ARFI评价急性药物性肝损伤的临床研究

The evaluation study acoustic pulse radiation force imaging in acute drug-induced liver injury

目的探讨声脉冲辐射力成像(ARFI)在急性药物性肝损伤中的应用价值。方法随机选取89例急性药物性肝损伤患者(肝损伤组)及60名健康体检者(健康对照组)作为研究对象,均行超声造影检查及ARFI检查,并检测肝功能指标。比较肝损伤组及健康对照组肝左叶、肝右前叶、肝右后叶剪切波速度。将急性药物性肝损伤患者分为3个亚组,比较3亚组剪切波速度及肝功能指标。采用Spearman相关系数分析剪切波速度与肝功能指标相关性。结果肝损伤组肝左叶、肝右前叶、肝右后叶剪切波速度高于健康对照组,组间比较差异有统计学意义(P<0.05);肝左叶、肝右前叶、肝右后叶剪切波速度组内比较,差异无统计学意义(P>0.05)。急性药物性肝损伤3个亚组剪切波速度及肝功能指标比较,差异均有统计学意义(P<0.05),其中剪切波速度从低到高依次为:C组<B组<A组;ALT、AST、GGT、ALP、Alb从低到高依次为:C组<B组<A组;GLB从低到高依次为:A组<B组<C组。剪切波速度与ALT、AST、GGT、ALP、Alb呈正相关(r值分别为0.518、0.309、0.715、0.474、0.691,P<0.05),与GLB呈负相关(r=-0.412,P<0.05),随着肝功能损伤由轻到重的转变,剪切波速度相应升高。ARFI对急性药物性肝损伤灵敏度、特异度、阳性预测值、阴性预测值、诊断准率分别为89.9%(80/89)、90.0%(54/60)、90.3%(80/86)、85.7%(54/63)、89.9%(134/149)。结论 AFRI有助于急性药物性肝损伤的鉴别诊断,且有助于其病理分型,值得临床上推广应用。

Objective To investigate the application value of acoustic pulse radiation force imaging(ARFI)in acute druginduced liver injury.Methods Eight-nine patients with acute drug-induced liver injury(liver injury group)admitted from January 2013 to November 2015 in our hospital and 60 healthy persons(healthy control group)were randomly enrolled as the study objects.Among all cases,ultrasound contrast examination and ARFI examination were performed,and liver function indexes were detected,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),gammaalanine aminotransferase(GGT),albumin(Alb),and so on.Shear wave speeds of left,right anterior and right posterior liver lobes were compared between the 2 groups,respectively.Furthermore,patients in liver injury group were divided into3 subgroups,among which comparisons of the shear wave speed and liver function indexes were conducted,respectively.And correlation analysis between shear wave speed and liver function indexes was carried out by Spearman correlation coefficient.Results The shear wave speeds of the left lobe,right anterior lobe and right posterior liver lobes in liver injury group were higher than those in healthy control group,respectively,which showed significant difference(P<0.05).However,the comparisons of shear wave speeds among left lobe,right anterior lobe and right posterior lobe within each group had no significant difference(P>0.05),respectively.Comparisons of shear wave speed and liver function indexes among the three subgroups showed significant differences(P<0.05).Shear wave speed showed a rising trend from group C to group B and to group A,so did ALT,AST,GGT,alkaline phosphatase(ALP),Alb;gamma globulin(GLB)showed a rising trend from group A to group B and to group C.Moreover,the shear wave speed had a positive correlation with ALT,AST,GGT,ALP and ALb(r values were respectively 0.518,0.309,0.715,0.474 and 0.691,P<0.05),respectively,and a negative correlation with GLB(r=-0.412,P <0.05),which revealed that shear wave speed increased with aggravation of liver function injury.For acute drug-induced liver injury diagnosis,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accurate rate of ARFI were 89.9%(80/89),90.0%(54/60),90.3%(80/86),85.7%(54/63),89.9%(134/149),respectively.Conclusion AFRI might be helpful in differential diagnosis and pathological typing of acute drug-induced liver injury,which is worthy of clinical promotion and application.