超声组织弥散定量分析技术评估乳腺癌TAC联合化疗患者肝脏损伤的价值研究

发布时间：2018-07-31 05:05

【摘要】：目的:应用超声组织弥散定量分析技术检测乳腺癌TAC联合化疗患者的肝脏组织弹性特征,为早期评估其肝损伤提供一种有效的超声定量检测方法。方法:选取2015年9月~2016年12月于大连大学附属中山医院就诊的门诊健康体检者及经病理证实乳腺癌、需行6周期TAC联合化疗的住院患者。其中,对照组38例,化疗组35例。化疗组中,新辅助化疗者24例,术后辅助化疗者11例,均连续化疗6个周期,21天为一个周期。化疗组患者的数据采集时段分别为化疗前以及化疗第2周期、第4周期、第6周期结束后的1-2天。主要检测内容:1.肝脏常规超声检查;2.超声组织弥散定量分析,包括:肝纤维化指数(liver fibrosis index,LFI)、蓝色区域面积百分比(area ratio,%AREA)、应变均值(mean,MEAN)、标准差(standard deviation,SD)、复杂度(complexity,COMP)、对比度(contrast,CONT)、峰度(kurtosis,KURT)、偏度(skewness,SKEW)、均等性(entropy,ENT)、杂乱度(inverse difference moment,IDM)、一致性(angular second moment,ASM)及相关性(correlation,CORR);3.肝功能生化检测,包括:谷氨酸转氨基酶(alanine aminotransferase,ALT)、天冬氨酸转氨基酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)、总胆红素(total bilirubin,TB)及结合胆红素(conjugated bilirubin,CB)。分别对上述检测内容进行化疗组化疗前与对照组的比较以及化疗组不同化疗周期间的比较,将反映肝脏硬度的弹性参数LFI、%AREA及MEAN与肝功生化指标做相关性分析,并进一步分别绘制化疗第2周期及第4周期结束后的ROC曲线,计算曲线下面积、临界值、灵敏度及特异度。结果:1.常规超声检测:35例化疗组患者化疗前的肝脏声像图均正常。与化疗前比较,化疗第2周期结束后,3例(8.57%)患者肝脏出现回声略增强的异常表现(P0.05);化疗第4周期结束后,18例(51.43%)患者肝脏出现回声增强的异常表现(P0.05);化疗第6周期结束后,29例(82.86%)患者肝脏出现回声增强的异常表现(P0.05)。2.组织弥散定量分析:化疗组化疗前与对照组比较,各项弹性参数差异性均无统计学意义(P0.05)。与化疗前比较,化疗第2周期结束后,%AREA、SD及LFI增高(P0.05);化疗第4周期结束后,MEAN减低(P0.05),%AREA、SD、CONT及LFI增高(P0.05);化疗第6周期结束后,MEAN减低(P0.05),%AREA、SD、COMP、CONT及LFI均增高(P0.05)。化疗不同周期间比较,化疗第4周期结束后与化疗第2周期结束后比较,MEAN减低(P0.05),%AREA、CONT、COMP及LFI增高(P0.05);化疗第6周期结束后与化疗第2周期结束后比较,MEAN减低(P0.05),%AREA、SD、COMP、CONT及LFI均增高(P0.05);化疗第6周期结束后与化疗第4周期结束后比较,MEAN减低(P0.05),%AREA、SD及LFI增高(P0.05)。3.肝功能生化指标:化疗组化疗前与对照组比较,各项指标差异性均无统计学意义(P0.05)。与化疗前比较,化疗第2周期结束后,ALT、AST呈上升趋势(P0.05),但AST仍在正常范围,ALT处于正常上限值;化疗第4周期结束后,ALT、AST及ALP升高(P0.05);化疗第6周期结束后,ALT、AST、ALP、TB及CB均升高(P0.05)。化疗不同周期间比较,化疗第4周期结束后与化疗第2周期结束后比较,AST、AST、ALP及CB升高(P0.05);化疗第6周期结束后与化疗第2周期结束后比较,ALT、AST、ALP、TB及CB均升高(P0.05);化疗第6周期结束后与化疗第4周期结束后比较,ALT、AST、ALP、TB及CB均升高(P0.05)。4.相关性分析:扣除化疗周期的影响,LFI与ALT(r=0.341,P=0.000)、%AREA与ALT(r=0.261,P=0.002)均呈正相关,MEAN与ALT(r=-0.215,P=0.011)呈负相关。5.ROC曲线显示LFI、%AREA及MEAN的曲线下面积于化疗第2周期分别为0.752、0.655和0.623,于化疗第4周期分别为0.921、0.795和0.804;在灵敏度与特异度之和最大化时,LFI、%AREA及MEAN对应的临界值于化疗第2周期分别为1.94(敏感度77.1%,特异度63.2%)、17.33(敏感度85.7%,特异度42.1%)和112.81(敏感度88.6%,特异度36.8%),于化疗第4周期分别为1.99(敏感度97.1%,特异度73.7%)、21.36(敏感度71.4%,特异度73.7%)和109.75(敏感度82.9%,特异度78.9%)。结论:超声组织弥散定量分析技术能够定量检测乳腺癌化疗患者肝组织的弹性特征。弹性参数LFI、%AREA及MEAN更具敏感性,其中LFI的灵敏度和特异性更佳,有望成为超声定量评估TAC联合化疗患者早期肝损伤的有价值指标。
[Abstract]:Objective: to detect the characteristics of liver tissue elasticity in patients with breast cancer TAC combined with chemotherapy by ultrasonic tissue diffusion quantitative analysis, and to provide an effective ultrasonic quantitative method for early assessment of liver injury. Methods: selected outpatient medical examiners and pathologically in Zhongshan Hospital Affiliated to Dalian University, September 2015, ~2016 years, in December. In the case of breast cancer, 6 cycles of TAC combined chemotherapy were required. Among them, 38 cases in the control group and 35 cases in the chemotherapy group. In the chemotherapy group, 24 cases were treated with neoadjuvant chemotherapy and 11 patients with adjuvant chemotherapy after operation, 6 cycles of continuous chemotherapy and a cycle for 21 days. The data collection period in the chemotherapy group was respectively before chemotherapy and second and fourth cycles, respectively. 1-2 days after the end of the 6 period. Main contents: 1. routine liver ultrasound examination; 2. ultrasound tissue diffusion quantitative analysis, including liver fibrosis index, LFI, area ratio,%AREA, strain mean (mean, MEAN), standard deviation (standard deviation, SD), complexity, contrast, contrast Ntrast, CONT), kurtosis (KURT), skewness, SKEW, entropy, ENT, inverse difference moment, IDM, consistency and correlation, including glutamate aminotransferase, aspartate aminotransferase Artate aminotransferase, AST), alkaline phosphatase (alkaline phosphatase, ALP), total bilirubin (total bilirubin, TB) and conjugated bilirubin (conjugated bilirubin, CB). Compared with the chemotherapy group before chemotherapy and the control group, and the comparison between the different chemotherapy cycles of the chemotherapy group and the elastic parameters reflecting the hardness of the liver. The correlation analysis of LFI,%AREA and MEAN with the biochemical indexes of liver function, and further drawing the ROC curve after the second cycle of chemotherapy and the end of the 4 cycle respectively, calculated the area under the curve, the critical value, the sensitivity and the specificity. Results: 1. routine ultrasound examination: 35 cases of chemotherapy group were normal before the chemotherapy, compared with the chemotherapy before chemotherapy, chemotherapy After the second cycle, 3 cases (8.57%) had abnormal echo enhancement in the liver (P0.05); after the end of the fourth cycle of chemotherapy, 18 cases (51.43%) had abnormal echo enhancement in the liver (P0.05); after the end of the chemotherapy sixth period, the abnormal expression of echo enhancement in the liver of 29 patients (82.86%) (P0.05).2. tissue diffusion quantitative analysis: Before chemotherapy before chemotherapy,%AREA, SD and LFI increased (P0.05), and MEAN decreased (P0.05),%AREA, SD, CONT and LFI increased (P0.05) after chemotherapy second cycle after chemotherapy second cycle. P, CONT and LFI increased (P0.05). Compared with chemotherapy for different weeks, after the end of chemotherapy fourth cycle and after the end of chemotherapy second cycle, MEAN decreased (P0.05),%AREA, CONT, COMP and LFI increased (P0.05). After the end of the cycle, after the end of the fourth cycle of chemotherapy, MEAN decreased (P0.05),%AREA, SD and LFI increased (P0.05).3. liver function biochemical indexes: before chemotherapy group, the difference of each index was not statistically significant compared with the control group (P0.05). After the chemotherapy before the chemotherapy, ALT, AST showed an upward trend (P0.05), but AST is still positive. ALT was at the normal limit; ALT, AST and ALP increased after fourth cycles of chemotherapy (P0.05); ALT, AST, ALP, TB and CB increased after the end of the sixth cycle of chemotherapy (P0.05). After the end of second cycles, ALT, AST, ALP, TB and CB were all increased (P0.05); after the end of the sixth cycle of chemotherapy, after the end of the fourth cycle of chemotherapy, ALT, AST, ALP, TB and CB were all increased. =0.011) showed a negative correlation.5.ROC curve showing LFI, the area of%AREA and MEAN was 0.752,0.655 and 0.623 in second cycles of chemotherapy, respectively, 0.921,0.795 and 0.804 in the fourth cycles of chemotherapy, and the critical value of LFI,%AREA and MEAN was 1.94 in the second cycle of chemotherapy (sensitivity 77.1%, specificity, specificity). Degree 63.2%), 17.33 (sensitivity 85.7%, specificity 42.1%) and 112.81 (sensitivity 88.6%, specificity 36.8%), 1.99 in the fourth cycle of chemotherapy (sensitivity 97.1%, specificity 73.7%), 21.36 (sensitivity 71.4%, specificity, specificity). Conclusion: ultrasound tissue diffusion quantitative analysis technique can be used for quantitative detection of breast cancer The elastic characteristics of liver tissue in patients with chemotherapy. The elastic parameters LFI,%AREA and MEAN are more sensitive, and the sensitivity and specificity of LFI are better. It is expected to be a valuable indicator for quantitative ultrasound assessment of early liver injury in patients with TAC combined with chemotherapy.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.9

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