were 44 cases of viral hepatitis,36 of metabolic fatty liver disease,22 of autoimmune hepatitis,20 of drug-induced hepatitis and 26 of primary biliary cholangitis.The SWE technique was used to detect the liver of all patients and ultrasound-guided liver biopsy was performed,the relationship between liver SWE elasticity and liver fibrosis stage was statistically analyzed with pathological results as the gold standard.Results The pathological diagnosis of chronic liver disease with liver fibrosis in 130 cases,and non-fibrosis in 18.There were significant differences in SWE elasticity,aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBiL),direct bilirubin(DBiL)and high density lipoprotein cholesterol(HDL-C)be-tween 2 groups[(9.34±4.73)kPa vs(6.24±1.46)kPa,(147.89±62.79)U/L vs(73.32±34.78)U/L,(270.56±60.95)U/L vs(105.94±52.97)U/L,(57.12±10.82)μmol/L vs(20.57±5.01)µmol/L,(38.41±7.95)μmol/L vs(9.35±4.88)µmol/L,(1.35±0.36)mmol/L vs(1.39±0.84)mmol/L.t=2.755,1.972,2.615,3.898,3.957,0.359,P＜0.05].The correlation analy-sis between SWE elasticity and various indexes in patients with chronic liver disease and liver fibrosis showed that SWE elastic-ity was positively correlated with age(r=0.338),fibrosis stage(r=0.736),blood glucose(GLU)(r=0.174)and prothrombin time(PT)(r=0.424)(P＜0.05).The diagnostic efficacy of SWE technique for liver fibrosis in chronic liver disease was analyzed.The results of receiver operating characteristic(ROC)curve analysis showed that cut-off values of SWE elastic measurement in S0/S1,S1/S2,S2/S3 and S3/S4 stages of liver fibrosis in chronic liver disease were 6.35 kPa,7.65 kPa,8.35 kPa and 17.30 kPa,re-spectively.The area under curve(AUC)was 0.736[95％confidence interval(CI)0.628-0.844],0.751(95％CI 0.657-0.845),0.803(95％CI 0.680-0.927)and 0.752(95％CI 0.566-0.939),respectively.Conclusion It is demonstrated that SWE technique is a real-time ultrasonic elastography technique,which is simple,non-invasive and highly accepted by patients,the elastic measurement value can be used for non-invasive quantitative evaluation of chronic liver fibrosis and its staging,and shows good clinical application prospect.
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