声脉冲辐射力成像定量评价肝移植术后非外科并发症的诊断价值

Evaluation of acoustic radiation force impulse in diagnosing non-surgical complications after livertransplantation

目的探讨声脉冲辐射力成像（acoustic radiation force impulse, ARFI）技术在肝移植术后评价非外科因素并发症的临床意义。方法对372例肝移植术后肝功能转归异常患者（排除外科并发症）行肝组织穿刺活检前应用ARFI测定肝脏剪切波速度（shear wave velocity，SWV），按照病理结果进行分组，并与23例肝移植术后肝功能转归正常者进行比较，另随机选取26例正常人作为对照组。结果①本组372例肝组织活检穿刺病理结果中，排异反应100例，胆道并发症82例，肝炎病毒感染52例，药物性肝损害49例，无特异性表现56例，脂肪变性9例，缺血缺氧改变3例，保存性损伤2例，组织学诊断不明确19例。②对照组SWV（1．49±0．66）m／s，肝功能转归正常组SWV（1．64±0．68）m／s，两组间差异无统计学意义（P〉0．05）；肝功能转归异常组SwV（2．08±0．66）m／s，明显高于肝功能转归正常组及对照组（P〈0．01）。③在肝移植术后非外科并发症明确病理分型中，肝炎病毒组swV最高[（2．29±0．72）m／s]，药物性肝损害组SWV最低[（1．94±0．57）m／s3，两组间差异有统计学意义（P〈0．01）。①ROC曲线结果显示swV测值诊断肝移植术后肝功能转归不良的曲线下面积为0．688，鉴别药物性肝损害和肝炎病毒感染的曲线下面积为0．655。结论ARFI作为一种无创的检测技术与组织病理学具有相关性，对于肝移植术后非外科因素的肝功能异常鉴别诊断具有一定的诊断价值。

Objective To evaluate the clinical significance of acoustic radiation force impulse （ARFI） technique in the assessment of non surgical complications after liver transplantation. Methods Three hundred and seventy-two patients with abnormal liver function after liver transplantation undergone ARFI exam before liver biopsy （excluding surgical complications）. The shear wave velocity （SWV） between different groups divided according pathological results after biopsy was compared, and SWV of 23 patients with normal liver function after liver transplantation was compared too. Moreover, 26 normal people were random selected as control group. Results ①Among the 372 patients, there were 100 cases of rejection,82 cases of biliary complications, 52 cases of hepatitis virus infection, 49 cases of drug induced liver injury, 56 cases of non-specific manifestation, 9 cases of steatosis, 3 cases of hypoxic ischemic, 2 cases of inappropriate preserve injury and 19 cases of diagnosis were not clear. ②SWVof control group was （1.49±0.66）m/s,of normal liver function group was （1.64±0.68）m/s, of abnormal liver function group was （2.08± 0.66） m/s. Abnormal liver function group had higher SWV than normal liver function group and control group （P〈0.01）. There was no significant difference between normal liver function group and control group （P〉0.05）. ③In the specific pathology manifestation patients, hepatitis virus infection group had the highest SWV[（2.29± 0.72）m/s] ,drug induced liver injury group had the lowest SWV[（1.94±0.57）m/ s], and there were significant differences between two groups （ P 〈0. 01 ）. ④The ROC results showed that the area under curve of ARFI was 0. 688 for patients with abnormal liver function after liver transplantation, and 0.655 for differential diagnosis between drug induced liver injury and hepatitis virus infection.Conclusions As a noninvasive technique, ARFI is correlated with histopathology and has clinical value in the differential diagnosis of non-surgical complications after transplantation.