摘要
目的应用超声E成像(即剪切波弹性成像,SWE)技术对慢性肝病患者进行检测和分析,探讨该技术在无创定量评价慢性肝病肝纤维化程度中临床应用价值。方法选择2019年8月至2021年7月在南京中医药大学附属医院就诊的慢性肝病患者148例,其中男性56例,女性92例;年龄17~75岁,平均年龄48.9岁;身高1.47~1.87 m,平均身高1.65 m;体质量44~106 kg,平均体质量65.50 kg;身体质量指数(BMI)17.51~35.85 kg/m^(2),平均BMI 24.00 kg/m^(2);疾病类型,病毒性肝炎44例,代谢相关脂肪性肝病36例,自身免疫性肝炎22例,药物性肝炎20例,原发性胆汁性胆管炎26例。对所有患者肝脏均应用SWE技术进行检测并行超声引导下肝脏组织穿刺活检,以病理诊断为金标准,对肝脏SWE弹性测值与肝脏纤维化分期关系进行统计学分析。结果经病理诊断,慢性肝病有肝纤维化患者130例,无纤维化患者18例。两者SWE弹性测值、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBiL)、直接胆红素(DBiL)及高密度脂蛋白胆固醇(HDL-C)比较,差异均有统计学意义[(9.34±4.73)kPa vs(6.24±1.46)kPa,(147.89±62.79)U/L vs(73.32±34.78)U/L,(270.56±60.95)U/L vs(105.94±52.97)U/L,(57.12±10.82)μmol/L vs(20.57±5.01)μmol/L,(38.41±7.95)μmol/L vs(9.35±4.88)μmol/L,(1.35±0.36)mmol/L vs(1.39±0.84)mmol/L。t=2.755、1.972、2.615、3.898、3.957、0.359,P<0.05]。对慢性肝病肝纤维化组患者SWE弹性测值与各项指标间进行相关分析显示,SWE弹性测值与年龄(r=0.338)、纤维化分期(r=0.736)、血糖(GLU)(r=0.174)及凝血酶原时间(PT)(r=0.424)呈正相关(P<0.05)。SWE技术对慢性肝病肝纤维化诊断效能分析,受试者工作特性(ROC)曲线分析结果显示,应用SWE技术诊断慢性肝病肝纤维化S0/S1期、S1/S2期、S2/S3期及S3/S4期SWE弹性测值截断值分别为6.35 kPa、7.65 kPa、8.35 kPa、17.30 kPa,其曲线下面积(AUC)分别为0.736[95%可信区间(CI)0.628~0.844]、0.751(95%CI 0.657~0.845)、0.803(95%CI 0.680~0.927)及0.752(95%CI 0.566~0.939)。结论SWE技术作为一种实时超声弹性成像技术,操作简便、无创,患者接受度高,其弹性测值可用来无创定量评价慢性肝病肝纤维化及其分期,具有良好的临床应用前景。
Objective To detect and analyze clinical application value of ultrasound E-imaging(shear wave elastography,SWE) technique in patients with chronic liver disease, and explore the clinical application value of SWE for non-invasive quantitative evaluation of liver fibrosis in patient with chronic liver disease. Methods From August 2019 to July 2021, a total of 148 patients with chronic liver disease were enrolled, which included 56 males and 92 females, aged 17-75 years old with mean age of 48.9 years old;height was 1.47-1.87 meters with mean height of 1.65 meters;body mass was 44-106 kg with mean body mass of 65.50 kg;body mass index(BMI) was 17.51-35.85 kg/m^(2)with mean BMI of 24.00 kg/m^(2). There were 44 cases of viral hepatitis, 36 of metabolic fatty liver disease, 22 of autoimmune hepatitis, 20 of drug-induced hepatitis and 26 of primary biliary cholangitis. The SWE technique was used to detect the liver of all patients and ultrasound-guided liver biopsy was performed, the relationship between liver SWE elasticity and liver fibrosis stage was statistically analyzed with pathological results as the gold standard. Results The pathological diagnosis of chronic liver disease with liver fibrosis in 130 cases, and non-fibrosis in 18. There were significant differences in SWE elasticity, aspartate aminotransferase(AST),alanine aminotransferase(ALT), total bilirubin(TBiL), direct bilirubin(DBiL) and high density lipoprotein cholesterol(HDL-C) between 2 groups[(9.34 ± 4.73) kPa vs(6.24 ± 1.46) kPa,(147.89 ± 62.79) U/L vs(73.32 ± 34.78) U/L,(270.56 ± 60.95) U/L vs(105.94 ± 52.97) U/L,(57.12 ± 10.82) μmol/L vs(20.57 ± 5.01) μmol/L,(38.41 ± 7.95) μmol/L vs(9.35 ± 4.88) μmol/L,(1.35 ± 0.36) mmol/L vs(1.39 ± 0.84) mmol/L. t = 2.755, 1.972, 2.615, 3.898, 3.957, 0.359, P < 0.05]. The correlation analysis between SWE elasticity and various indexes in patients with chronic liver disease and liver fibrosis showed that SWE elasticity was positively correlated with age(r = 0.338), fibrosis stage(r = 0.736), blood glucose(GLU)(r = 0.174) and prothrombin time(PT)(r = 0.424)(P < 0.05). The diagnostic efficacy of SWE technique for liver fibrosis in chronic liver disease was analyzed. The results of receiver operating characteristic(ROC) curve analysis showed that cut-off values of SWE elastic measurement in S0/S1, S1/S2, S2/S3 and S3/S4 stages of liver fibrosis in chronic liver disease were 6.35 kPa, 7.65 kPa, 8.35 kPa and 17.30 kPa, respectively. The area under curve(AUC) was 0.736[95 % confidence interval(CI) 0.628-0.844], 0.751(95 % CI 0.657-0.845),0.803(95 % CI 0.680-0.927) and 0.752(95 % CI 0.566-0.939), respectively. Conclusion It is demonstrated that SWE technique is a real-time ultrasonic elastography technique, which is simple, non-invasive and highly accepted by patients, the elastic measurement value can be used for non-invasive quantitative evaluation of chronic liver fibrosis and its staging, and shows good clinical application prospect.
作者
汪向前
马云飞
吴意赟
邓正明
乔飞
傅吉强
夏云锦
周希乔
WANG Xiang-qian;MA Yun-fei;WU Yi-yun;DENG Zheng-ming;QIAO Fei;FU Ji-qiang;XIA Yun-jin;ZHOU Xi-qiao(The First School of Clinical Medicine,Nanjing University of Chinese Medicine,Nanjin210023,Jiangsu,China;Department of Ultrasound Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjin210029,Jiangsu,China;Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjin210029,Jiangsu,China;Department of Infectious,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjin210029,Jiangsu,China;De-partment of Endocrinology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjin210029,Jiangsu,China)
出处
《生物医学工程与临床》
CAS
2024年第4期540-545,共6页
Biomedical Engineering and Clinical Medicine
基金
国家自然科学基金面上项目(82074432)
南京中医药大学附属医院院级创新发展基金专项课题(Y2021CX10)。
关键词
实时剪切波弹性成像
慢性肝病
肝纤维化
病理学
shear-wave elastic imaging
chronic liver disease
liver fibrosis
pathology
