声脉冲辐射力弹性成像技术在小儿黄疸中的应用

Application of acoustic radiation force impulse imaging in jaundice of neonatal and little baby

目的探讨声触诊组织量化技术评价新生儿(年龄≤28 d)和婴儿(28 d<年龄≤90 d)黄疸肝损伤的临床应用价值。方法选取2014年10月至2015年5月在北京军区总医院儿童医院收治的183例黄疸患儿,根据临床诊断分为生理性黄疸(124例)与病理性黄疸(59例)2组,病理性黄疸组中依据黄疸天数分为3个亚组,同时选取同期健康新生儿及婴儿162例作为对照组。对各组新生儿和婴儿肝脏进行声脉冲辐射力弹性成像检查,获取剪切波速度(SWV)测值,比较各组间的剪切波平均速度的差异。结果生理性黄疸组肝脏SWV值为(1.13±0.08)m/s,病理性黄疸组肝脏SWV值为(1.20±0.12)m/s,正常组肝脏SWV值为(1.11±0.09)m/s,3组比较差异具有统计学意义(F=11.658,P<0.05)。病理性黄疸组与健康及生理性黄疸新生儿的SWV水平差异均有统计学意义(t=3.548,4.823,P值均<0.01),生理性黄疸组与健康组相比,SWV水平差异无统计学意义(t=1.454,P>0.05)。不同天数黄疸亚组间SWV水平差异具有统计学意义(F=5.619,P<0.01)。结论声触诊组织量化技术用于新生儿和婴儿黄疸肝脏硬度的检测,为新生儿和婴儿黄疸类型及胆汁淤积程度的判断提供了一种新的无创,可定量的方法,有利于患儿肝脏受损程度的监测,从而使黄疸患儿得到及时治疗。

Objective To evaluate the clinical value of virtual touch tissue imaging quantification technique in liver injury of newborn（age ≤ 28 days） and baby（ 28 days, ≤ 90 days）. Methods One hundred and eighty-three patients with jaundice in the Children′s Hospital from 2014 October to 2015 May were divided into two groups： physiological jaundice group（n=124） and pathologic jaundice group（n=59） according to the clinical diagnosis. Based on the number of jaundice days, the pathological jaundice group was divided into three subgroups. At the same time, 162 normal newborns and baby were selected as the control group. Acoustic radiation force impulse imaging（ARFI） was used to detect the shear wave velocity（SWV） of liver tissue in the three groups, and to compare the average velocity of the shear wave among groups/subgroups. Results The average SWV of liver was（1.13±0.08） m/s in physiological jaundice group,（1.20±0.12） m/s in pathological jaundice group, and（1.11±0.09） m/s in normal group, F=11.658, P〈0.05. There were significant differences in the levels of SWV between the pathological jaundice and normal/physiological jaundice（t=3.548, 4.823, P〈0.01）. There was no significant difference in the levels of SWV between physiological jaundice group and normal group（t=1.454, P〉0.05）. The levels of SWV in the different days of jaundice subgroup were significantly different（F=5.619, P〈0.01）. Conclusion Using acoustic touch tissues quantification（VTQ） techniques to measure liver elasticity provides a new noninvasive, safe and quantitative method for the evaluation of jaundice and the degree of cholestasis in the newborn and baby. It can help to monitor the degree of liver damage, so that the jaundice children can receive treatment timely.