慢性病毒性肝炎患者肝脏硬度和颈动脉弹性的超声评估

肝脏 ›› 2022, Vol. 27 ›› Issue (10): 1106-1109.

慢性病毒性肝炎患者肝脏硬度和颈动脉弹性的超声评估

孙翔, 赵小禹, 谭杰

430012 湖北武汉市汉口医院超声影像科(孙翔,谭杰);华中科技大学同济医学院附属武汉市中心医院超声科(赵小禹)

收稿日期:2022-04-14 出版日期:2022-10-31 发布日期:2022-11-22
通讯作者: 谭杰,Emial:18086066813@163.com
基金资助:
湖北省卫计委科研项目(WJ2017F042)

The evaluation of liver stiffness and carotid elasticity by ultrasond in patients with chronic viral hepatitis

SUN Xiang¹, ZHAO Xiao-yu², TAN Jie¹

1. Department of Ultrasound Imaging, Hankou Hospital, Hubei 430012;
2. Department of Ultrasound, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei 430014, China

Received:2022-04-14 Online:2022-10-31 Published:2022-11-22
Contact: TAN Jie, Emial:18086066813@163.com

摘要/Abstract

摘要： 目的分析慢性病毒性肝炎患者剪切波速度(SWV)、颈动脉弹性参数与肝纤维化的关系。方法纳入2020年1月至2022年2月慢性乙型肝炎患者117例(CHB组)、慢性丙型肝炎患者57例(CHC组)和健康者50名(对照组)。对3组研究对象进行ARFI和颈动脉超声检查,记录SWV、CIMT、PWV、DC、CC、僵硬度参数(α、β)以及动脉压增强指数(AIx)。比较3组血生化指标、SWV及颈动脉弹性参数。结果 CHB组HbA1c、ALT、AST分别为(5.5±1.0)%、(46.5±8.5)U/L、(45.2±7.2)U/L,CHC组分别为(6.7±1.7)%、(43.2±9.4)U/L、(37.7±7.6)U/L,均高于对照组的(5.2±0.5)%、(28.2±5.8)U/L、(23.8±5.7)U/L(P<0.05)。CHB组Alb、HDL为(40.8±8.7)g/L、(1.0±0.3)mmol/L,CHC组为(40.8±8.1)g/L、(0.9±0.3)mmol/L,均低于对照组的(43.8±9.2)g/L、(1.2±0.4)mmol/L(P<0.05)。CHB组SWV、CIMT、PWV、α、β和AIx为(1.84±0.50)m/s、(0.63±0.15)mm、(6.70±1.16)m/s、(4.13±1.61)、(8.42±3.15)和(3.08±0.46)%,CHC组为(1.86±0.36)m/s、(0.69±0.17)mm、(7.96±1.33)m/s、(5.77±2.22)、(11.67±4.26)和(3.03±0.45)%,均高于对照组的(1.03±0.10)m/s、(0.51±0.11)mm、(6.09±0.76)m/s、(3.03±0.63)、(6.18±1.30)和(1.65±0.52)%(P<0.05)。CHB组DC、CC为(0.020±0.009)1/kPa、(1.05±0.34)mm²/kPa,CHC组DC、CC为(0.017±0.007)1/kPa、(0.82±0.38)mm²/kPa,均低于对照组的(0.032±0.010)1/kPa、(1.29±0.20)mm²/kPa(P<0.05)。CHB患者中S0、S1、S2、S3及S4分别为17例、20例、41例、25例及14例,肝纤维化程度较高CHB患者SWV、CIMT均高于纤维化程度较低者(P<0.05)。CHC患者中S0、S1、S2、S3及S4分别为11例、12例、11例、14例及9例,肝纤维化程度较高CHC患者SWV、CIMT均高于纤维化程度较低者(P<0.05)。结论 CHB、CHC患者不仅肝脏硬度明显增加,而且颈动脉弹性参数也发生变化。利用ARFI技术和颈动脉超声检查可以评价肝纤维化程度,有助于CHB、CHC患者心血管事件的监测。

关键词: 慢性病毒性肝炎, 剪切波速度, 颈动脉内-中膜厚度

Abstract: Objective To explore the changes in shear wave velocity (SWV) and carotid elasticity parameters of Ultrosound in patients with chronic viral hepatitis, and analyze their relationship with the degree of liver fibrosis. Methods From January 2020 to February 2022, 117 patients with chronic hepatitis B (CHB group), 57 patients with chronic hepatitis C (CHC group) and 50 age and sex matched healthy people (control group) were enrolled in this study. Acoustic radiation force pulse imaging (ARFI) and carotid ultrasound were performed on the three groups of subjects, and shear wave velocity (SWV), carotid intima-media thickness (CIMT), pulse wave conduction velocity (PWV), dilation coefficient (DC), compliance coefficient (CC), stiffness parameters (α, β) and arterial pressure enhancement index (AIx) were recorded. Blood biochemical indexes, SWV and carotid elasticity parameters were compared among the three groups. Results The glycosylated hemoglobin (HbA1c), Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) in CHB group were (5.5±1.0)%, (46.5±8.5) U/L and (45.2±7.2) U/L, respectively, while those in CHC group were (6.7±1.7)% and (43.2±9.4) U/L. They were significantly higher than those of (5.2±0.5)%, (28.2±5.8) U/L and (23.8±5.7) in the control group U/L(P<0.05). The Alb and HDL in CHB group were (40.8±8.7) g/L and (1.0±0.3) mmol/L, while those in CHC group were (40.8±8.1) g/L and (0.9±0.3) mmol/L, which were significantly lower than those of (43.8±9.2)g/L and(1.2±0.4)mmol/L in the control group (P<0.05). SWV, CIMT, PWV, α, β and AIx in CHB group were (1.84±0.50) m/s, (0.63±0.15)mm, (6.70±1.16) m/s, (4.13±1.61), (8.42±3.15) and (3.08±0.46)%, and in CHC group were (1.86±0.36) m/s, (0.69±0.17)mm, (7.96±1.33) m/s, (5.77±2.22), (11.67±4.22) and (3.03±0.45)%, respectively, which were significantly higher than those of (1.03±0.10) m/s, (0.51±0.11)mm, (6.09±0.76) m/s, (3.03±0.63), (6.18±1.30) and (1.65±0.52)% in the control group (P<0.05). The DC and CC of CHB group were (0.020±0.009) 1/kPa, (1.05±0.34) mm²/kPa, while those of CHC group were (0.017±0.007) 1/kPa and (0.82±0.38) mm²/kPa, which were significantly lower than those of (0.032±0.010) 1/kPa, (1.29±0.20) mm²/kPa in the control group (P<0.05). The number of S0, S1, S2, S3 and S4 patients were 17 cases, 20 cases, 41 cases, 25 cases and 14 cases, respectively. SWV and CIMT in CHB patients with higher degree of liver fibrosis were significantly higher than those with lower degree of liver fibrosis (P<0.05). S0, S1, S2, S3 and S4 in patients with CHC were 11 cases, 12 cases, 11 cases, 14 cases and 9 cases, respectively. SWV and CIMT in patients with high degree of liver fibrosis were significantly higher than those with low degree of liver fibrosis (P<0.05). Conclusion In patients with CHB and CHC, not only the liver hardness increased significantly, but also the carotid elasticity parameters changed. Using ARFI technology and carotid ultrasound to evaluate the degree of liver fibrosis is helpful to monitor cardiovascular events in patients with CHB and CHC.

Key words: Chronic viral hepatitis, Shear wave velocity, Carotid intima-media thickness

孙翔, 赵小禹, 谭杰. 慢性病毒性肝炎患者肝脏硬度和颈动脉弹性的超声评估[J]. 肝脏, 2022, 27(10): 1106-1109.

SUN Xiang, ZHAO Xiao-yu, TAN Jie. The evaluation of liver stiffness and carotid elasticity by ultrasond in patients with chronic viral hepatitis[J]. Chinese Hepatolgy, 2022, 27(10): 1106-1109.

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