基于宽频剪切波技术无创诊断CHB合并NAFLD肝纤维化的研究

Chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) are the most dominant chronic liver diseases in China. It is very common that the two diseases are combined together. CHB will induce liver fibrosis and cirrhosis, whose accurate diagnosis is necessary not only to predict the long-term clinical course but also to determine an appropriate therapy scheme. Ultrasound elastography is a newly emerged technique for noninvasively diagnosis of liver fibrosis; and it has been widely used in clinical applications. However, for the fibrosis of CHB combined with NAFLD, current elastography techniques tend to be invalid. This study analyzed the limitations of the current techniques and proposed a broad-band shear wave technique, which can simultaneously measure the viscoelasticity of liver, for the diagnosis of CHB combined with NAFLD. This study will develop research platform for ultrasound elastography and investigate the key problems of the innovative method based on rat model of liver fibrosis combined with steatosis. This study could promote the noninvasive diagnosis technique for liver fibrosis, especially for CHB combined with NAFLD; and has great clinical significance.

慢性乙肝（chronic hepatitis B, CHB）和非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）分列我国慢性肝脏疾病的第一和第二大原因，这两种疾病并存的情况非常普遍。慢性乙肝会导致肝纤维化甚至肝硬化，精确诊断肝纤维化程度对患者的疾病监控和治疗至关重要。超声弹性成像是无创诊断肝纤维化的一种新技术，在临床得到广泛应用。但对于CHB合并NAFLD的肝纤维化，现有弹性成像技术往往失效。本项目通过分析现有技术的局限性，提出用宽频剪切波技术同时测量肝脏的弹性和粘性，实现CHB合并NAFLD肝纤维化无创诊断新方法。本项目开发超声弹性成像实验平台，利用脂肪肝合并肝纤维化的大鼠动物模型对新方法的关键问题进行研究。本项目的开展将促进CHB合并NAFLD肝纤维化无创诊断技术的发展，具有重要的临床意义。

慢性乙肝（chronic hepatitis, CHB）和非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）分列我国慢性肝脏疾病的第一和第二大原因，这两种疾病并存的情况非常普遍。慢性乙肝会导致肝纤维化甚至肝硬化，精确诊断肝纤维化程度对患者的疾病监控和治疗至关重要。超声弹性成像是无创诊断肝纤维化的一种新技术，在临床得到广泛应用。但对于CHB合并NAFLD的肝纤维化，现有弹性成像技术往往失效。.本项目围绕CHB合并NAFLD肝纤维化无创诊断方法的研究，建立了超声弹性成像实验平台，提出并开发了宽频剪切波技术同时测量肝脏的弹性和粘性的新方法、建立肝纤维化、非酒精性脂肪肝及脂肪肝纤维化混合模型等多种大鼠动物模型、以及基于动物模型的在体和离体的超声粘弹性测量、离体样本的动态力学测试、超声射频信号特征检测，血清生化指标检测，肝组织的病理切片多种方法的测试，最后从多个维度的数据中发掘规律，探索提高CHB合并NAFLD肝纤维化的无创诊断准确性的方法。..本项目的研究成果明确了纤维化和脂肪变性的存在能够显著性的影响肝脏粘弹性值，同时发现超声粘弹性检测可以有效区分单纯性脂肪肝和肝炎；脂肪变性的存在显著性影响了轻度肝纤维化的评估，而对肝纤维化严重期没有显著性影响。这些研究成果已经在临床实践上发挥指导作用，有助于提高CHB 合并NAFLD 肝纤维化的无创诊断准确性，检查不必要的活检。项目取得的重要成果如下：（1）项目组发表有基金号标注的论文12篇，其中SCI论文8篇；（2）申请专利3项；（3）项目组成员作为主要参加者获得广东省科技进步三等奖1项；（4）项目成果在临床实践进行推广应用。