超声弹性成像诊断抗结核药物性肝损害的临床价值  

Clinical value of ultrasound elastography in the diagnosis of anti-tuberculosis drug-induced liver injury

作　　者：黄琨 曾伟梅 李志艳 赖宇婷 董常峰[1] 郑保奇 张子腾 Huang Kun;Zeng Weimei;Li Zhiyan;Lai Yuting;Dong Changfeng;Zheng Baoqi;Zhang Ziteng(Department of Ultrasound,Shenzhen Third People's Hospital,Guangdong Shenzhen 518112,China;Guangdong Medical University,Guangdong Zhanjiang 524000,China;National Clinical Research Center for Infectious Diseases,Shenzhen Third People's Hospital,Guangdong Shenzhen 518112,China)

机构地区：[1]深圳市第三人民医院超声科,广东深圳518112 [2]广东医科大学第一临床学院,广东湛江524000 [3]深圳市第三人民医院,国家感染性疾病临床研究中心,广东深圳518112

出　　处：《新发传染病电子杂志》2022年第2期30-34,共5页Electronic Journal of Emerging Infectious Diseases

基　　金：国家自然科学基金项目(81570552);深圳市科技计划项目(JCYJ20210324131211032)。

摘　　要：目的探讨超声弹性成像技术无创性评估抗结核药物性肝损害的临床价值及预测抗结核药物性肝损害发生风险。方法选取2020年1月至12月就诊于深圳市第三人民医院的56例结核病住院患者,分为抗结核药物性肝损害组(n=26),无抗结核药物性肝损害组(n=30),另外纳入30例健康体检者为对照组(n=30),所有受检者接受二维超声、声触诊弹性成像(STE)、声触诊弹性定量(STQ)及肝功能血生化检测。采用ROC曲线分析超声弹性成像诊断抗结核药物性肝损害的诊断效能,采用Logistic单因素及多因素回归分析筛选抗结核药物性肝损害的独立危险预测因素。结果①脾长、肝脏STE测值、肝脏STQ测值在抗结核药物性肝损害组中均高于对照组和抗结核无药物性肝损害组。②肝脏STE测值、肝脏STQ测值和脾脏STE测值诊断抗结核药物性肝损害的灵敏度分别为88.46%、80.77%、69.23%,特异度分别为96.77%、86.89%、73.68%;曲线下面积分别为0.978、0.894、0.739。③多因素Logistic回归分析显示肝脏STE测值是抗结核药物性肝损害的独立预测因素。结论超声弹性成像尤其是肝脏STE测值对抗结核药物性肝损害的诊断和风险预测具有临床价值。Objective To explore the clinical application value of ultrasound elastography in non-invasive evaluating anti-tuberculosis drug-induced liver injury and predicting the risk of it to avoid the aggravation of patients’condition.Method Fifty-six patients hospitalized at the Third People’s Hospital of Shenzhen from January to December 2020 were selected and divided into two groups:anti-tuberculosis group with liver injury(n=26)and anti-tuberculosis group without liver injury(n=30).Thirty healthy volunteers were enrolled in this study as the normal control group(n=30).All subjects underwent two-dimensional ultrasound examination,ultrasound elastography and blood biochemical test.Receiver operating characteristiccurves(ROC)were used to analyze the efficacy of ultrasound elastography in the diagnosis of anti-tuberculosis drug-induced liver injury.Logistic regression analysis was used to screen the independent risk predictors of anti-tuberculosis drug-induced liver injury.Result①The values of spleen length,liver STE and liver STQ in the anti-tuberculosis group with liver injury were significantly higher than those in the control group and the anti-tuberculosis group without liver injury.②The sensitivity of liver STE,liver STQ and splenic STE in the diagnosis of anti-tuberculosis drug-induced liver injury were 88.46%,80.77%and 69.23%respectively,and the specificity was 96.77%,86.89%and 73.68%.The areas under the curve were 0.978,0.894 and 0.739.③Logistic multivariate regression analysis showed that liver STE was an independent predictor of anti-tuberculosis drug-induced liver injury.Conclusion Ultrasound elastography,especially liver STE,has clinical value for the risk prediction and diagnosis of anti-tuberculosis drug-induced liver injury.

关 键 词：抗结核药物性肝损害 超声弹性成像 诊断效能 风险预测 

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]