肝脏横向剪切波速度与肝纤维化指标的相关性及其在肝硬化Child-Pugh分级中的应用

Correlation between Liver Shear Wave Velocity and Serum Fibrosis Markers and Its Application in Child-Pugh Scoring for Liver Cirrhosis

目的:探讨声脉冲辐射力成像(acoustic radiation force impulse,ARFI)技术测得的肝脏横向剪切波速度(shear wave velocity,Vs)与肝纤维化指标的相关性及在诊断肝硬化、肝硬化Child-Pugh分级中的应用。方法:回顾分析2013年7月—2014年7月在上海市徐汇区大华医院就诊的150例肝硬化患者及50例健康人应用ARFI技术测得的Vs值,将150例肝硬化患者作为观察组并按照Child-Pugh分级标准分为A级50例、B级50例、C级50例,将50例健康人作为对照组。所有研究对象均行血清肝纤维化4项指标(透明质酸、层黏蛋白、Ⅲ型前胶原、Ⅳ型胶原)的检测,采用独立样本t检验比较观察组与对照组间测量指标的差异;将观察组Vs值与血清肝纤维化4项指标值进行Pearson直线相关分析及受试者工作特征(receiver operator characteristic,ROC)曲线分析。结果:观察组Vs值、透明质酸、层黏蛋白、Ⅲ型前胶原、Ⅳ型胶原值均高于对照组(P<0.01);观察组Vs值与透明质酸、层黏蛋白、Ⅲ型前胶原、Ⅳ型胶原值均呈正相关(r=0.672、0.672、0.765、0.568,P<0.01);Vs值与血清肝纤维化4项指标在Child A级中的ROC曲线下面积分别为0.85、0.65、0.71、0.63、0.73,在Child B级中的ROC曲线下面积分别为0.93、0.83、0.86、0.84、0.80;在Child C级中的ROC曲线下面积分别为0.99、0.94、0.85、0.95、0.94。结论:Vs值为无创性反映肝脏弹性及硬度的指标,与血清肝纤维化指标具有显著的相关性,其敏感性及特异性较血清肝纤维化4项指标更好,可对肝硬化程度的评估做出定性分析,为临床治疗提供依据。

Objective：To explore the correlation between liver shear wave velocity（Vs）measured with acoustic radiation force impulse（ARFI）imaging technique and serum fibrosis indexes and its application in the diagnosis of liver cirrhosis and ChildPugh scoring for cirrhosis.Methods：The liver Vs value measured with ARFI technique of 150 patients with liver cirrhosis（observation group）and 50 healthy volunteers（control group）who visited Shanghai Dahua Hospital in Xuhui District during Jul2013 and Jul 2014 were analyzed retrospectively.The 150 patients with liver cirrhosis were set as observation group and further divided into Class A（n=50）,Class B（n=50）and Class C（n=50）according to Child-Pugh scoring system.The 50 healthy volunteers were set as control group.Serum fibrosis indexes testing,including hyaluronic acid（HA）and laminin（LN）,procollagenⅢ（PCⅢ）and collagenⅣ（Ⅳ-C）,were performed in all subjects.Differences between the observation group and the control group regarding indexes were compared by using independent sample t-test.Pearson correlation analysis and receiver operator characteristic（ROC）curve analysis were conducted between Vs and four serum indexes in the observation group.Results：The values of Vs,HA,LN,PCⅢ andⅣ-C in the observation group were higher than those in the control group（P〈0.01）.Furthermore,the Vs value in the observation group demonstrated positive correlation with HA,LN,PCⅢandⅣ-C,and the correlation coefficients were 0.672,0.672,0.765 and 0.568,respectively（P〈0.01）.Area under ROC curve of the values of Vs and serum inedxes were 0.85 0.65,0.71,0.63,0.73 in Class A,0.93,0.83,0.86,0.84,0.80 in Class B,and0.99,0.94,0.85,0.95,0.94 in Class C,respectively.Conclusions：Vs,a non-invasive marker for liver elasticity and stiffness,is significantly correlated with serum fibrosis indexes.Its sensitivity and specificity are superior to those of four serum fibrosis indexes.It could provide qualitative analysis for evaluating the severity of liver cirrhosis,so as to offer valuable evidence for further clinical treatment.