评估声脉冲辐射力成像（ARFI）技术联合瞬时弹性成像（TE）技术对慢性乙型肝炎（CHB）肝纤维化的诊断价值。

选取2015年10月至2017年6月在哈尔滨医科大学附属第四医院就诊的121例CHB患者，进行肝脏穿刺活检、常规生化检查、ARFI及TE检查。采用方差分析比较肝纤维化各组的年龄、AST、ALT、ARFI值及TE值，进一步比较采用SNK-q检验，并与病理结果做相关性分析。以肝纤维化病理学分期为"金标准"，采用工作特征曲线（ROC）对比分析ARFI及TE技术对CHB肝纤维化分期的准确性，并应用Logistic回归进行联合诊断的风险预测，并通过预测值绘制ROC曲线，比较ARFI、TE及两者联合对肝纤维化S≥1期及S≥2期的诊断价值。

ARFI及TE值均与肝纤维化分期具有较好的正相关性（r=0.789、0.845，P均<0.0001）。ARFI及TE技术诊断肝纤维化S≥1期的AUROC分别为0.849及0.903（P=0.424）；S≥2期的AUROC分别为0.874及0.923（P=0.191）；S≥3期的AUROC分别为0.938及0.954（P=0.526）；S=4期的AUROC分别为0.913及0.926 （P=0.842）。ARFI及TE技术联合诊断肝纤维化S≥1期的AUROC为0.925，与两者单独诊断相比，差异均无统计学意义（P均>0.05），但联合后的敏感度、特异度及准确性均提高；联合诊断S≥2期的AUROC为0.949，与两者单独诊断相比，仅优于ARFI的单独诊断，差异有统计学意义（P=0.009），但联合后的敏感度及准确性均有所提高。

ARFI技术联合TE技术有助于提高肝纤维化S≥1期及S≥2期的诊断。

To evaluate the diagnostic value of acoustic radiation force impulse (ARFI) imaging combined with transient elastography (TE) for liver fibrosis in chronic hepatitis B (CHB) patients.

One hundred and twenty-one patients with CHB were included from October 2015 to June 2017 at the Fourth Hospital of Harbin Medical University. Liver biopsy, routine biochemical tests, ARFI, and TE were carried out. The age, AST, ALT, ARFI, and TE were calculated and analyzed by one-way ANOVA, followed by pairwise comparisons using the SNK-q test. The results of ARFI and TE were compared with pathological results. Using the pathological stage of liver fibrosis as the ″golden standard″, the accuracy of ARFI and TE in diagnosing different stages of liver fibrosis were assessed by receiver operating characteristic (ROC) curve analysis. Logistic regression was used to predict the risk of joint diagnosis, and ROC curve was drawn based on the predicted value to compare the diagnostic value of ARFI, TE, and their combination in S≥1 and S≥2 liver fibrosis.

ARFI and TE were positively correlated with the fibrosis degree, and the correlation coefficients were 0.789 and 0.845, respectively (P<0.0001). The areas under the ROC cruves (AUROCs) of ARFI imaging and TE were 0.849 and 0.903 (P=0.424) in diagnosing S≥1 liver fibrosis, 0.874 and 0.923 (P=0.191) for S≥2, 0.938 and 0.954 (P=0.526) for S≥3, and 0.913 and 0.926 (P=0.842) for S4, respectively. The AUROC of ARFI plus TE for diagnosis of S≥1 liver fibrosis was 0.925, with no significant improvement compared with either of them (P>0.05), but the sensitivity, specificity, and accuracy of the combination were improved. The AUROC of the combined diagnosis for S≥2 was 0.949, which was only better than that of ARFI alone (P=0.009), but the sensitivity and accuracy of the combination were improved.

ARFI combined with TE improves the diagnosis of S≥1 and S≥2 liver fibrosis.