声触诊组织量化技术无创评估急性肝炎患者肝损害程度及预测预后的临床研究  

Non-invasive evaluation of liver damage and prognosis in patients with acute hepatitis by virtual touch tissue quantification technique

作　　者：包明稳[1] 董常峰[1] 冯程 BAO Mingwen;DONG Changfeng;FENG Cheng(Department of Ultrasound,the Third People’s Hospital of Shenzhen,Shenzhen 518020,China)

机构地区：[1]深圳市第三人民医院超声科

出　　处：《临床超声医学杂志》2019年第7期490-494,共5页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金重点项目(61031003);深圳市科技计划项目(卫生类)(2016013)

摘　　要：目的应用声触诊组织量化(VTQ)技术动态检测肝脏剪切波速度(SWV)变化,探讨其无创评估急性肝炎患者肝损害程度及预测预后的临床应用价值。方法选取42例急性肝炎患者(实验组)和55例慢性乙肝病毒携带者(对照组)作为研究对象,检测两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)及凝血酶原活动度(PTA),并于同日行VTQ检查测量肝脏SWV,计算超声评分;分析SWV与肝功能血清学指标的相关性。随访12周,根据临床结局或实验室指标分为好转组(治疗后好转出院)和恶化组(持续进展总胆红素>正常值上限10倍且PTA≤40%),比较两组肝SWV的变化。以随访12周结束时临床结局为标准,绘制SWV预测急性肝炎预后不良的受试者工作特征(ROC)曲线,确定其截断值并计算曲线下面积。结果两组肝脏SWV总检测成功率为92.78%,7例检测失败(实验组3例、对照组4例),实际纳入统计者共90例,实验组39例,对照组51例。实验组基线水平肝脏SWV值为(1.95±0.78)m/s,高于对照组(1.13±0.15)m/s,差异有统计学意义(P<0.05)。实验组基线水平肝脏SWV值与AST、ALT、总胆红素均呈正相关(r=0.303、0.415、0.512,均P<0.05),与GGT、ALP、PTA均无相关性。动态检测肝脏SWV,好转组维持在1.87m/s以下并呈下降趋势。恶化组的肝脏SWV为(2.35±0.89)m/s,高于实验组基线水平,差异有统计学意义(P<0.05)。以2.18m/s作为肝脏SWV预测急性肝炎预后不良的截断值,其诊断敏感性为0.82,特异性为0.75,ROC曲线下面积为0.891。结论应用VTQ技术检测肝脏SWV可无创评估急性肝炎患者肝损害程度;急性肝炎患者肝脏SWV值持续高于2.18m/s者预后较差。Objective To measure the hepatic shear wave velocity(SWV) by virtual touch tissue quantification (VTQ)technique,and to investigate the clinical application value of VTQ for non-invasive evaluation of liver damage and prognosis in patients with acute hepatitis. Methods Forty-two patients with acute hepatitis(experimental group) and 55 patients with chronic hepatitis B virus(control group) were enrolled,and alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TB),glutamyl transpeptidase(GGT),alkaline phosphatase(ALP)and prothrombin activity(PTA)were detected,and on the same day VTQ was performed to measure the hepatic SWV,and ultrasound score was calculated.The correlation between SWV and various serological indicators was analyzed.During 12 weeks of follow-up,hepatic SWV was measured every 2 weeks,and the prognosis was divided into the improved group(improved after treatment)and the worse group(continuous progression of TB>upper limit of normal value 10 times and PTA≤40%),the hepatic SWV changes of the two groups were compared. Based on the clinical outcome at the end of the 12-week follow-up,receiver operating characteristic(ROC)curve of SWV for predicting poor prognosis of acute hepatitis was drawn,the cut-off value was determined and the area under the curve was calculated. Results The total success rate of SWV in the two groups was 92.78%(90/97),and 7 cases failed(3 cases in the experimental group and 4 cases in the control group).The total number of patients in the survey was 90 cases,39 cases in the experimental group and 51 cases in the control group. The baseline SWV value of the experimental group was higher than that of the control group[(1.95±0.78)m/s vs.(1.13±0.15)m/s,P<0.05].The SWV values of the baseline liver were positively correlated with AST,ALT and TB(r=0.303,0.415,0.512,all P<0.05),and there was no correlation with GGT,ALP and PTA.The liver SWV was dynamically detected,and the improved group maintained below 1.87 m/s and showed a downward trend,while the worse group

关 键 词：超声检查 声触诊组织量化技术 肝炎 急性 预后 

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