剪切波弹性成像对布加综合征患者肝损害的评价

Evaluation of the liver damage in patients with Budd-Chiari syndrome by shear wave elastography

目的探讨剪切波弹性成像技术对布加综合征(BCS)患者肝损害的评价作用。方法收集2013年5月至2015年7月在广州中医药大学附属第一医院诊治的BCS患者16例,所有患者的诊断结果均经介入治疗或下腔静脉造影证实;收集在广州中医药大学附属第一医院行常规体检的健康志愿者50名,所有志愿者均无任何肝病史、手术史及糖尿病等代谢性疾病。所有研究对象均行常规二维超声检查,且二维超声显示肝脏声像图无明显异常表现。对BCS患者及健康志愿者行肝脏超声弹性检查,分析超声弹性图像特征并获得定量弹性值,对比分析BCS患者及健康志愿者肝脏弹性值之间的差异。结果健康志愿者弹性图像表现为均匀一致的浅蓝色。BCS患者的弹性图像多表现为蓝、绿、黄三色相间的混杂图像。BCS患者肝脏弹性均值、最大值及最小值分别为(18.1±9.4)、(20.6±10.5)及(15.5±8.5)k Pa;健康志愿者肝脏弹性均值、最大值及最小值分别为(6.2±1.0)、(7.5±1.2)及(4.8±1.1)k Pa;BCS患者与健康志愿者肝脏弹性均值、最大值及最小值比较,差异均有统计学意义(t值=7.69、8.94、7.83,P均<0.01)。结论剪切波弹性成像技术可用于早期诊断二维超声图像无异常改变的BCS肝损害患者,对患者治疗方式的选择、疗效及预后评价有一定作用。

Objective To investigate the value of shear wave elastography（SWE） in the evaluation of liver damage in patients with Budd-Chiari syndrome（BCS）. Methods Sixteen patients with BCS which were all confirmed by interventional therapy or inferior vena cava angiography were enrolled in the study. And fifty healthy volunteers who were confirmed with no liver disease history, no surgical history and no metabolic disease such as diabetes were included in this study. All the subjects underwent conventional ultrasound and no obvious abnormality was detected. All the BCS patients and the volunteers underwent SWE. The elastic graph and the quantitative elastic value, including the average value, the maximum value and the minimum value, were acquired and compared between BCS patients and the volunteers. Results The elastic graphs for the healthy volunteers were uniform light blue while the elastic graphs for BCS patients were hybrid images of blue, green and yellow. The average value, the maximum value and the minimum value of BCS patients were（18.1±9.4） k Pa,（20.6±10.5） k Pa and（15.5±8.5） k Pa, which were statistically higher than those of healthy volunteers [（6.2±1.0） k Pa,（7.5±1.2） k Pa and（4.8±1.1） k Pa, t=7.69, 8.94 and 7.83, all P 0.01]. Conclusions SWE can reflect the liver damage of patients with BCS before the change of the two-dimensional ultrasound. It can play an important role in the accurate selection of treatment and the accurate evaluation of treatment effect and the prognosis.