声脉冲辐射力成像技术评估肝纤维化的临床应用

Clinical application of liver fibrosis evaluation with acoustic radiation force impulse

目的探讨声脉冲辐射力成像技术(ARFI)评估不同程度肝纤维化的临床应用价值。方法对健康志愿者250例、肝病患者361例行ARFI检测,测量其声触诊组织量化值(VTQ),统计归纳出肝纤维化程度的增加与VTQ相关性及相应界限值。结果受检361例患者中348例行超声引导下肝脏穿刺活检并行S0～S4分期,不同时期肝纤维化VTQ平均值(m/s):S0(1.21±0.14)、S1(1.26±0.13)、S2(1.36±0.13)、S3(1.77±0.32)、S4(2.23±0.20),正常组(1.11±0.17);各组间除S0和S1期的病例组(P=0.048)并不能说明实际临床上VTQ值差异是否具有临床意义外,其余组间VTQ值差异均有统计学意义(P均<0.001);慢性肝病程度的加重,弹性参数值也随之增加,两者具有一定相关性。结论 ARFI能对肝纤维化程度进行量化分析,从而避免肝脏穿刺活检,为临床提供一种无创、操作简单、可重复性强的肝纤维化程度及疗效的评估手段。

Objective To investigate clinical application value of acoustic radiation force impulse （ARFI） in the as- sessment of liver fibrosis. Methods 250 healthy volunteers and 361 patients with liver disease were detected by ARFI measuring the virtual touch tissues quantification（ VTQ）, the degree of liver fibrosis increased with VTQ correlation and the corresponding threshold value were generalized statistically. Results 348 cases underwent ultrasound guided liver biopsy in parallel SO ～ S4 stages. The mean VTQ （m/s） values from different stages of liver fibrosis were as follows, SO （1.21±0.14）, S1 （1.26±0.13）, $2（1.36±0.13）, $3 （1.77 ±0.32）, $4（2.23±0.20） and the normal group （ 1.11 ± 0.17）. VTQ values in Groups SO and S1 （P = 0. 048） did not display significant clinical application values. The other groups all demonstrated significant clinical application values with significant VTQ value differences （P 〈 0. 001 ）. The relative correlation was found between the elastic parameter and chronic liver diseases. The elastic parame- ter increased as chronic fiver diseases exacerbated. Conclusion ARFI could be used to anlayze quantitatively liver fi- brosis without liver biopsy. The technique will provide a noninvasive, simple and repeatable evaluation method for liver fibrosis and therapeutic efficacy.