二维剪切波弹性成像肝硬度值评估慢加急性肝衰竭患者病情变化  

Liver Stiffness for Evaluating Change of Condition in Patients with Acute-on-chronic Liver Failure

作　　者：郭欢仪[1] 徐士丞 廖梅[1] 金洁玚 曾婕[1] 郑荣琴[1] GUO Huan-yi;XU Shi-cheng;LIAO Mei;JIN Jie-yang;ZENG Jie;ZHENG Rong-qin(Department of Medical Ultrasonics//Guangdong Key Laboratory of Liver Disease Research,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院超声科//广东省肝脏疾病研究重点实验室

出　　处：《中山大学学报（医学版）》2019年第5期723-730,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81601503);国家重点研发计划项目(2017YFC0112000)

摘　　要：【目的】慢加急性肝衰竭(ACLF)患者中,分析肝细胞性黄疸胆红素变化与二维剪切波弹性成像(2D-SWE)肝硬度值(LSM)变化的相关性,评估慢加急性肝衰竭患者病情变化。【方法】2015年1月至2016年3月来中山大学附属第三医院感染科住院确诊的慢加急性乙型肝炎肝衰竭(ACLF-HBV)患者150例。所有病例均行2D-SWE检查,同时记录临床及实验室血生化指标。胆红素变化与肝硬度值变化的相关分析,选用Pearson相关分析及线性回归分析。【结果】121例ACLF-HBV患者获得有效LSM纳入研究分析。以总胆红素(TB)水平变化为病情分组依据,胆红素下降组和胆红素未下降组。胆红素下降组的2D-SWE肝硬度值下降了5.1(2.2~6.6)kPa,与肝硬度值的变化具有相关性的指标有谷丙转氨酶(ALT),总胆红素(TB),谷氨酰转肽酶(GGT)。胆红素未下降组其2D-SWE肝硬度值上升了6.2(1.2~12.8)kPa,与肝硬度值的变化具有相关性的指标有ALT,TB。胆红素下降组,随胆红素下降,肝硬度值下降,患者达临床好转标准,平均住院时间为(30±15)d,反映病情好转;胆红素未下降组,随胆红素上升,肝硬度值呈增加趋势,至随访终点,4例死亡,6例行肝移植治疗,其余患者未达临床好转标准。胆红素未下降组,6例患者行肝移植治疗。随访终点移植前,患者胆红素高于20倍正常上限值,2D-SWE肝硬度值均有不同程度升高。病理结果显示肝细胞呈亚大块坏死伴结节状增生,毛细胆管内淤胆。【结论】慢加急性肝衰竭患者发生肝细胞坏死程度加重致胆红素持续升高,肝硬度值明显升高,反映患者病情加重;反之,肝硬度值持续下降,反映病情好转。【Objective】To study the correlation between hepatocellular jaundice and liver stiffness measurement and reflect the changes in patients with acute-on-chronic liver failure(ACLF).【Methods】Between January 2015 and March 2016,a total of 150 patients with ACLF-HBV infection were enrolled to collect clinical data,2D-SWE and biochemical variables. According to data distribution,correlation of total bilirubin with LSM by 2D-SWE was assessed by Pearson correlation analysis.【Results】One hundred and twenty-one patients were analyzed and divided into two groups:descended TB group and elevated TB group. For descended TB group,LSM decreased 5.1(2.2~6.6)kPa. For elevated TB group, LSM increased 6.2(1.2~12.8)kPa. A significant parallel correlation between TB and LSM value either the descended TB group or the elevated TB group. For descended TB group, accompanied with the decrease of LSM,patients reached clinical improvement standard and their average hospitalization time was 30 ± 15 days. Six patients underwent liver trans-plantation in the elevated TB group,and showed TB level higher than twenty ULN(the upper limit of normal),accompanied with increased LSM value. Histological characteristics of these patients showed submassive hepatic necrosis.【Conclusion】The degree of hepatic necrosis aggravation in patients with ACLF,which results in the continuous increase of TB and LSM,reflects the aggravation of patients′ condition;on the contrary,the decline in value of LSM reflects the improvement of patients′ condition.

关 键 词：胆红素 二维剪切波弹性成像 慢加急性肝衰竭 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]