声脉冲辐射力成像评估儿童肝移植术后肝组织硬度的研究  

Evaluation of Acoustic Radiation Force Impulse Elastography in Assessing Liver Tissue After the Children's Liver Transplantation

作　　者：于慧敏[1] 唐缨[1] 赵静雯[1] 王晶[1] 张国英[1] 刘洋[1] 刘菁[1] Yu Huimin;Tang Ying;Zhao Jingwen;Wang Jing;Zhang Guoying;Liu Yang;Liu Jing(Deprtment of Ultrasound,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院超声科,天津市300192

出　　处：《中国超声医学杂志》2021年第4期425-428,共4页Chinese Journal of Ultrasound in Medicine

基　　金：天津市科技计划项目(No.18ZXZNSY00250);天津市第一中心医院基金资助项目(No.2019CF40)

摘　　要：目的探讨声脉冲辐射力弹性成像(ARFI)定量评估儿童肝移植术后肝脏硬度的价值。方法收集228例行肝穿刺活检的肝移植患儿,于48 h内行ARFI技术检查,测定肝脏剪切波速度(SWV)。根据病理结果分组,比较组间SWV值的差异性。利用受试者工作特征(ROC)曲线分析ARFI技术评价移植肝有无病理改变及鉴别不同并发症的超声参数曲线下面积及临界值;另随机选取28例正常儿童作为对照组。结果 (1)无病理改变组SWV(1.203±0.14)m/s高于对照组SWV(1.103±0.16)m/s,两组间差异有统计学意义(P=0.002)。(2)有病理改变组SWV(1.449±0.38)m/s高于无病理改变组SWV(1.203±0.14)m/s(P<0.01),两组间有统计学差异(P=0.000)。(3)有特异度改变伴无纤维化组SWV(1.501±0.40)m/s高于无特异度改变伴有纤维化组SWV(1.293±0.23)m/s,两组间有统计学差异(P=0.017)。(4)特异度改变分组中,排斥反应组SWV(1.595±0.46)m/s高于药物性肝损伤组SWV(1.285±0.16)m/s,两组间有统计学差异(P=0.01)。(5)ROC曲线结果显示SWV测值诊断儿童肝移植术后肝脏有病理改变的曲线下面积为0.728,临界值为1.295 m/s;鉴别排斥反应和药物性肝损害的曲线下面积为0.722,临界值为1.435 m/s。结论 ARFI作为一种无创、简便的技术,其检测的SWV值与组织病理学具有良好的相关性,为临床定期评估儿童肝移植术后肝组织硬度及鉴别不同并发症提供有价值的依据。Objective To explore acoustic radiation force impulseelastography(ARFI) in quantitative assessing liver tissue characterization after the children′s livertransplantation. Methods 228 livertransplantation′s children were examined by ARFI in liver biopsy 48 hours, and obtained shear wave velocity(SWV).SWV between different groups divided according pathological results after biopsy was compared. Using the receiver-operating characteristic(ROC) curve analysed ARFI parameters′cut-off value and AUC of diagnosing pathological changes and identifying complications after liver transplantation;Moreover, 28 cases of normal children were randomly selected as control group. Results(1)SWV of no pathological change group was(1.203±0.14) m/s, of the control group was(1.103±0.16) m/s, the differences between the two groups was statistically significant(P=0.002).(2)SWV of with pathological change group was(1.449±0.38) m/s, SWV no pathological change group was(1.203±0.14) m/s, the differences between the two groups was statistically significant(P=0.000).(3)SWV with specific change with no fibrosis group was(1.501±0.40) m/s, SWV of without specific changes associated with fibrosis group was(1.293±0.23) m/s, the differences between the two groups was statistically significant(P=0.017).(4)SWV of rejection group was(1.595±0.46) m/s, SWV of drug-induced liver injury was(1.285±0.16) m/s, the differences between the two groups was statistically significant(P=0.01).(5)The ROC showed that the area under curve of ARFI was 0.728, the critical value of 1.295 m/s, for patients with pathological changesafter liver transplantation, and 0.722, the critical value of 1.435 m/s for differential diagnosis between rejection and drug-induced liver injury. Conclusions As a noninvasive and easy technique, ARFI is correlated with histopathology and provides valuable imaging basis for regularly assessing liver tissue hardness and identifing different complications after children′s liver transplantation.

关 键 词：声脉冲辐射力弹性成像 儿童肝移植 组织硬度 

分 类 号：R726.5[医药卫生—儿科] R445.1[医药卫生—临床医学]