黄 振,郝晓一

脂肪性肝病的长期进展伴随肝纤维化的形成，肝纤维化是各种慢性肝病向肝硬化乃至肝癌发展过程中的关键步骤，如何在不依赖活检的情况下对纤维化进行准确分级，是当前临床研究的核心议题。二维剪切波弹性成像（2D-SWE）是在超声成像技术基础上定量检测肝脏组织的硬度，能够实现肝脏硬度程度的可靠测量，为判断其是否进入纤维化提供了必要的手段。本文通过阐述2D-SWE的工作原理与操作方法，并结合关于代谢相关脂肪肝、酒精性脂肪肝等不同类型脂肪肝患者的临床研究资料，介绍了该技术的当前状况与发展趋势，以期为2D-SWE在脂肪肝肝纤维化的评估提供参考。

二维剪切波弹性成像；脂肪肝；肝纤维化

[1] Murag Soumya,Ahmed Aijaz,Kim Donghee.Recent Epidemiology of Nonalcoholic Fatty Liver Disease.[J].Gut and liver,2020,15(2). [2] 陆伦根,尤红,谢渭芬,贾继东.肝纤维化诊断及治疗共识(2019年)[J].实用肝脏病杂志,2019,22(06):793-803. [3] 杨金秋,赵文霞,周铖,刘通.非酒精性脂肪性肝病发生进展期肝纤维化的危险因素及列线图预测模型构建[J].临床肝胆病杂志, 2024,40(08):1579-1584. [4] 陈丽红,涂海斌,冯斯奕.二维剪切波弹性成像技术对自身免疫性肝病纤维化的诊断效能及影响因素[J].肝脏,2025, 30(09):1210-1214. [5] Guo HuanYi,et al."Two-dimensional shear wave elastography utilized in patients with ascites:a more reliable method than transient elastography for noninvasively detecting the liver stiffness-an original study with 170 patients.."Annals of translational medicine 11.2(2023). [6] 鲍春旭,马小萍,高文涛,邓燕龄,王红.剪切波弹性成像联合肝脂肪变性指数对肥胖者中非酒精性脂肪肝患者疗效的评估[J].宁夏医学杂志,2024,46(03):256-258. [7] 李良芳,朱俊志,欧海宁,等.剪切波弹性成像超声在脑卒中偏瘫上肢痉挛定量评估中的应用[J].中国康复医学杂志,2022,37(1):75-78. [8] 梁萍,郑荣琴.二维剪切波弹性成像评估慢性乙型肝炎肝纤维化临床应用指南[J].临床肝胆病杂志,2018,34(02):255-261. [9] Imajo Kento,et al."Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease."Clinical Gastroenterology and Hepatology 20.4(2020). [10] Seo Jung Wook,et al."Transient elastography with controlled attenuation parameter versus twodimensional shear wave elastography with attenuation imaging for the evaluation of hepatic steatosis and fibrosis in NAFLD.."Ultrasonography(Seoul,Korea)42.3(2023). [11] Célia Charlier,et al."Reference values for liver stiffness in children using shear-wave elastography.."Archives de pediatrie:organe officiel de la Societe francaise de pediatrie 32.5(2025). [12] Tran Léa Chantal,et al."Noninvasive Pediatric Liver Fibrosis Measurement:Two-Dimensional Shear Wave Elastography Compared With Transient Elastography."Frontiers in Pediatrics 10.(2022). [13] 陈丽红,涂海斌,冯斯奕.二维剪切波弹性成像技术对自身免疫性肝病纤维化的诊断效能及影响因素[J].肝脏,2025, 30(09):1210-1214. [14] 叶桂林,黄河,凌文武,邱婷婷,卢强,林玲,罗燕.实时二维剪切波弹性成像诊断自身免疫性肝病患者肝纤维化程度[J].中国医学影像技术,2021,37(03):401-405. [15] Tamaki Nobuharu,Ajmera Veeral,Loomba Rohit.Non-invasive methods for imaging hepatic steatosis and their clinical importance in NAFLD.[J].Nature reviews.Endocrinology,2021,18(1):55-66.

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