剪切波弹性成像在脑死亡供肝质量评估的应用价值研究

Application value of shear wave elastography in assessment of liver grafts from brain death donor

目的探讨剪切波弹性成像在脑死亡供肝质量评估中的应用价值。方法脑死亡供肝39例术前分别行超声检查、SWE测量及相关实验室检查,根据受体术后早期肝功能恢复情况,将对应供肝分为早期肝功能恢复延迟组(EAD)和早期肝功能恢复正常组(非EAD),并对结果进行统计分析。结果肝移植术后EAD组SWE弹性值、超声分级、受体MELD评分、受体TBIL均较非EAD组高,差异有统计学意义(P<0.05),供体肝脏SWE值大于4.56kPa是肝移植术后发生EAD的独立危险因素(P=0.013);两组间供体AST、ALT、TBIL、INR、门静脉血流量差异均无统计学意义(P>0.05)。ROC曲线分析可得,供体SWE的最佳阈值为4.56kPa(P<0.001,ROC曲线下面积为0.939)、供体超声分级的最佳阈值为3.5级(P=0.003,ROC曲线下面积为0.806)、受体MELD评分的最佳阈值为11.05(P=0.011,ROC曲线下面积为0.739)、受体TBIL的最佳阈值35.5mg/dL(P=0.020,ROC曲线下面积为0.717)。结论剪切波弹性成像技术可以评价脑死亡供肝硬度值,并与肝移植受体术后EAD发生有一定关联,对脑死亡供肝质量的评估有应用价值。

Objective To investigate the value of shear wave elastography(SWE)in evaluating the liver grafts from brain death donor(DBD).Methods Thirty-nine cases of DBD were detected by ultrasonography,SWE and laboratory before operation.The donors were classified into two groups by early allograft function of transplant recipients:early allograft dysfunction(EAD)group and early allograft function normal(non-EAD)group.Data analysis was used to search for the relationship.Results The SWE value,Ultrasonic grading,MELD score and TBIL of EAD group were significantly higher than those of non-EAD group(P<0.05).The SWE value above 4.56 kPa was a independent risk factor for EAD(P=0.013);but there was no significant difference in the laboratory data and portal venous flow(P>0.05).The receiver operating characteristic(ROC)curve revealed that the optimal cut-off value of SWE was 4.56 kPa〔P<0.001,aera under ROC curve(AUC)=0.939〕,the optimal cut-off value of ultrasonic grading was level 3.5(P=0.003,AUC=0.806),the optimal cut-off value of MELD score was 11.05(P=0.011,AUC=0.739),and the optimal cut-off value of TBIL of transplant recipient was 35.5 mg/dL(P=0.020,AUC=0.717).Conclusion SWE is able to assess the liver stiffness of DBD with a high diagnostic accuracy.There is significant relationship between EAD after liver transplantation and the SWE value of liver grafts.SWE is likely to improve the assessment of liver grafts from DBD.