二维剪切波弹性成像检测乳腺癌术后化疗患者肝弹性值变化的应用价值  

Application value of two-dimensional shear wave elastography for detecting chemotherapy-induced changes of liver stiffness in postoperative breast cancer patients

作　　者：江超 郭鲁[1] 时丹丹[1] 商蒙蒙 孙霄[1] 李杰[1] Jiang Chao;Guo Lu;Shi Dandan;Shang Mengmeng;Sun Xiao;Li Jie(Department of Ultrasound,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院超声科,济南250012

出　　处：《中华超声影像学杂志》2022年第4期312-317,共6页Chinese Journal of Ultrasonography

摘　　要：目的应用二维剪切波弹性成像(2D-SWE)检测乳腺癌术后患者化疗前后肝脏弹性值的变化,并分析其与肝功能血清学指标的相关性,探讨2D-SWE技术定量诊断化疗性肝损伤的应用价值。方法选取2021年1月至2021年11月在山东大学齐鲁医院行术后化疗的乳腺癌患者60例,分别于化疗前后行肝脏常规二维超声、2D-SWE和肝功能血清学检查[包括丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转移酶(γ-GT)、碱性磷酸酶(AKP)]。测量并比较全肝及各肝段(S4、S5/S6、S7/S8)化疗前后的弹性值中位数(EQImed);比较化疗后不同肝段(S4、S5/S6、S7/S8)的EQImed;分析化疗后全肝EQImed与肝功能血清学指标间的相关性。结果①与化疗前相比,乳腺癌术后患者化疗后全肝及各肝段EQImed明显降低(均P<0.001)。②乳腺癌术后患者化疗后各肝段间的EQImed不同(F=7.489,P=0.001),化疗后S5/S6、S7/S8的EQImed明显低于化疗后S4的EQImed(P=0.002、0.001)。③相关性分析显示,化疗后全肝EQImed与ALT、AST、γ-GT呈线性负相关(r=-0.776,P<0.001;r=-0.656,P<0.001;r=-0.428,P=0.010),与AKP无线性相关(r=-0.146,P=0.267)。结论2D-SWE技术可以无创、实时、定量评估乳腺癌术后化疗患者肝脏弹性值的变化,为临床诊断化疗性肝损伤提供了一种有价值的无创影像学手段。Objective To detect the changes of liver stiffness before and after chemotherapy in postoperative breast cancer patients using the two-dimensional shear wave elastography(2D-SWE)technique,and analyze its correlation with liver serum indexs,then discuss the application value of 2D-SWE technique in the quantitative diagnosis for chemotherapeutic liver injury.Methods Sixty breast cancer patients underwent postoperative chemotherapy in Qilu Hospital of Shandong University from January 2021 to November 2021 were included.Conventional two-dimensional ultrasound,2D-SWE and the serum tests including alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase(γ-GT),alkaline phosphatase(AKP)were performed before and after chemotherapy,respectively.The medians of ElastQ Imaging stiffness(EQImeds)of the whole liver and different liver segments(S4,S5/S6,S7/S8)before and after chemotherapy were measured and compared.The EQImeds of different liver segments(S4,S5/S6,S7/S8)after chemotherapy were compared.The correlation between EQImed of the whole liver and serum indexes after chemotherapy was analyzed.Results①Compared with before chemotherapy,the EQImeds of the whole liver and different liver segments after chemotherapy were significantly decreased(P<0.001,respectively).②The EQImeds among different liver segments were different after chemotherapy(F=7.489,P=0.001).Moreover,the EQImeds of S5/S6 and S7/S8 were significantly lower than those of S4 after chemotherapy(P=0.002,0.001).③The EQImed of the whole liver was negatively correlated with ALT,AST,andγ-GT(r=-0.776,P<0.001;r=-0.656,P<0.001;r=-0.428,P=0.010),while there was no correlation between the EQImed of the whole liver and AKP(r=-0.146,P=0.267).Conclusions 2D-SWE is expected to be a new,real-time,noninvasive and quantitative method to evaluate the changes of liver stiffness before and after chemotherapy in postoperative patients,thus provides a promising method for the early clinical diagnosis of chemotherapy-induced liver injury in breast ca

关 键 词：超声检查 二维剪切波弹性成像 肝脏弹性值 化疗性肝损伤 乳腺癌 

分 类 号：R737.9[医药卫生—肿瘤]