剪切波频散成像评估肝急性移植物抗宿主病的初步研究

Preliminary study of shear wave dispersion imaging in the evaluation of hepatic acute graft-versus-host disease

目的探讨剪切波频散(SWD)成像技术评估肝脏急性移植物抗宿主病(aGVHD)的可行性。方法纳入42只Wistar大鼠作为受体,10只Fischer 344大鼠作为供体,进行骨髓移植,以建立aGVHD模型。每周随机选择6只大鼠,进行临床观察并评分;随后行超声SWD检查,以获得剪切波速度(SWS)及剪切波频散斜率(SWDS)。以组织学特征为参考标准,将大鼠分为未发生aGVHD(nGVHD)组和aGVHD组。比较两组临床评分及SWD测值的差异,并利用二元Logistic回归分析筛选差异有统计学意义的指标,得出预测参数;绘制ROC曲线并比较诊断效能。分析SWS、SWDS、临床评分与病理分级间的相关性。结果与nGVHD组比较,aGVHD组临床评分、SWS及SWDS增高,差异有统计学意义(均P<0.05)。SWDS与病理评分的相关性(r=0.678,P<0.001)高于SWS、临床评分与病理的相关性(r=0.579,P=0.005;r=0.452,P=0.034)。Logistic回归分析筛选SWDS为差异有统计学意义的指标;此外,使用SWDS及预测参数确定的AUC值为0.859、0.886,显著高于临床评分的AUC(0.760)(均P<0.05)。结论SWD成像技术可能成为评估肝脏aGVHD的一种有前景的方法。

Objective To investigate the feasibility of using shear wave dispersion(SWD)imaging in evaluating acute graft-versus-host disease(aGVHD)of the liver.Methods A total of 42 Wistar rats were used as receptors and 10 Fischer 344 rats were used as donors for bone marrow transplantation to establish aGVHD models.Six rats were randomly selected every week for clinical observation and scoring.Then,ultrasonic SWD was performed to obtain shear wave speed(SWS)and shear wave dispersion slope(SWDS).Then,the histological characteristics were used as a reference standard,and the rats were divided into two groups:the group without aGVHD(nGVHD group)and the group with aGVHD.The differences in the clinical score and SWD values between the two groups were compared,the meaningful indexes were screened by binary Logistic regression analysis,and the joint prediction parameters were obtained.The ROC curve was plotted and the diagnostic efficiency was compared.The correlations between SWS,SWDS,clinical score and pathological grade were analyzed.Results Clinical score,SWS,and SWDS in aGVHD group were higher than those in the nGVHD group(all P<0.05).The correlation between SWDS and pathological grade(r=0.774,P<0.001)was higher than those between SWS,clinical score and pathological grade(r=0.579,P=0.005;r=0.452,P=0.034).Logistic regression showed that SWDS was a significant indicator.In addition,the AUC values determined by SWDS and predictive parameters were(0.859,0.886),which were significantly higher than the AUC of the clinical score(0.760,P<0.05).Conclusions SWD imaging technology may become a promising method to evaluate hepatic aGVHD.