声触诊弹性定量成像技术筛查非酒精性脂肪性肝炎高危人群的应用价值初探  

Application value of sound touch quantification in screening high risk group of non-alcoholic steatohepatitis

作　　者：杨绿敏[1] 胡萍香[1] 李敏 蔡玉英[1] 肖小鹏[1] 王宏艳[2] Yang Lyumin;Hu Pingxiang;Li Min;Cai Yuying;Xiao Xiaopeng;Wang Hongyan(Department of Ultrasound,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,China;Digestive Endoscopy Center,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,China)

机构地区：[1]深圳市中医院超声影像科,518033 [2]深圳市中医院消化内镜中心,518033

出　　处：《中华超声影像学杂志》2020年第9期767-770,共4页Chinese Journal of Ultrasonography

基　　金：深圳市卫生计生系统科研项目(SZBC2017017)。

摘　　要：目的探讨声触诊弹性定量(sound touch quantification,STQ)成像技术筛查非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)高危人群的应用价值。方法选取2019年2月至2020年1月在深圳市中医院就诊的98例非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者及36例健康人群行STQ检查。根据NASH高危人群临床诊断标准将NAFLD患者分为NASH高危组和NASH低危组,健康人群作为对照组。比较三组之间杨氏模量的差异,采用受试者工作特征(ROC)曲线分析STQ筛查NASH高危人群的效能,当约登指数最大值时取最佳界值,分析其敏感性、特异性及准确性。其中15例NASH高危患者行肝组织活检为验证组,对界值进行验证。结果NASH高危组、NASH低危组与对照组三组间肝杨氏模量均值比较差异有统计学意义(F=33.068,P<0.01),其中NASH高危组高于NASH低危组及对照组,差异均有统计学意义(P<0.05),NASH低危组与对照组比较差异无统计学意义(P=0.443)。采用杨氏模量6.46 kPa为NASH高危人群最佳筛查界值,敏感性为89.2%,特异性为85.2%,准确性为88.6%。验证组对照病理结果分析,杨氏模≥6.46 kPa,诊断NASH的准确性为73.3%,敏感性为75.0%,特异性为66.7%。结论STQ成像技术对筛查NASH高危人群有一定价值,可作为NASH高危患者行肝穿活检的参考指标。Objective To investigate the application value of sound touch quantification(STQ)in screening high risk group of non-alcoholic steatohepatitis(NASH).Methods From February 2019 to January 2020,98 patients with non-alcoholic fatty liver disease(NAFLD)and 36 healthy volunteers were included in this study.NAFLD patients were divided into NASH high risk group and NASH low risk group.The liver Young′s modulus were measured by STQ and compared among the three groups.The ROC curve was used to analyze the effectiveness of STQ in screening NASH high risk population.When the maximum value of Jordan index was selected,the best boundary threshold was selected to analyze its sensitivity,specificity and accuracy.Liver biopsy was performed in 15 patients with abnormal liver function as validation group.Results There were significant differences in the mean values of Young′s modulus among high risk group,low risk group and control group(F=33.068,P<0.01).The Young′s modulus of NASH high risk group was significantly higher than those in NASH low risk group and control group(P<0.05).The Young′s modulus between NASH Low risk group and control group was not significantly different(P=0.443).The best screening threshold was 6.46 kPa,the sensitivity was 89.2%,the specificity was 85.2%,and the accuracy was 88.6%.In the verification group,when the Young′s modulus≥6.46 kPa,the accuracy was 73.3%,the sensitivity was 75.0%,and the specificity was 66.7%.Conclusions As a screening index,STQ elastic imaging technology has certain value in screening NASH high risk group.

关 键 词：声触诊弹性定量成像 非酒精性脂肪性肝炎 杨氏模量 

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