基于声辐射力脉冲成像的诊断模型对胆道闭锁患儿肝纤维化的应用价值  

Application value of an acoustic radiation force impulse diagnostic model in pediatric biliary atresia-related hepatic fibrosis

作　　者：樊艳辉[1] 刘蕾[1] 聂丽丽[1] 张会欣 耿建磊[1] 贺新建[1] FAN Yanhui;LIU Lei;NIE Lili;ZHANG Huixin;GENG Jianlei;HE Xinjian(Ultrasound Diagnosis Department,Hebei Provincial Children’s Hospital,Shijianzhuang 050031,China)

机构地区：[1]河北省儿童医院超声诊断科,石家庄050031

出　　处：《国际医学放射学杂志》2024年第1期26-30,共5页International Journal of Medical Radiology

摘　　要：目的分析基于声辐射力脉冲成像(ARFI)定量参数建立的无创诊断模型对胆道闭锁患儿肝纤维化的诊断价值。方法回顾性收集100例接受ARFI检查并行肝门-空肠吻合术(Kasai’s)治疗及肝组织活检的胆道闭锁患儿,男42例,女58例,平均年龄(68.79±8.79)d。根据活检病理结果分为肝纤维化组(71例)和非肝纤维化组(29例)。依据Metavir分级标准将肝纤维化分为5级:F0(29例)、F1(31例)、F2(24例)、F3(11例)、F4(5例)。2组临床资料和ARFI定量参数的比较采用t检验或χ^(2)检验;采用单因素方差分析比较肝纤维化不同分级间的剪切波速度(SWV)。采用多因素Logistic回归分析影响胆道闭锁患儿发生肝纤维化的独立危险因素,并构建基于ARFI定量参数的无创诊断模型。采用受试者操作特征(ROC)曲线评价模型的诊断效能,计算其曲线下面积(AUC)。结果肝纤维化组血清中性粒细胞(NEUT)、总胆红素(TBIL)、层黏蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-Col)浓度,以及SWV均高于非肝纤维化组(均P<0.05)。多因素Logistic回归分析结果显示,SWV、血清TBIL及LN、HA、PCⅢ、Ⅳ-Col浓度高是影响胆道闭锁患儿发生肝纤维化的危险因素(均P<0.05)。基于SWV的无创诊断模型诊断胆道闭锁患儿发生肝纤维化的最佳临界值为1.75 m/s,敏感度、特异度、准确度、阳性预测值、AUC分别为93.15%、70.09%、90.25%、88.80%、0.922。结论基于ARFI定量参数建立的无创诊断模型,可较为准确地诊断出胆道闭锁患儿是否存在肝纤维化,且具有较高的应用价值。Objective To analyze the diagnostic value of noninvasive diagnostic model based on quantitative parameters of acoustic radiation force impulse(ARFI)for hepatic fibrosis in children with biliary atresia.Methods A total of 100 children with biliary atresia who underwent ARFI examination,hepatohilar-jejunostomy(Kasai procedure)and liver biopsy were retrospectively collected,including 42 males and 58 females,with an average age of(68.79±8.79)days.According to the biopsy results,the patients were divided into hepatic fibrosis group(71 cases)and non-hepatic fibrosis group(29 cases).Liver fibrosis was classified into five grades according to the Metavir grading standard:F0(29 cases),F1(31 cases),F2(24 cases),F3(11 cases)and F4(5 cases).The clinical data and ARFI quantitative parameters of the two groups were compared by t-test or χ^(2) test.The shear wave velocity(SWV)values among different stages of hepatic fibrosis were compared using one-way ANOVA.Multivariate Logistic regression was used to analyze independent risk factors for liver fibrosis in children with biliary atresia.Subsequently,a noninvasive diagnostic model based on ARFI quantitative parameters was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficiency of the model,and the area under the curve(AUC)was calculated.Results Serum levels of neutrophil(NEUT),total bilirubin(TBIL),laminin(LN),hyaluronic acid(HA),procollagen typeⅢ(PCⅢ),Ⅳtypecollagen(Ⅳ-Col),and SWV in hepatic fibrosis group were higher than those in non-hepatic fibrosis group(all P<0.05).The difference of SWV among F0-F4 grades was statistically significant,and SWV increased gradually with the increase of F0-F4 grades(P<0.05).Multivariate Logistic regression analysis showed that high concentrations of SWV,serum TBIL,LN,HA,PCⅢ,andⅣ-Col were risk factors for liver fibrosis in children with biliary atresia(all P<0.05).The optimal critical value of SWV-based noninvasive diagnostic model for diagnosing liver fibrosis in children with bili

关 键 词：声辐射力脉冲成像 剪切波速度 胆道闭锁 肝纤维化 无创诊断模型 

分 类 号：R575[医药卫生—消化系统] R445.1[医药卫生—内科学]