声脉冲辐射力成像与实时剪切波弹性成像诊断肝纤维化程度的价值研究

发布时间：2018-02-10 02:13

  本文关键词： 肝硬化 肝纤维化 超声检查 诊断 超声辐射脉冲成像 实时剪切波弹性成像　出处：《中国全科医学》2017年30期 　论文类型：期刊论文

【摘要】：目的探讨声脉冲辐射力成像(ARFI)、实时剪切波弹性成像(SWE)诊断肝纤维化程度的价值,以期为临床工作提供参考。方法选择2015年1月—2016年5月于上海市东方医院吉安医院就诊的符合纳入标准的慢性肝病患者149例为研究对象。收集患者一般资料,分别采用ARFI、SWE检测患者的肝实质硬度(LS)。根据ARFI、SWE检查结果,将患者分别分为ARFI检测到LS组、ARFI未检测到LS组和SWE检测到LS组、SWE未检测到LS组。收集并比较ARFI检测到LS组与ARFI未检测到LS组、SWE检测到LS组与SWE未检测到LS组患者性别、年龄、BMI、丙氨酸氨基转移酶(ALT)水平。采用多因素Logistic回归分析计算ARFI、SWE联合的多因素Logistic回归方程;以超声引导下肝脏穿刺活检结果为金标准,分别绘制ARFI、SWE及其联合诊断慢性肝病患者肝纤维化程度(≥S2、≥S3、S4期)的受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC)、灵敏度、特异度。结果 ARFI检测到LS率高于SWE(P0.05)。ARFI检测到LS组与ARFI未检测到LS组患者性别、年龄、BMI、ALT水平比较,差异均无统计学意义(P0.05)。SWE检测到LS组与SWE未检测到LS组患者性别、年龄、ALT水平比较,差异均无统计学意义(P0.05);SWE检测到LS组患者BMI低于SWE未检测到LS组(P0.05)。ARFI、SWE及其联合诊断慢性肝病患者肝纤维化≥S2期的AUC分别为0.936[95%CI(0.895,0.978)]、0.837[95%CI(0.754,0.919)]、0.972[95%CI(0.949,0.995)],临界值分别为1.32 m/s、17.14 kPa、-9.228,灵敏度分别为87.8%、80.0%、91.1%,特异度分别为97.3%、83.8%、91.9%。ARFI、SWE及其联合诊断慢性肝病患者肝纤维化≥S3期的AUC分别为0.915[95%CI(0.859,0.970)]、0.867[95%CI(0.796,0.938)]、0.910[95%CI(0.851,0.968)],临界值分别为1.45 m/s、25.36 kPa、7.114,灵敏度分别为90.9%、85.5%、90.9%,特异度分别为88.9%、87.5%、91.7%。ARFI、SWE及其联合诊断慢性肝病患者肝纤维化S4期的AUC分别为0.860[95%CI(0.746,0.974)]、0.948[95%CI(0.902,0.993)]、0.975[95%CI(0.949,1.000)],临界值分别为1.52 m/s、38.54 kPa、1.878,灵敏度分别为88.0%、96.0%、96.0%,特异度分别为92.2%、93.1%、91.2%。ARFI单独诊断慢性肝病患者肝纤维化≥S2、≥S3期的AUC大于SWE,诊断慢性肝病患者肝纤维化S4期的AUC小于SWE(P0.05)。ARFI单独诊断慢性肝病患者肝纤维化≥S2、S4期的AUC小于ARFI、SWE联合(P0.05);ARFI单独诊断慢性肝病患者肝纤维化≥S3期的AUC与ARFI、SWE联合比较,差异无统计学意义(P0.05)。SWE单独诊断慢性肝病患者肝纤维化≥S2、≥S3、S4期的AUC小于ARFI、SWE联合(P0.05)。结论 ARFI、SWE联合诊断肝纤维化程度的价值较单独ARFI、SWE好。
[Abstract]:Objective to evaluate the diagnostic value of acoustic pulse radiation force imaging (ARFI) and real time shear wave elastic imaging (SWE) in the diagnosis of hepatic fibrosis. Methods from January 2015 to May 2016, 149 patients with chronic liver disease who met the inclusion criteria in Ji'an Hospital of Oriental Hospital of Shanghai were selected as the study objects. The general data of the patients were collected. The hardness of liver parenchyma was detected by ARFI SWE. The patients were divided into two groups: ARFI detected LS group not detected LS group and SWE group detected LS group not detected LS group. Collected and compared ARFI detected LS group and ARFI group not detected LS group detected LS group and SWE group did not detect sex of LS group. The multivariate Logistic regression analysis was used to calculate the multivariate Logistic regression equation of ARFISWE combined with ARFISWE, and the results of liver biopsy guided by ultrasound were used as the gold standard. The operating characteristic curves of patients with chronic liver disease (鈮，

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