Эластометрия с применением форсированного импульса акустической радиации (ARFI-эластометрия) при хронических вирусных гепатитах

Цель исследования: определить информативность эластометрии с применением  форсированного импульса акустической радиации (ARFI-эластометрия) в выявлении стадий  фиброза печени у пациентов с хроническими вирусными гепатитами (ХВГ).

Материал и методы. В исследование вошло 135 человек, которые были разделены на 2  группы. Для определения возможностей ARFI-эластометрии при ХВГ обследовано 103  (76,3%) пациента (основная группа) (мужчин – 52 (50,4%), женщин – 51 (49,5%)); среди  них с вирусным гепатитом В 11 пациентов, с вирусным гепатитом С 87 пациентов, с  вирусным гепатитом В+D 5 пациентов. Биопсия печени с последующим гистологическим  исследованием биоптата и определением стадии фиброза по шкале METAVIR выполнялась в  течение 1–2 дней после выполнения ультразвукового исследования. В контрольную группу  для определения жесткости паренхимы печени в норме вошло 32 (23,7%) здоровых  пациента (20 (62,5%) добровольцев и 12 (37,5%) потенциальных доноров фрагмента печени). Средний возраст пациентов составил 26,9 ± 5,3 года. У добровольцев в анамнезе отсутствовали заболевания печени, поджелудочной железы, желчевыводящих  путей; они имели нормальные показатели по данным общего и биохимического анализов крови.

Результаты. Выявлена сильная корреляция (r = 0,74, р < 0,001) между стадиями фиброза  по гистологии и жесткостью печени. При использовании ROC-анализа было выявлено, что  при пороговом значении скорости сдвиговой волны ≥1,36 м/с при стадиях фиброза F ≥ 2 диагностическая точность составила 77%, чувствительность – 65,9%, специфичность –  79,0%; при пороговом значении ≥ 1,41 м/с при стадиях фиброза F ≥ 3 диагностическая  точность – 95%, чувствительность – 95,5%, специфичность – 81,5%; при пороговом  значении >1,66 м/с для стадии фиброза F = 4 диагностическая точность – 97%,  чувствительность – 93,3%, специфичность – 100%. Значения жесткости паренхимы печени при стадиях F0–F2 достоверно отличались от стадий F3–F4 (1,25 ± 0,18 м/с против 2,0 ± 0,52 м/с, р < 0,05).

Выводы. ARFI-эластометрия является достаточно точным инструментальным методом  определения фиброза печени при стадиях F ≥ 2. По мере увеличения степени фиброза  диагностическая точность ARFI-эластометрии возрастает и достигает наилучших значений при циррозе печени.

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