声辐射力脉冲成像评价儿童肝纤维化的临床应用价值

Clinical value of acoustic radiation force impulse imaging in evaluation of liver fibrosis in children

目的探讨声辐射力脉冲成像(ARFI)评价儿童肝纤维化程度的临床应用价值。方法对70例患有常见肝病的儿童(病例组)和50例健康儿童(对照组)分别行ARFI和血清学检测,比较两组剪切波速度(SWV)和谷草转氨酶与血小板计数比值(APRI)的差异。分析病例组SWV、APRI与肝纤维化METAVIR分级的相关性。绘制受试者工作特征(ROC)曲线,确定肝脏SWV诊断肝纤维化分级≥F1、≥F2、≥F3的截断值,计算其特异性、敏感性和曲线下面积。结果对照组测得SWV值为(1.18±0.12)m/s。病例组F0～F4各级肝纤维化SWV值比较,差异有统计学意义(F=22.38,P<0.05);APRI值比较差异无统计学意义(F=0.926,P=0.455)。SWV值与儿童肝纤维化程度成呈相关(r=0.71,P<0.05);APRI值与肝纤维化程度无相关性。ROC曲线分析表明,肝纤维化分级≥F1时,SWV截断值为1.73 m/s,敏感性54.30%,特异性100%,曲线下面积0.823;肝纤维化分级≥F2时,SWV截断值为1.67 m/s,敏感性89.50%,特异性74.50%,曲线下面积0.895;肝纤维化分级≥F3时,SWV截断值为1.84 m/s,敏感性84.60%,特异性83.30%,曲线下面积0.907。结论 ARFI在无创评价儿童肝纤维化方面有较高的临床价值,尤其能准确评价中重度肝纤维化,为儿童肝病的诊断、治疗及疾病随访提供重要影像学依据。

Objective To explore the clinical application value of acoustic radiation force impulse(ARFI)imaging in evaluating the stage of liver fibrosis in children.Methods ARFI imaging and serologicaltest were performed on 70 children with chronic liver disease( case group)and 50 healthy children(control group).The difference of SWV and the ratio of aspartate aminotransferase(AST)and platelet index(APRI)between the groups were compared,and the correlation between SWV,APRI and histopathological liver fibrosis METAVIR scoring system was analyzed.ROC curve was used to assess the cut-off value of SWV for liver fibrosis stages≥F1,≥F2,≥F3.The sensitivity,specificity and the area under the ROC curve were calculated.Results There were significant differences in SWV values between F0 and F4 levels of liver fibrosis(F=22.38,P<0.05),and no significant differences in APRI values(F=0.926,P=0.455).The SWV was correlated with the stage of liver fibrosis(r=0.71,P<0.05),while the APRI values had no correlation with liver fibrosis stages(r=-0.02,P>0.05).ROC curve analysis showed:cut-off values of SWV for discriminating fibrosis stages≥F1,≥F2,≥F3,were 1.73 m/s,1.67 m/s,1.84 m/s,the sensitivity was 54.30%,89.50%,84.60%,the specificity was 100%,74.50%,83.3%,and the areas under the ROC curves were 0.82,0.89,0.91,respectively.Conclusion ARFI imaging plays an important role in evaluating the liver fibrosis of children,and it provides a reference for diagnosis,treatment and follow up of liver diseases in children.