多参数超声联合血液指标在慢性肝病进展风险分层中的价值评估  

The Value Evaluation of Multi-Parameter Ultrasound Combined with Haematological Indicators in Risk Stratification of the Progression of Chronic Liver Disease

作　　者：乔晓慧 李雪齐 薛立云 程广文 梁静 邱路萍 丁红 Qiao Xiaohui;Li Xueqi;Xue Liyun;Cheng Guangwen;Liang Jing;Qiu Luping;Ding Hong(Department of Ultrasound,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院超声医学科,上海市200040

出　　处：《中国超声医学杂志》2024年第11期1262-1266,共5页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.82302217,82202185);上海市科技计划项目(No.22Y11911500)。

摘　　要：目的探讨超声剪切波弹性成像(SWE)、剪切波频散成像(SWD)、衰减成像(ATI)联合血液学指标对慢性肝病患者进展风险分层的评估价值。方法前瞻性收集进行肝脏穿刺活检的慢性肝病患者,在穿刺前进行SWE、SWD及ATI检查,记录患者的基线资料以及血液指标。以病理为金标准,高风险肝病定义为显著炎症合并显著纤维化。通过单因素及多因素Logistic回归分析筛选高风险肝病的影响因素,建立预测模型,采用受试者工作特征曲线、校准曲线评估模型的准确度和稳定性。结果SWE测值肝脏硬度(LS)、SWD测值频散斜率(DS)、丙氨酸转氨酶(ALT)和空腹血糖(FBG)是高风险肝病的独立影响因素(P<0.05),基于上述指标构建预测模型。训练集中,LS、DS及预测模型诊断高风险肝病的曲线下面积分别为0.888、0.887和0.926,在验证集中分别为0.743、0.732和0.835。校准曲线显示,采用预测模型诊断慢性肝病进展高风险患者在训练集和验证集中均具有较好的一致性。结论基于超声SWE、SWD及血液指标ALT、FBG的预测模型可有效识别慢性肝病患者中的高风险人群,为及时进行临床干预提供重要的参考依据。Objective To investigate the value of shear wave elastography(SWE),shear wave dispersion(SWD),attenuation imaging(ATI)and haematological indexes for the risk stratification of the progression of chronic liver disease.Methods The patients with chronic liver diseases who underwent liver biopsy were prospectively collected.SWE,SWD and ATI examinations were carried out before liver biopsy.Meanwhile,the baseline data and haematological indexes related to metabolism and liver function were recorded.The high-risk liver disease was defined as significant inflammation combined with significant fibrosis based on pathological results.Univariate and multivariate Logistic regression analyses were used to screen the factors related to high-risk liver disease and construct predictive model.The receiver operating characteristic(ROC)curve and calibration curve were applied to evaluate the diagnostic efficacy and stability of the model.Results The SWE measurement liver stiffness(LS),SWD measurement dispersion slope(DS),alanine transaminase(ALT)and fasting blood glucose(FBG)were the risk factors of high-risk liver disease(P<0.05),and a prediction model was developed based on these indicators.In training set,the area under the curve(AUC)of LS,DS and the prediction model for identifying high-risk liver disease was respectively 0.888,0.887 and 0.926,and in validation set it was 0.743,0.732 and 0.835,respectively.Calibration curve analysis exhibited good consistency of the predicted and actual high-risk liver disease in both training and validation sets.Conclusions The prediction model based on SWE,SWD,ALT and FBG can effectively identify the high-risk population in patients with chronic liver disease,providing important reference basis for timely clinical intervention.

关 键 词：剪切波弹性成像 剪切波频散成像 衰减成像 高风险肝病 丙氨酸转氨酶 空腹血糖 

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]