超声弹性成像诊断抗结核药物性肝损害的临床价值

Clinical value of ultrasound elastography in the diagnosis of anti-tuberculosis drug-induced liver injury

目的探讨超声弹性成像技术无创性评估抗结核药物性肝损害的临床价值及预测抗结核药物性肝损害发生风险。方法选取2020年1月至12月就诊于深圳市第三人民医院的56例结核病住院患者,分为抗结核药物性肝损害组(n=26),无抗结核药物性肝损害组(n=30),另外纳入30例健康体检者为对照组(n=30),所有受检者接受二维超声、声触诊弹性成像(STE)、声触诊弹性定量(STQ)及肝功能血生化检测。采用ROC曲线分析超声弹性成像诊断抗结核药物性肝损害的诊断效能,采用Logistic单因素及多因素回归分析筛选抗结核药物性肝损害的独立危险预测因素。结果①脾长、肝脏STE测值、肝脏STQ测值在抗结核药物性肝损害组中均高于对照组和抗结核无药物性肝损害组。②肝脏STE测值、肝脏STQ测值和脾脏STE测值诊断抗结核药物性肝损害的灵敏度分别为88.46%、80.77%、69.23%,特异度分别为96.77%、86.89%、73.68%;曲线下面积分别为0.978、0.894、0.739。③多因素Logistic回归分析显示肝脏STE测值是抗结核药物性肝损害的独立预测因素。结论超声弹性成像尤其是肝脏STE测值对抗结核药物性肝损害的诊断和风险预测具有临床价值。

Objective To explore the clinical application value of ultrasound elastography in non-invasive evaluating anti-tuberculosis drug-induced liver injury and predicting the risk of it to avoid the aggravation of patients’condition.Method Fifty-six patients hospitalized at the Third People’s Hospital of Shenzhen from January to December 2020 were selected and divided into two groups:anti-tuberculosis group with liver injury(n=26)and anti-tuberculosis group without liver injury(n=30).Thirty healthy volunteers were enrolled in this study as the normal control group(n=30).All subjects underwent two-dimensional ultrasound examination,ultrasound elastography and blood biochemical test.Receiver operating characteristiccurves(ROC)were used to analyze the efficacy of ultrasound elastography in the diagnosis of anti-tuberculosis drug-induced liver injury.Logistic regression analysis was used to screen the independent risk predictors of anti-tuberculosis drug-induced liver injury.Result①The values of spleen length,liver STE and liver STQ in the anti-tuberculosis group with liver injury were significantly higher than those in the control group and the anti-tuberculosis group without liver injury.②The sensitivity of liver STE,liver STQ and splenic STE in the diagnosis of anti-tuberculosis drug-induced liver injury were 88.46%,80.77%and 69.23%respectively,and the specificity was 96.77%,86.89%and 73.68%.The areas under the curve were 0.978,0.894 and 0.739.③Logistic multivariate regression analysis showed that liver STE was an independent predictor of anti-tuberculosis drug-induced liver injury.Conclusion Ultrasound elastography,especially liver STE,has clinical value for the risk prediction and diagnosis of anti-tuberculosis drug-induced liver injury.