实时二维剪切波弹性成像评估慢加急性肝衰竭患者的预后

发布时间：2018-04-20 05:10

本文选题：剪切波弹性成像 + 慢加急性肝衰竭　；参考：《中山大学学报(医学科学版)》2017年05期

【摘要】：【目的】探讨实时二维剪切波弹性成像(2D SWE)评估慢加急性乙型肝炎肝衰竭(ACLF-HBV)患者预后的临床应用价值。【方法】入组对象为2013年10月1日至2015年12月31日我院感染科确诊的312例慢加急性乙型肝炎肝衰竭患者。观察终点为90 d,根据临床结局分为好转组192例和恶化组120例。入组后3 d内,应用2D SWE进行肝脏硬度测量,收集患者血常规、凝血、生化等血清学指标,观察患者肝实质回声均匀度、肝包膜光滑度、右肝厚度、胆囊壁厚度、脾脏指数、腹水指数、门静脉主干内径、附脐静脉是否重开,计算终末期肝病评分(MELD)、CTP评分(CTP)、皇家医学院医院评分(KCH),入组后每2-4周动态检测2D SWE,直至患者出院或死亡\肝移植。【结果】恶化组的2D SWE高于好转组[(44.0±7.5)k Pa vs(36.8±10.3)k Pa,t=-6.5,P=0.000],39.2 k Pa可作为预后不良的阈值。2D SWE评估ACLF-HBV患者预后的受试者操作特征曲线下面积(AUROC)为0.73,预后效能高于KCH(AUROC:0.65,z=2.1,P=0.033)。动态检测2D SWE,好转组维持在40 k Pa以下,恶化组则一直高于40 k Pa,并有升高趋势。【结论】2D SWE评估ACLF-HBV患者预后的准确性较高,测值高于39.2 k Pa的患者预后较差,反之预后较好;动态检测2D SWE的变化对于ACLF-HBV患者的预后评估也有潜在价值。
[Abstract]:[objective] to evaluate the clinical value of 2D SWE in evaluating the prognosis of patients with chronic and acute hepatitis B liver failure (ACLF-HBV). [methods] the patients were selected from October 1, 2013 to December 31, 2015. 312 cases of chronic and acute hepatitis B liver failure were diagnosed. The observation end point was 90 days. According to the clinical outcome, 192 cases were divided into two groups: improvement group (192 cases) and worsening group (120 cases). Within 3 days after entering the group, the liver hardness was measured by 2D SWE, and the blood routine, coagulation, biochemical and other serological indexes were collected. The liver parenchyma echo uniformity, hepatic capsule smoothness, right liver thickness, gallbladder wall thickness, spleen index were observed. Ascites index, portal vein diameter, umbilical vein reopening, To calculate the end stage liver disease score (MELDD / CTP) and the Royal Medical College Hospital (RCMH), 2D SWE was measured dynamically every 2-4 weeks until the patient was discharged from hospital or died of liver transplantation. [results] 2D SWE in the worsening group was higher than that in the improved group [44.0 卤7.5kPa vs(36.8 卤10.3k Pat-6.5kPa 0.000] 39.2 KPA. The area under the operating characteristic curve was 0.73, which could be used as a threshold for poor prognosis. 2D SWE was more effective than KCHAUROC0.65% in evaluating the prognosis of ACLF-HBV patients. The dynamic detection of 2D SWE showed that the improvement group remained below 40 KPA, while the worsening group was higher than 40 KPA and had an increasing trend. [conclusion] 2D SWE is more accurate in evaluating the prognosis of ACLF-HBV patients, and the prognosis of the patients whose values are higher than 39.2 KPA is poor. On the contrary, the change of 2D SWE has potential value in evaluating the prognosis of ACLF-HBV patients.
【作者单位】：中山大学附属第三医院超声科;中山大学附属第三医院肝脏疾病研究重点实验室;中山大学附属第三医院感染科;中山大学附属东华医院超声科;
【基金】：广东省自然科学基金(2016A030313205,2015A030313172)
【分类号】：R445.1;R575.3

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