超声剪切波弹性成像联合血液生化指标对胆道闭锁的诊断价值  

Diagnostic value of ultrasonic shear wave elastography plus blood biochemical indicators for biliary atresia

作　　者：姚桃月 段星星[1] 周梦洁[1] 杨柳 陈文娟[1] Yao Taoyue;Duan Xingxing;Zhou Mengjie;Yang Liu;Chen Wenjuan(Department of Ultrasound,Hunan Children Hospital,Changsha 410007,China.)

机构地区：[1]湖南省儿童医院超声科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2021年第2期119-125,共7页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷协调防治科技重大专项(编号:2019 SK1010);湖南省自然科学基金(编号:2017JJ2141);湖南省卫生健康委科研计划项目(编号:20200149)。

摘　　要：目的探讨超声剪切波弹性成像联合血液生化指标对胆道闭锁(biliary atresia,BA)的诊断价值。方法对湖南省儿童医院临床拟诊为胆汁淤积性肝病的患者行常规超声检查及肝脏剪切波弹性成像(shear wave elastography,SWE)检查,同时收集距SWE检查近3天内肝功能血生化指标。经术中胆管造影及肝活检病理检查确诊为胆道闭锁者归为BA组,经内科治疗后黄疸消除,临床排除胆道闭锁后归为Non-BA组。比较分析血生化指标、常规肝胆超声SWE各指标及联合诊断BA的灵敏度、特异度、阳性预测值、阴性预测值及准确性。结果本研究共纳入57例胆汁淤积性肝病患者,其中BA组24例,Non-BA组33例。血生化检查指标中,ROC曲线分析显示诊断BA效能最大的是谷氨酰转肽酶(gamma glutamyl transpeptadase,GGT),其ROC曲线下面积为0.754。当GGT最佳截断值取282.165 IU/L时,诊断BA的灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为75.0%、75.8%、69.2%、80.6%和75.4%。常规超声检查中,诊断BA效能最大的指标为胆囊形态异常,其灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为95.8%、72.7%、71.8%、96%和82.5%。BA组和Non-BA组LSM分别为(16.2±4.0)KPa和(10.7±2.9)KPa,差异有统计学意义(t=5.747,P<0.001)。LSM诊断BA的ROC曲线下面积为0.822,当最佳截断值取11.9 KPa时,诊断BA的灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为91.7%、72.7%、71%、92.3%和80.7%。联合诊断实验中,胆囊形态异常联合LSM诊断BA的效能最大,其灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为87.5%、93.3%、91.3%、91.2%和91.2%,但其灵敏度不如胆囊形态异常;GGT联合LSM诊断BA的灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为75%、87.9%、81.8%、82.9%和82.5%。GGT联合胆囊形态异常诊断BA的灵敏度、特异度、阳性预测值、阴性预测值、准确性分别Objective To explore the diagnostic value of ultrasonic shear wave elastography(SWE)in combination with blood biochemical indicators to biliary atresia(BA).Methods Infants within 90 days who were suspected with cholestatic hepatopathy received conventional ultrasonography(US)and SWE for measuring liver stiffness measurement(LSM).Blood biochemical indicators were collected within 3 days from SWE examination.They were divided into BA(n=24)and non-BA(n=33)groups according to the result of pathological examination.The sensitivity,specificity,positive predictive value,negative predictive and accuracy were compared and analyzed.Results Finally A total of 57 infants with infantile cholestatic hepatopathy(ICH)were selected.In blood biochemical test,gamma glutamyl transpeptadase(GGT)had the best diagnostic performance.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of GGT>282.165 IU/L were 75%,75.8%,69.2%,80.6%and 75.4%respectively.Abnormal gallbladder in BA group was significantly associated with the sign of triangular cord(TC)and hepatic subcapsular flow(HSF)as compared with non-BA group(P<0.001).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of abnormal gallbladder were 95.8%,72.7%,71.8%,96%and 82.5%.The LSM of BA and non-BA groups were(16.2±4.0)and(10.7±2.9)KPa with a significant difference(P<0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of LSM>11.9 KPa were 91.7%,72.7%,71%,92.3%and 80.7%.In the series,LSM plus abnormal gallbladder had the best diagnostic performance with the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 87.5%,93.3%,91.3%,91.2%and 91.2%respectively.But its sensitivity was lower than conventional US.GGT plus LSM or abnormal gallbladder had similar diagnostic performance.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 75%,70.8%,87.9%,87.9%,81.8%,81%,82.9%,80.6%,82.5%an

关 键 词：超声检查 剪切波弹性成像 生化现象 胆道闭锁/诊断 血液/微生物学 

分 类 号：R604[医药卫生—外科学] R575.7[医药卫生—临床医学]