ARFI技术无创定量评价非酒精性脂肪肝病的初步研究

发布时间：2018-07-03 16:40

本文选题：声脉冲辐射力成像 + 非酒精性脂肪肝病　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:探讨声辐射力脉冲成像技术(acoustic radiation force impulse,ARFI)中声触诊组织量化(virtual touch tissue quantification,VTQ)无创评价非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)脂肪变性程度的临床应用价值。方法:全部病例均来自2016年9月-2016年12月的住院患者,行腹部超声、计算机体层扫描(computer tomography,CT)检查及实验室检查,并根据二维超声声像图、CT结果将目标人群分成:健康人群65例与NAFLD患者155例,后者包括轻度脂肪肝组71例,中度脂肪肝组48例,重度脂肪肝组36例。四组间一般人群特征、血生化指标、肝脏及脾脏弹性超声指标多组间计量资料的比较采用方差分析,两两之间比较采用LSD法。计数资料采用卡方检验。相关分析采用Spearman秩相关,一致性分析采用kappa分析。截断值分析采用受试者工作特征曲线(Receive operating charaeteristie curve,ROC),选取灵敏度与特异度相加最大值时。双侧P0.05有统计学意义。结果:单因素Spearman相关分析发现肝VTQ、肝/脾VTQ、APRI均与NAFLD分度具有相关性,相关系数分别为0.61、0.47、0.37(P0.001)。正常组与轻度组肝VTQ、肝/脾VTQ、APRI、ALT、AST无统计学意义,重度组的肝VTQ、肝/脾VTQ、APRI、ALT、AST高于正常及轻度组;TG、GT、APO B及HDL均高于正常组;Cys C高于轻度组。中度组的肝VTQ、肝/脾VTQ、APRI、HDL、ALT、AST均高于正常及轻度组;TG、GT、APO B均高于正常组。NAFLD患者轻度脂肪肝组:肝VTQ、肝/脾VTQ和APRI平均值分别为1.16±0.28m/s、0.46±0.14m/s、0.39±0.22,中度脂肪肝组:肝VTQ、肝/脾VTQ和APRI平均值分别为1.45±0.41 m/s、0.59±0.16m/s、0.52±0.23,重度脂肪肝组:肝VTQ、肝/脾VTQ和APRI平均值分别为1.62±0.34 m/s、0.65±0.04m/s、0.57±0.22。三种测值均与NAFLD的严重程度存在正相关,相关系数分别为肝VTQ 0.61(P0.001)、肝/脾VTQ 0.47(P0.001)、APRI指数0.37(P0.001)。ARFI诊断NAFLD程度的轻中重度脂肪肝的肝VTQ截断值分别为:1.00m/s、1.22m/s、1.42m/s,ROC曲线下面积分别为:0.57、0.86、0.97,灵敏度分别为:76%、94%、94%,特异度分别为:60%、71%、92%。ARFI诊断NAFLD程度的轻中重度脂肪肝的肝/脾VTQ截断值分别为:0.30m/s、0.51m/s、0.56m/s,ROC曲线下面积分别为:0.51、0.74、0.84,灵敏度分别为:94%、88%、94%,特异度分别为:20%、68%、80%。APRI诊断NAFLD程度的轻中重度脂肪肝截断值分别为:0.33×10~9、0.43×10~9、0.50×10~9,ROC曲线下面积分别为:0.55、0.71、0.81,灵敏度分别为:57%、58%、70%,特异度分别为:60%、75%、83%。肝VTQ和CT结果的一致性检验,Kappa=0.7721,P=0.007。结论:肝VTQ、肝/脾VTQ和APRI指数对NAFLD的轻中重度脂肪肝的定量评价中都是有意义的,ARFI技术作为实时超声弹性成像技术,较APRI指数能更准确的无创定量评价NAFLD严重程度,经ARFI技术测定的肝VTQ值较肝/脾VTQ值更能准确、全面的定量评价NAFLD严重程度。Kappa=0.7721,P=0.007,说明ARFI技术中的肝VTQ与CT检查这两种检测方法对于非酒精性脂肪性肝病的定量评估一致性较好。
[Abstract]:Objective: to evaluate the clinical application value of acoustic palpation tissue quantification (virtual touch tissue quantificationVTQ) in non-alcoholic fatty liver disease (nonalcoholic fatty liver disease) with nonalcoholic fatty liver disease (nonalcoholic fatty liver). Methods: all the patients were admitted from September 2016 to December 2016. Abdominal ultrasound, computer tomographic CT and laboratory examination were performed. According to the results of two-dimensional ultrasonography and CT, the target population was divided into five groups: 65 healthy persons and 155 NAFLD patients, including 71 cases of mild fatty liver group, 48 cases of moderate fatty liver group and 36 cases of severe fatty liver group. The analysis of variance was used to compare the general population characteristics, blood biochemical indexes, liver and spleen elastic ultrasound data among the four groups, and the LSD method was used to compare the data between the two groups. The counting data were checked by chi-square test. Spearman rank correlation was used for correlation analysis and kappa analysis was used for consistency analysis. The truncation value was analyzed by the receiver operating charaeteristie curve (ROC), when the sensitivity and specificity were added to the maximum value. Bilateral P0.05 had statistical significance. Results: single factor Spearman correlation analysis showed that liver VTQ, liver / spleen VTQQ APRI were correlated with NAFLD scores, the correlation coefficients were 0.61T 0.47 (P 0.001). There was no significant difference between normal group and mild group in liver VTQ, liver / spleen VTQ APRIAPRI AST, but in severe group, liver VTQ, liver / spleen VTQP APRI ALTO B and HDL in severe group were higher than those in normal group and mild group, which were higher than those in mild group. The mean values of liver VTQ, liver / spleen VTQ and APRI in moderate group were 1.16 卤0.28 m / s 0.46 卤0.14 msec 0.39 卤0.22 in moderate fatty liver group, higher than those in normal group and mild group respectively. The mean value of liver VTQ, liver / spleen VTQ and APRI in mild fatty liver group were higher than those in normal group and mild group. The mean value of liver VTQ, liver / spleen VTQ and APRI in moderate fatty liver group were 1.16 卤0.28 m / s 0.46 卤0.14 msP / s 0.39 卤0.22, respectively. In moderate fatty liver group: liver VTQ, liver / spleen VTQ and APRI were higher than those in mild fatty liver group. The mean values of liver VTQ, liver / spleen VTQ and APRI in severe fatty liver group were 1.62 卤0.34 m / s 0.65 卤0.04 msg / s 0.57 卤0.22, respectively. The three values were positively correlated with the severity of NAFLD. The correlation coefficients were liver VTQ 0.61 (P0.001), liver / spleen VTQ 0.47 (P0.001) and APRI index 0.37 (P0.001) .ARFI for the diagnosis of NAFLD mild, moderate and severe fatty liver, respectively. The liver VTQ truncation value of liver VTQ of NAFLD was 1.22ms1.22ms1.22ms1.42 msROC, respectively. The liver / spleen VTQ truncation values of mild, moderate and severe fatty liver were: 0. 30 m / s / s 0.51 m / s ~ 0. 51 m / s ~ 0. 56 m / s ~ (-1) ROC = 0: 0. 51 / 0. 744 ~ 0. 84, respectively, sensitivity = 1: 94 ~ 88 ~ 88 ~ 94 ~ 94, and specificity = 1 / 20 ~ 68 ~ 80. APRI = 0. 33 脳 10 ~ 90 ~ 0. 43 脳 10 ~ 10 ~ 90. 43 脳 10 ~ 0. 50 脳 10 ~ 9 ~ (9) ROC, respectively. The area under the curve was: 0. 33 脳 10 ~ (90.43) 脳 10 ~ 0 ~ 0. 50 脳 10 ~ 9 ~ (9) ROC, respectively. With a sensitivity of 0. 557 and 58, respectively, the sensitivity is 0. 05 and 0. 71, and the sensitivity is 0. 70, and the specificity is: 60, 75 and 83, respectively. The conformance test of liver VTQ and CT results showed that Kappa was 0. 7721 and P was 0. 007. Conclusion: the quantitative evaluation of liver VTQ, liver / spleen VTQ and APRI index in NAFLD patients with mild, moderate and severe fatty liver is of significance as a real-time ultrasonic elastic imaging technique, which is more accurate and noninvasive than APRI index in evaluating the severity of NAFLD. The VTQ of liver measured by ARFI technique was more accurate than that of liver / spleen VTQ. The comprehensive and quantitative evaluation of NAFLD severity. Kappaa 0.7721 P0. 007, which indicated that the two methods of liver VTQ and CT in ARFI technique were more consistent in quantitative evaluation of non-alcoholic fatty liver disease.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575;R445.1

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