实时剪切波弹性成像与肝纤维化血清学检测评价兔肝纤维化的效能及相关性研究  

Efficacy and correlation of real-time shear wave elastography and liver fibrosis serological markers in evaluating liver fibrosis in rabbits

作　　者：刘清玉 薛恩生[1] 俞丽云[1] 何以敉[1] 唐秀斌 林文金[1] 钱清富 LIU Qingyu;XUE Ensheng;YU Liyun;HE Yimi;TANG Xiubin;LIN Wenjin;QIAN Qingfu(Department of Ultrasound,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院超声科,福州市350001

出　　处：《临床超声医学杂志》2018年第12期830-834,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨实时剪切波弹性成像与肝纤维化血清学检测评估兔肝纤维化程度的效能,并就二者与肝纤维化病理分期进行相关性研究。方法新西兰大白兔48只,随机分成实验组40只(皮下注射四氯化碳橄榄油溶液)和对照组8只(皮下注射生理盐水)。在造模开始的第4、8、12、16周末随机抽取实验组10只和对照组2只,行肝实时剪切波弹性成像、肝纤维化血清学指标和病理检查,分析肝Emean及肝纤维化血清学指标[Ⅳ型胶原蛋白(CⅣ)、Ⅲ型前胶原氨基端肽(PⅢNP)、透明质酸(HA)和层粘蛋白(LN)]与肝纤维化病理分期的相关性;受试者工作特征(ROC)曲线评估二者对肝纤维化程度的诊断效能。结果 40只实验组中,死亡8只,32只造模成功的兔肝脏病理呈不同程度的纤维化;对照组8只均存活。共计40只兔参与后期实验,其中肝纤维化S0期8只,S1期8只,S2期9只,S3期8只,S4期7只。肝纤维化不同病理分期肝Emean比较差异有统计学意义(F=74.283,P=0.000),且任意两期之间肝Emean比较差异均有统计学意义(均P<0.05);肝Emean与肝纤维化病理分期的相关系数为0.940,大于HA、PⅢNP、CⅣ和LN的相关系数(0.511、0.464、0.527、0.554)。Emean诊断肝纤维化≥S1、≥S2、≥S3及S4期的ROC曲线下面积均大于0.90,大于CⅣ、PⅢNP和LN诊断的ROC曲线下面积;且在诊断肝纤维化≥S2、≥S3、S4期的ROC曲线下面积大于HA诊断的ROC曲线下面积,差异均有统计学意义(均P<0.05)。Emean除与HA在诊断肝纤维化≥S1期的特异性比较差异无统计学意义外,其在诊断肝纤维化其他各病理分期的敏感性、特异性均大于89%,且均大于各肝纤维化血清学指标的诊断效能(均P<0.05)。结论实时剪切波弹性成像对兔肝纤维化程度的诊断效能高于肝纤维化血清学指标,且肝Emean与兔肝纤维化程度呈正相关。Objective To evaluate the efficacy of real-time shear wave elastography(SWE)and liver fibrosis serological markers in evaluating liver fibrosis in rabbits,and to analyze the correcation of SWE,liver fibrosis serological makers and pathological stages of hepatic fibrosis.Methods A total of 48 New Zealand white rabbits were randomly divided into experimental group(n=40,subcutaneous injection of CCl4 olive oil solution)amd control group(n=8,subcutaneous injection of normal saline).At 4,8,12 and 16 weeks after the experiment,10 rabbits in the experimental group and 2 rabbits in the control group were randomly underwent SWE,liver fibrosis serological markers[typeⅣcollagen(CⅣ),typeⅢprocollagen amino terminal peptide(PⅢNP),laminin(LN),hyaluronic acid(HA)]and pathological examination.Emean values and serum fibrosis markers were correlated with the pathological stages of hepatic fibrosis and diagnostic efficiency on the liver fibrosis severities were evaluated by receiver operating characteristic(ROC)curve.Results Among the 48 experimental groups and control group,40 rabbits successfully molded had different degrees of fibrosis including 8 of S0,8 of S1,9 of S2,8 of S3,and 7 of S4.There was statistically significant difference in the value of Emean value between any two phases(all P<0.05).The positive correlation index between Emean value and liver fibrosis stage was 0.940,which was higher than that of HA,PⅢNP,CⅣand LN(0.511,0.464,0.527,0.554).The area under the curve of Emean value diagnosis of liver fibrosis stage equal and greater than S1,S2,S3 and S4 were greater than 0.90,which was higher than that of CⅣ,PⅢNP and LN,and was higher than HA diagnosis of liver fibrosis equal and greater than S2,S3,S4,the difference were statistically significant(all P<0.05).The sensitivity and specificity of Emean value in the diagnosis of liver fibrosis pathological stage were higher than 89%,and were significantly better than fibrosis serological markers(all P<0.05),except for the difference in the specificity of HA va

关 键 词：超声检查 弹性成像 剪切波 实时 血清学检测 肝纤维化 兔 

分 类 号：R445.1[医药卫生—影像医学与核医学] R-332[医药卫生—诊断学]