超声剪切波弹性成像技术对胆道闭锁筛查与诊断的临床价值分析

Value of shear wave elastography in differentiating biliary atresia from cholestatic hepatitis in infants

目的初步探讨超声剪切波弹性成像(shear wave elastography,SWE)技术对胆道闭锁(biliary atresia,BA)的鉴别诊断价值。方法以2016年11月至2017年12月湖南省儿童医院收治的138例日龄90 d内、疑似胆汁淤积性肝病患儿为研究对象,采用SWE技术对患儿进行肝杨氏模量检测。根据病理诊断结果将所有患儿分为BA组与非BA组,并根据日龄分为≤30 d、31～60 d、61～90 d组。运用受试者操作特性曲线(receiver operating characteristic curve,ROC)得到肝杨氏模量值诊断BA的曲线下面积(area under ROC,AUROC),并计算最佳临界值、敏感性、特异性、阳性预测值、阴性预测值及诊断准确率。结果 138例患儿中,BA组51例,非BA组87例。由ROC曲线结果得出肝杨氏模量值鉴别BA与非BA的最佳临界值为12. 35 k Pa,敏感度为84. 3%,特异度为89. 7%,阳性预测值为82. 7%,阴性预测值为90. 7%,正确率为87. 7%,AUROC为0. 936。以12. 35 k Pa为最佳临界值,≤30 d组、31～60 d组及61～90 d组在肝杨氏模量取最佳临界值时诊断BA的敏感性分别为65. 0%、94. 7%、100%,特异性分别为97. 9%、89. 3%、54. 5%。结论运用SWE技术检测黄疸患儿肝杨氏模量值有助于BA的鉴别诊断,且SWE对日龄30 d以上BA的诊断敏感性更高。

Objective To explore the value of shear wave elastography （SWE） in differentiating biliaryatresia （BA） from cholestatic hepatitis in infants aged under 90 days. Methods SWE was employed for detecting hepatic Youngs modulus of 138 infants aged under 90 days with suspected cholestatic hepatitis. Theywere classified as BA and nonBA groups by surgical or pathological standard. The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of different liver Youngs modulus in the diagnosis ofBA were calculated by receiver operating characteristic curve （ROC）. Results Among them,51 cases werediagnosed as BA and another 87 cases nonBA. ROC analysis showed a cutoff value of 12. 35 kPa for differentiating two groups. The area under ROC （AUROC） curve was 0. 936 with the values of sensitivity,specificity,positive predictive value,negative predictive value and accuracy at 84. 3%,89. 7%,82. 7%,90. 7% and 87. 7%respectively. Using the same cutoff value of 12. 35 kPa,the sensitivity for diagnosing BA was 65. 0%,94. 7%and 100% in ≤30,31 - 60 and 61 - 90 day groups and the specificity 97. 9%,89. 3% and 54. 5% respectively. Conclusion Measuring hepatic stiffness in pediatric patients with jaundice by SWE is helpful to identifyBA and SWE may be more sensitive for infants aged 〉 30 days than those ≤30 days.