肝硬化Child-Pugh分级中ARFI的应用及肝固有动脉血流动力学变化临床意义的初步研究  

Preliminary study of clinical significance for the application of ARFI and hepatic artery hemodynamics in Child-Pugh classification liver cirrhosis

作　　者：孙晓岚[1] 门琼[2] 姚晖[3] 侯克 陈真[5] 徐长青[6] 梁立维[7] SUN Xiao-lan;MEN Qiong;YAO Hui(Department of Ultrasound,East City Hospital of Yangpu District,Shanghai 200433,China;Department of Medical Oncology,East City Hospital of Yangpu District,Shanghai 200433,China;Department of Surgery,East City Hospital of Yangpu District,Shanghai 200433,China)

机构地区：[1]上海市杨浦区市东医院超声科,上海200433 [2]上海市杨浦区市东医院肿瘤内科,上海200433 [3]上海市杨浦区市东医院放疗科,上海200433 [4]上海市杨浦区市东医院外一科,上海200433 [5]上海市杨浦区市东医院病理科,上海200433 [6]上海市杨浦区市东医院影像科,上海200433 [7]上海市杨浦区市东医院消化内科,上海200433

出　　处：《临床和实验医学杂志》2018年第6期589-593,共5页Journal of Clinical and Experimental Medicine

基　　金：杨浦区卫计委;杨浦区科委课题(YP15M18)

摘　　要：目的初步探讨肝硬化Child-Pugh分级中声脉冲辐射力成像技术(ARFI)与肝固有动脉血流动力学的临床意义。方法选取100例肝硬化患者作为观察组,对患者肝硬化程度进行Child-Pugh(CP)分级;选取110例健康志愿者作为对照组。应用ARFI技术检测所有研究对象的肝脏横向剪切波速度(SWV)与肝固有动脉血流动力学检测指标:收缩期峰值流速(PSV)、阻力指数(RI)。观察观察组不同CP等级各指标与对照组的差异,分析不同CP等级肝硬化患者各指标的分布规律;并分析肝硬化程度与各指标的相关性,采用ROC曲线评估各指标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SWV、PSV及RI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SWV、PSV及RI均呈显著正相关(r=0.468,P<0.01;r=0.646,P<0.01;r=0.556,P<0.01)。ROC曲线分析结果:SWV、PSV及RI诊断不同CP等级肝硬化的AUC比较结果显示:C级>B级>A级,其中SWV三个CP等级的AUC均高于PSV和RI。SWV、PSV及RI联用诊断不同CP等级肝硬化的AUC均高于各指标单用。结论 ARFI技术与肝固有动脉的血流动力学变化联合应用可提高肝硬化的诊断能力,尤其对肝硬化早期诊断具有重要意义,值得临床进一步深入研究。Objective To explore the clinical significance for the application of ARFI and hepatic artery hemodynamics in Child-Pugh classification liver cirrhosis.Methods One hundred patients with liver cirrhosis were selected as the observation group,and the patients were graded by Child-Pugh(CP)score.And one hundred and ten healthy volunteers were selected as the control group.The shear wave velocity(SWV),the hepatic artery hemodynamics indexes:peak systolic velocity(PSV)and resistance index(RI)of all research objects were detected by acoustic radiation force impulse imaging technique(ARFI).SWV,PSV and RI in different grade CP score were observed and compared with the liver cirrhosis patients and healthy population,the distribution of each index in patients with different CP levels were analyzed.The correlation between the degree of liver cirrhosis and the indexes were analyzed.The diagnostic value of each index in liver cirrhosis was evaluated by ROC curve.Results SWV,PSV and RI with A,B,C three grades of CP score in observation group were higher than those of the control group,and C grade>B grade>A grade.The differences were statistically significant(P<0.05).CP score was significantly positively correlated with SWV,PSV and RI(r=0.468,P<0.01;r=0.646,P<0.01;r=0.556,P<0.01).The AUC of ROC analysis comparison results of SWV,PSV and RI of different CP grades of cirrhosis showed that:C grade>B grade>A grade,which the AUC of SWV for three CP grades were higher than PSV and RI.the AUC of SWV,PSV and RI combined diagnosis for different CP grades of cirrhosis were higher than these indexs single using.Conclusion The combined application of ARFI technology and the hemodynamic changes of hepatic artery can improve the diagnostic ability of liver cirrhosis,especially for the early diagnosis of liver cirrhosis.It is worthy for further study.

关 键 词：肝硬化 声辐射力脉冲成像技术 肝固有动脉血流动力学 收缩期峰值流速 阻力指数 临床意义 

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]