声脉冲辐射力成像技术对肝纤维化程度分级的临床研究

Clinical research on acoustic pulse radiation imaging technology assess classification of liver fibrosis

目的探讨声脉冲辐射力成像技术(ARFI)对肝纤维化程度分级的诊断准确性,明确其临床应用价值。方法将2010年6月～2012年8月在我院住院的慢性肝炎患者共200例纳入研究,对所有患者行肝穿刺活检,根据肝活检结果按Metavir分期方法将肝纤维化分为S0～S4期。对所有患者进行超声弹性成像检查,并记录肝脏声触诊组织量化值(VTQ);同时行肝功能及血常规检查,记录门冬氨酸氨基转移酶和血小板数值及APRI值,比较VTQ值和实验室APRI评分的对肝纤维化程度判断的准确性。对所有患者行肝脏CT扫描,并比较CT扫描与超声弹性成像技术在诊断肝纤维化方面的准确性。结果根据肝穿刺活检,200例患者中,40例为S0期,47例为S1期,48例为S2期,35例为S3期,30例为S4期。VTQ速度越高,肝纤维化程度越重(P<0.05),APRI均值越高,肝纤维化程度也越重(P<0.05)。对肝纤维化程度的诊断,VTQ值敏感度为95.23%,特异度为79.04%,准确率为84.97%,阳性预测值为77.04%,阴性预测值为93.98%,均比APRI评分及CT检查高(P<0.05)。结论声脉冲辐射力成像技术可较准确地评估肝纤维化程度,对于评价纤维化有着较好的临床应用价值,值得临床推广。

Objective To study diagnosis accuracy of the RTE score of ARFI for the classification of liver fibrosis, clear the clinical application value. Methods A total of 200 cases of patients with chronic hepatitis from June 2010 to August 2012 in our hospital were included in the study, to all patients with liver biopsy, according to the results of liver biopsy in Metavir stage method,liver fibrosis were divided into S0~S4.All patients to ultrasonic elasticity imaging, did liver function and blood routine examination, recorded nmda amino transferase and platelet numerical and APRI, compared the accuracy of the judgment of the degree of liver fibrosis of VTQ and laboratory APRI score. For all pa- tients of liver CT scanning, and compared CT scans and ultrasound elasticity imaging technology in the diagnosis of liver fibrosis of accuracy. Results According to the liver biopsy, 200 cases of patients, 40 cases are SO, 47 cases are S1, 48 cases were $2, 35 cases were S3, 30 cases were S4. RTE score, the higher, the degree of liver fibrosis was heavier （P 〈0. 05）, APRI mean the higher the degree of liver fibrosis was the heavier （P 〈 0.05）. To the degree of hepatic fibrosis diagnosis, VTQ sensitivity was 95.23%, 79.04% of the specific degree, 84.97% of accuracy, has the positive predictive value was 77.04%, 93.98% of the negatie predictie alue, were higher than APRI score and CT scanning （P 〈 0.05）. Conclusion ARFI can be more accurate assessment of the degree of liver fibrosis, for evaluation of fibrosis has good clinical value, worthy of clinical promotion.