声脉冲辐射力成像技术联合肝纤维化指标评估肝硬化程度的诊断价值  

Diagnostic value of acoustic radiation force imaging in combination with serum hepatic fibrosis parameters index in evaluating the degree of liver cirrhosis

作　　者：丰乃奇[1,2] 曲俊朴[2] 王雪瑞[2] 徐霞[2] 董云[3] FENG Nai-Qi QU Jun Pu WANG Xue-Rui et al(Department of Ultrasound, Dongsheng District of People＇s Hospital, Ordos 017000, China)

机构地区：[1]内蒙古鄂尔多斯市东胜区人民医院超声科,内蒙古017000 [2]内蒙古医科大学临床医学院鄂尔多斯市中心医院超声科,内蒙古017000 [3]上海市东方医院超声科,上海200120

出　　处：《放射学实践》2016年第11期1093-1097,共5页Radiologic Practice

基　　金：国家自然科学基金(61471231)

摘　　要：目的:探讨声脉冲辐射力成像技术(ARFI)联合肝纤维化指标评估肝硬化程度的诊断价值。方法:选取本院90例肝硬化患者作为观察组,按照Child-Pugh(CP)评分对患者肝硬化程度进行分级;选取45例健康体检者作为对照组。检测所有研究对象的肝纤维化4项指标:透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C),并行ARFI技术检测,测得肝实质硬度值(LS)。观察不同CP评分分级的LS值与肝纤维化4项指标(HA、LN、PCⅢ、Ⅳ-C),采用受试者操作特征(ROC)曲线分析LS值与血清肝纤维化4项指标单用或联用对肝硬化的诊断价值。结果:观察组CP评分A、B、C三级患者的LS值和血清肝纤维化4项指标水平均明显高于对照组,且C级>B级>A级,差异均具有统计学意义(P<0.05)。CP评分与LS值、HA、LN、PCⅢ、Ⅳ-C均呈正相关(r=0.782,P<0.01;r=0.147,P<0.05;r=0.485,P<0.01;r=0.421,P<0.01;r=0.262,P<0.05)。ROC曲线显示:不同CP等级的LS值的AUC均高于血清肝纤维化4项指标;而LS值与血清肝纤维化4项指标联用对不同CP等级肝硬化诊断的AUC、敏感性及特异性均高于其单用。结论:ARFI检测的LS值联合血清肝纤维化4项指标对肝硬化程度的诊断效能较高,具有重要的临床应用价值。Objective：To study the diagnostic value of acoustic radiation force imaging （ARFI） in combination with serum hepatic fibrosis parameters for the evaluation of the degree of liver cirrhosis. Method：Ninety patients with liver cirrhosis were selected as the study group,and the liver cirrhosis degree of patients were graded by Child-Pugh （CP） score. Forty-five healthy people were recruited as control group. Of all the study objects, four serum parameters for liver fibrosis including hyaluronie acid （HA） ,laminin （LN） ,type Ⅲ collagen （PC m ） ,and type Ⅳ collagen （Ⅳ-C） were examined. The value of the hardness of the liver parenchyma （LS） was measured by ARFI. The values of LS and the four serum parameters （HA.LN.PC Ⅲ. Ⅳ-C） of liver fibrosis in different grade of CP score were studied. Receiver operating characteristic （ROC） was used to analyzed. The LS value and the LS value in combination with the four liver fibrosis parameters in the diagnosis of liver cirrhosis were studied. Resuits：LS and four liver fibrosis serum parameters with the A, B,C score of CP in the study group were higher than those of the control group, and C grade〉B grade〉A grade with statistically significant differences （P〈0.05）. The CP score was significantly positively correlated with LS, HA,LN,PCm and Ⅳ-C （r=0. 782 ,P 〈0.01;r=0. 147,P〈0.05;r=0. 485,P〈0.01;r=0. 421,P〈0.01;r=0. 262,P〈0.05）. ROC curve showed： that LS values of AUC in different CP grades were all higher than those of the 4 parameters of liver fibrosis. The AUC,sensitivity and specificity of 4 serum parameters of liver fibrosis in combination with LS value in different CP grades were higher than those of using separately. Conclusion： LS value measured by ARFI in combination with four serum parameters of liver fibrosis showed more efficacy in the diagnosis of liver cirrhosis degree, and provided important clinical application value.

关 键 词：肝硬化 超声检查 多普勒 彩色 弹性成像技术 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]