摘要
目的探讨剪切波弹性成像(shear wave elastrography,SWE)技术测得的肝脏弹性模量值与肝脏纤维化指标的相关性及其在肝硬化Child-Pugh分级中的应用价值。方法选取2015年5月至2018年2月在滨州医学院附属医院就诊的135例乙肝后肝硬化患者,根据Child-Pugh分级将肝硬化患者分为A级48例,B级45例,C级42例,应用SWE技术测得肝脏的EI值,135例患者均检测血清肝脏纤维化指标(血清透明质酸、Ⅲ型前胶原肽、层黏连蛋白、Ⅳ型胶原);将测得的肝脏EI值与Child-Pugh分级及血清肝纤维化4项指标值进行Pearson直线相关性分析及受试者工作特征曲线分析。结果肝硬化患者测得的弹性模量值与Child-Pugh分级、血清透明质酸、Ⅲ型前胶原肽、层黏连蛋白、Ⅳ型胶原的检测值均呈正相关(r=0.812、0.767、0.778、0.792、0.683,P<0.05);弹性模量值与血清肝脏纤维化指标在Child A级中的ROC曲线下面积分别为0.807、0.764、0.612、0.702、0.758;在Child B级中的ROC曲线下面积分别为0.907、0.828、0.787、0.792、0.754;在Child C级中的ROC曲线下面积分别为0.956、0.808、0.857、0.892、0.845。结论弹性模量值为无创性评估肝脏弹性及硬度的指标,其与Child-Pugh分级及血清肝纤维化指标具有显著的相关性,不但能够对肝脏硬化程度进行评估,动态观察肝脏纤维化进展,为临床治疗提供诊疗依据,其在一定程度上可以反应肝功能的储备情况。
Objective To investigate the correlation between liver elastic modulus measured by shear wave elastography and serum fibrosis indexes and its application in the diagnosis of liver cirrhosis and Child-Pugh scoring for cirrhosis.Methods 135 patients in our hospital from May 2015 to February 2018 with chronic hepatitis B cirrhosis after hepatitis B were selected in this study.The patients were divided into Class A(48 cases),Class B(45 cases),Class C(42 cases)according to Child-Pugh scoring system.The liver elastic modulus measured with SWE technique of 135 patients,Serum fibrosis indexes testing including hyaluronic acid(HA)and procollagenⅢ(PCⅢ)and laminin(LN),and collagenⅣ(Ⅳ-C)were performed in all patients.Linear correlation analysis and ceceiver operator characteristic curve analysis were conducted between of liver El and Child-Pugh scoring system and serum liver fibrosis.Results The El values measured in patients with cirrhosis were positively correlated with Child-Pugh scoring system,HA,PCⅢ,LN,IV-C,the correlation coefficients were 0.812,0.767,0.778,0.792,0.683,respectively(P<0.05).The area of El value and serum liver fibrosis index in the ROC curve were 0.807,0.764,0.612,0.702,0.758 in Child A;0.907,0.828,0.787,0.792,0.754 in Child B:0.956,0.808,0.857,0.892,0.845 in Child C.Conclusion The El value is a non-invasive index for assessing liver elasticity and hardness.It has a significant correlation with the Child-Pugh classification and serum liver fibrosis indexes.It can be used to not only assess the degree of liver sclerosis,but also dynamically observe the progress of liver fibrosis.It provides the basis for clinical treatment,which can reflect the reserve of liver function to some extent.
作者
王坤
张文晓
李保卫
王明辉
李高峰
卢艳敏
WANG Kun;ZHANG Wenxiao;LI Baowei;WANG Minghui;LI Gaofeng;LU Yanmin(Department of Medical Ultrasonics,Binzhou Medical University Hospital,Binzhou 256603,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第4期522-526,共5页
The Journal of Practical Medicine
基金
山东省自然科学基金项目(编号:ZR2015HL084)
滨州医学院科技计划项目(编号:BY2013KJ37)。