超声弹性成像动态定量评估移植肝质量的作用  

Role of dynamic quantitative evaluation in liver transplantation by ultrasonic elastography

作　　者：于慧敏[1] 唐缨[1] 陈云 张国英[1] 王明阳 Yu Huimin;Tang Ying;Chen Yun;Zhang Guoying;Wang Mingyang(Department 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300192

出　　处：《中华超声影像学杂志》2022年第7期612-619,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82172031);天津市卫健委科技人才培育项目(KJ20078)。

摘　　要：目的探讨超声联合弹性成像在动态定量评估移植肝脏中的价值。方法收集2019年4-12月天津市第一中心医院27例肝移植患者及其供者,应用剪切波弹性成像(SWE)联合实时组织弹性成像(RTE)技术分别对供者术前24 h内供肝及受者术后第1 d、第7 d移植肝进行测定,获得肝脏的弹性模量(E)、应变均值(MEAN)、炎症指数(A)及声衰减测量(ATT)。术中取肝组织行HE染色,观察指标为肝细胞的水样变性、炎症、坏死、脂肪变。于肝移植术后第1 d及第7 d检测血清中丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)、直接胆红素(DB)水平。分析超声参数与病理参数之间的相关性,选取E、MEAN、A、ATT绘制ROC曲线。根据供肝病理分为无或轻度水样变组与中重度水样变组、无炎症组与有炎症组、无脂肪肝组与有脂肪肝组,分别比较对应两组间供肝联合弹性成像参数的差异及移植肝术后第7 d的肝功能及超声参数的差异。分析供肝术前及移植术后第1 d、第7 d超声参数的变化趋势。分析肝移植术后第1 d至第7 d肝功能变化趋势。分析肝移植术后第1 d、第7 d的肝功能与超声参数的相关性。结果①供肝术前24 h超声参数与病理参数的相关性:E与水样变程度及炎症程度呈正相关(rs=0.597、0.497,均P<0.05);MEAN与水样变程度及炎症程度呈负相关(rs=-0.601、-0.584,均P<0.05);A与炎症程度呈正相关(rs=0.452,P=0.016);ATT与脂肪变程度呈正相关(rs=0.564,P=0.006)。②供肝术前24 h超声参数的差异性:中重度水样变组E值高于无或轻度水样变组(P<0.001),MEAN值低于无或轻度水样变组(P<0.001);炎症组E值高于无炎症组(P=0.012),MEAN值低于无炎症组(P=0.026);脂肪肝组ATT高于非脂肪肝组(P=0.006)。③ROC曲线分析:E、MEAN诊断肝细胞中度以上水样变的曲线下面积(AUC)分别为0.882、0.875,临界值分别为8.72 kPa、106.62;诊断有无炎症的AUC为0.898,临界值为1.2Objective To investigate the role of combinational elastography in the dynamic quantitative evaluation of liver transplantation.Methods From April to December 2019 in Tianjin First Central Hospital,27 cases of the liver transplant patients and donors were examined by shear wave elastography and real-time tissue elastography,respectively on donor preoperative within 24 h and postoperative day 1,day 7,in order to obtain liver elastic modulus E,measured average relative strain value(MEAN),the index activity(A)and acoustic attenuation measurement(ATT),and to obtain pathologic specimens during operation,including:hydropic degeneration,inflammation,necrosis,steatosis.AST,ALT,TB,DB were detected by automatic biochemistry analyzeron postoperative day 1,day 7.Correlation analysis was performed for pathological parameters and ultrasonic parameters,E,MEAN,A,ATT were selected to plot ROC curve,to analyze ultrasonic parameters′cut-off value and area under the curve(AUC).According to the pathological signs donor liver were divided into no or mildhydropic group and moderate-to-severehydropic group,non-inflammation group and inflammation group,non-steatosis group and steatosis group.Ultrasonic parameters of donor liver were compared between the two groups,and differences in liver function and ultrasonic parameters on postoperative day 7 were analyzed between the two groups.The change trends of ultrasonic parameters were analyzed from preoperative donor liver to postoperative day 1,day 7 of recipient.The changes of liver function were analyzed from the first day to 7th days.Correlation analysis was performed for liver function and ultrasonic parameters respectively on postoperative day 1,day 7.Results①Correlation of the ultrasonic parameters of donor liver preoperative within 24 h and pathological parameters:E value and hydropic degeneration and inflammation of pathological signs were significantly and positively correlated(rs=0.597,0.497;all P<0.05);MEAN and hydropic degeneration and inflammation of pathological signs were s

关 键 词：超声弹性成像 肝移植 定量 硬度 炎症 脂肪变 

分 类 号：R657.3[医药卫生—外科学] R445.1[医药卫生—临床医学]