超声二维剪切波弹性成像评估HIV感染者肝纤维化状况的临床研究
Clinical Study on the Evaluation of Liver Fibrosis in HIV-Infected Patients Using Ultrasonic Two-Dimensional Shear Wave Elastography

目的：探讨二维剪切波弹性成像(2D-SWE)在HIV感染者肝纤维化评估中的临床应用价值。方法：前瞻性选取2023年10月~2024年10月157例在本院艾滋病门诊接受正规治疗的HIV感染者和70例年龄、性别相匹配的同期健康正常人作为研究对象。均进行2D-SWE检查及血常规、肝功能等相应的血清学检查，对两组之间所有测量参数进行差异性、相关性的统计学分析。结果：1) 长、短病程组的骨密度按照对照组、短病程组、长病程组的顺序逐渐降低(F = 25.161, P < 0.05)；均有统计学意义；2) 长、短病程两组的血糖、ALT、AST、甘油三脂、APRI高于对照组(F = 5.292, 4.838, 7.919, 3.926, 6.405；均P < 0.05)；3) 杨氏模量值按照对照组、短病程组、长病程组的顺序逐渐增高(F = 32.579, P < 0.05)；4) 重复性检测显示操作性及重复性良好；5) Pearson相关性分析表明，杨氏模量值与病程、ALT、AST、APRI、尿肌酐、甘油三脂、BMI呈明显正相关；6) ROC曲线分析显示杨氏模量值的曲线下面积、灵敏度、特异度均高于APRI及FIB-4。结论：2D-SWE技术可早期定量评估HIV感染者的肝纤维化，比APRI、FIB-4更早地发现肝纤维化的改变，可为临床提供客观参考依据。
Objective: To investigate the clinical value of two-dimensional shear wave elastography (2D-SWE) in the evaluation of liver fibrosis in HIV-Infected patients. Methods: From October 2023 to October 2024, 157 HIV-Infected patients who received formal treatment in the AIDS clinic of our hospital and 70 age and gender-matched healthy people in the same period were prospectively selected as the research objects. 2D-SWE examination, blood routine, liver function, and other corresponding serological tests were performed on all patients. The differences and correlations of all measured parameters between the two groups were statistically analyzed. Results: 1) The BMD of the long and short course groups gradually decreased in the order of the control group, the short course group, and the long course group (F = 25.161, P < 0.05). 2) The blood glucose, ALT, AST, triglyceride, and APRI of the long course group and the short course group were higher than those of the control group (F = 5.292, 4.838, 7.919, 3.926, 6.405; All P < 0.05). 3) The Young’s modulus increased gradually in the order of the control group, the short-course group, and the long-course group (F = 32.579, P < 0.05). 4) The repeatability test showed good operability and repeatability. 5) Pearson correlation analysis showed that Young’s modulus was positively correlated with the course of disease, ALT, AST, APRI, urine creatinine, triglyceride, and BMI. 6) ROC curve analysis showed that the area under the curve, sensitivity, and specificity of Young’s modulus value were higher than those of APRI and FIB-4. Conclusions: 2D-SWE can quantitatively assess liver fibrosis in HIV-Infected patients at an early stage. Compared with APRI and FIB-4, 2D-SWE can detect changes in liver fibrosis earlier and provide an objective reference for clinical practice.