肝脾MR弹力值及其联合模型对肝纤维化分期诊断效能的对比研究  

Comparison study of the efficacy of liver and spleen stiffness and combined model in the diagnosis of liver fibrosis

作　　者：何青[1] 王宇[2] 王晓培 马红[2] 赵新颜[2] 杨大为[1] 任浩 张楠[1] 杨正汉[1] He Qing;Wang Yu;Wang Xiaopei;Ma Hong;Zhao Xinyan;Yang Dawei;Ren Hao;Zhang Nan;Yang Zhenghan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Liver Research Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,100050 [2]首都医科大学附属北京友谊医院肝病中心,100050

出　　处：《中华放射学杂志》2021年第9期968-974,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(61871276);首都卫生发展科研专项(2018-2-2023);北京自然科学基金(7184199);首都医科大学附属北京友谊医院科研启动基金资助项目(yyqdkt2020-25)。

摘　　要：目的对比MR弹性成像(MRE)测得肝、脾弹力值及其联合模型对慢性肝病肝纤维化程度分期的诊断效能。方法前瞻性连续纳入2018年11月至2019年11月首都医科大学附属北京友谊医院104例慢性肝病患者,行腹部MRE检查,测量肝、脾弹力值(kPa)。所有患者经肝穿刺活检获得病理肝纤维化分期(F0~F4)。运用单因素方差分析或独立样本t检验比较肝、脾弹力值在不同纤维化级别间差异,采用Spearman秩相关分析与肝纤维化分期的相关性。基于logistic回归建立肝、脾弹力值联合模型。采用ROC曲线分析肝、脾弹力值及两者联合模型分别诊断肝纤维化(≥F1)、显著肝纤维化(≥F2)、进展期肝纤维化(≥F3)和肝硬化(F4)的效能,曲线下面积(AUC)的比较采用Delong检验。结果肝、脾弹力值在不同肝纤维化分期间差异均有统计学意义(F=64.058、32.890,P均<0.001)。肝、脾弹力值均与肝纤维化分期呈正相关(rs=0.89、0.69,P均<0.001)。肝弹力值诊断≥F1、≥F2、≥F3的AUC分别为0.91、0.97、0.93,脾弹力值分别为0.81、0.82、0.85,肝弹力值的AUC均高于脾弹力值,差异有统计学意义(Z=2.283、4.085、2.314,P=0.022、<0.001、0.021)。肝、脾弹力值诊断F4的AUC均为0.95。肝、脾弹力值联合模型诊断≥F1、≥F2、≥F3和F4的AUC分别为0.92、0.97、0.93和0.96,与对应肝弹力值AUC差异均无统计学意义(P>0.05)。结论MRE测得肝弹力值对肝纤维化分期的诊断效能优于脾弹力值。肝脾弹力值联合诊断模型略提高早期纤维化诊断效能,但与肝弹力值差异无统计学意义。脾弹力值有望用于肝硬化的诊断。Objective To assess the performance of liver and spleen stiffness measured by MR elastography(MRE)and their combined model in diagnosing liver fibrosis.Methods From November 2018 to November 2019,104 patients with chronic liver disease were prospectively enrolled in Beijing Friendship Hospital,all patients underwent MRE scans.Liver and spleen stiffness were measured from MRE elastograms.Liver biopsy was used to identify fibrosis stage(F0—F4).The differences among different fibrosis stages were analyzed by one-way ANOVA or independent samples t test.The Spearman rank correlation analysis was used to evaluate the correlation with fibrosis stages.Liver and spleen stiffness combined model was established by logistic regression.The ROC curve was used to evaluate the performance of the liver,spleen stiffness and combined model in staging fibrosis(≥F1),significant fibrosis(≥F2),advanced fibrosis(≥F3),and cirrhosis(F4).The area under the ROC curve(AUC)was compared using Delong test.Results The liver and spleen stiffness both showed significant differences among the 5 fibrosis stages(F=64.058,32.890,both P<0.001).The liver and spleen stiffness were positively associated with fibrosis stage(rs=0.89,0.69,both P<0.001).The AUC of liver stiffness in staging≥F1,≥F2,≥F3 were 0.91,0.97,0.93,respectively.The corresponding AUCs of the spleen stiffness were 0.81,0.82,0.85,respectively,which were statistically lower than those of liver stiffness(Z=2.283,4.085,2.314,P=0.022,<0.001,0.021).In diagnosing F4,the AUCs of liver and spleen stiffness were both 0.95.The AUCs of the liver and spleen combined model were 0.92,0.97,0.93,0.96 in diagnosing≥F1,≥F2,≥F3 and F4,with no significantly differences from liver stiffness(all P>0.05).Conclusions The liver stiffness measured with MRE have better diagnostic performance than spleen stiffness in staging fibrosis.Parameters combined model slightly improves diagnostic value but without significant difference with liver stiffness in staging early fibrosis.Spleen stiffness evalua

关 键 词：磁共振成像 肝纤维化 弹性成像 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]