本文選題：聲脈沖輻射力成像 + 非酒精性脂肪肝病��； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討聲輻射力脈沖成像技術(shù)(acoustic radiation force impulse,ARFI)中聲觸診組織量化(virtual touch tissue quantification,VTQ)無創(chuàng)評(píng)價(jià)非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)脂肪變性程度的臨床應(yīng)用價(jià)值。方法:全部病例均來自2016年9月-2016年12月的住院患者,行腹部超聲、計(jì)算機(jī)體層掃描(computer tomography,CT)檢查及實(shí)驗(yàn)室檢查,并根據(jù)二維超聲聲像圖、CT結(jié)果將目標(biāo)人群分成:健康人群65例與NAFLD患者155例,后者包括輕度脂肪肝組71例,中度脂肪肝組48例,重度脂肪肝組36例。四組間一般人群特征、血生化指標(biāo)、肝臟及脾臟彈性超聲指標(biāo)多組間計(jì)量資料的比較采用方差分析,兩兩之間比較采用LSD法。計(jì)數(shù)資料采用卡方檢驗(yàn)。相關(guān)分析采用Spearman秩相關(guān),一致性分析采用kappa分析。截?cái)嘀捣治霾捎檬茉囌吖ぷ魈卣髑�(Receive operating charaeteristie curve,ROC),選取靈敏度與特異度相加最大值時(shí)。雙側(cè)P0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:單因素Spearman相關(guān)分析發(fā)現(xiàn)肝VTQ、肝/脾VTQ、APRI均與NAFLD分度具有相關(guān)性,相關(guān)系數(shù)分別為0.61、0.47、0.37(P0.001)。正常組與輕度組肝VTQ、肝/脾VTQ、APRI、ALT、AST無統(tǒng)計(jì)學(xué)意義,重度組的肝VTQ、肝/脾VTQ、APRI、ALT、AST高于正常及輕度組;TG、GT、APO B及HDL均高于正常組;Cys C高于輕度組。中度組的肝VTQ、肝/脾VTQ、APRI、HDL、ALT、AST均高于正常及輕度組;TG、GT、APO B均高于正常組。NAFLD患者輕度脂肪肝組:肝VTQ、肝/脾VTQ和APRI平均值分別為1.16±0.28m/s、0.46±0.14m/s、0.39±0.22,中度脂肪肝組:肝VTQ、肝/脾VTQ和APRI平均值分別為1.45±0.41 m/s、0.59±0.16m/s、0.52±0.23,重度脂肪肝組:肝VTQ、肝/脾VTQ和APRI平均值分別為1.62±0.34 m/s、0.65±0.04m/s、0.57±0.22。三種測值均與NAFLD的嚴(yán)重程度存在正相關(guān),相關(guān)系數(shù)分別為肝VTQ 0.61(P0.001)、肝/脾VTQ 0.47(P0.001)、APRI指數(shù)0.37(P0.001)。ARFI診斷NAFLD程度的輕中重度脂肪肝的肝VTQ截?cái)嘀捣謩e為:1.00m/s、1.22m/s、1.42m/s,ROC曲線下面積分別為:0.57、0.86、0.97,靈敏度分別為:76%、94%、94%,特異度分別為:60%、71%、92%。ARFI診斷NAFLD程度的輕中重度脂肪肝的肝/脾VTQ截?cái)嘀捣謩e為:0.30m/s、0.51m/s、0.56m/s,ROC曲線下面積分別為:0.51、0.74、0.84,靈敏度分別為:94%、88%、94%,特異度分別為:20%、68%、80%。APRI診斷NAFLD程度的輕中重度脂肪肝截?cái)嘀捣謩e為:0.33×10~9、0.43×10~9、0.50×10~9,ROC曲線下面積分別為:0.55、0.71、0.81,靈敏度分別為:57%、58%、70%,特異度分別為:60%、75%、83%。肝VTQ和CT結(jié)果的一致性檢驗(yàn),Kappa=0.7721,P=0.007。結(jié)論:肝VTQ、肝/脾VTQ和APRI指數(shù)對(duì)NAFLD的輕中重度脂肪肝的定量評(píng)價(jià)中都是有意義的,ARFI技術(shù)作為實(shí)時(shí)超聲彈性成像技術(shù),較APRI指數(shù)能更準(zhǔn)確的無創(chuàng)定量評(píng)價(jià)NAFLD嚴(yán)重程度,經(jīng)ARFI技術(shù)測定的肝VTQ值較肝/脾VTQ值更能準(zhǔn)確、全面的定量評(píng)價(jià)NAFLD嚴(yán)重程度。Kappa=0.7721,P=0.007,說明ARFI技術(shù)中的肝VTQ與CT檢查這兩種檢測方法對(duì)于非酒精性脂肪性肝病的定量評(píng)估一致性較好。
[Abstract]:Objective: to evaluate the clinical application value of acoustic palpation tissue quantification (virtual touch tissue quantificationVTQ) in non-alcoholic fatty liver disease (nonalcoholic fatty liver disease) with nonalcoholic fatty liver disease (nonalcoholic fatty liver). Methods: all the patients were admitted from September 2016 to December 2016. Abdominal ultrasound, computer tomographic CT and laboratory examination were performed. According to the results of two-dimensional ultrasonography and CT, the target population was divided into five groups: 65 healthy persons and 155 NAFLD patients, including 71 cases of mild fatty liver group, 48 cases of moderate fatty liver group and 36 cases of severe fatty liver group. The analysis of variance was used to compare the general population characteristics, blood biochemical indexes, liver and spleen elastic ultrasound data among the four groups, and the LSD method was used to compare the data between the two groups. The counting data were checked by chi-square test. Spearman rank correlation was used for correlation analysis and kappa analysis was used for consistency analysis. The truncation value was analyzed by the receiver operating charaeteristie curve (ROC), when the sensitivity and specificity were added to the maximum value. Bilateral P0.05 had statistical significance. Results: single factor Spearman correlation analysis showed that liver VTQ, liver / spleen VTQQ APRI were correlated with NAFLD scores, the correlation coefficients were 0.61T 0.47 (P 0.001). There was no significant difference between normal group and mild group in liver VTQ, liver / spleen VTQ APRIAPRI AST, but in severe group, liver VTQ, liver / spleen VTQP APRI ALTO B and HDL in severe group were higher than those in normal group and mild group, which were higher than those in mild group. The mean values of liver VTQ, liver / spleen VTQ and APRI in moderate group were 1.16 鹵0.28 m / s 0.46 鹵0.14 msec 0.39 鹵0.22 in moderate fatty liver group, higher than those in normal group and mild group respectively. The mean value of liver VTQ, liver / spleen VTQ and APRI in mild fatty liver group were higher than those in normal group and mild group. The mean value of liver VTQ, liver / spleen VTQ and APRI in moderate fatty liver group were 1.16 鹵0.28 m / s 0.46 鹵0.14 msP / s 0.39 鹵0.22, respectively. In moderate fatty liver group: liver VTQ, liver / spleen VTQ and APRI were higher than those in mild fatty liver group. The mean values of liver VTQ, liver / spleen VTQ and APRI in severe fatty liver group were 1.62 鹵0.34 m / s 0.65 鹵0.04 msg / s 0.57 鹵0.22, respectively. The three values were positively correlated with the severity of NAFLD. The correlation coefficients were liver VTQ 0.61 (P0.001), liver / spleen VTQ 0.47 (P0.001) and APRI index 0.37 (P0.001) .ARFI for the diagnosis of NAFLD mild, moderate and severe fatty liver, respectively. The liver VTQ truncation value of liver VTQ of NAFLD was 1.22ms1.22ms1.22ms1.42 msROC, respectively. The liver / spleen VTQ truncation values of mild, moderate and severe fatty liver were: 0. 30 m / s / s 0.51 m / s ~ 0. 51 m / s ~ 0. 56 m / s ~ (-1) ROC = 0: 0. 51 / 0. 744 ~ 0. 84, respectively, sensitivity = 1: 94 ~ 88 ~ 88 ~ 94 ~ 94, and specificity = 1 / 20 ~ 68 ~ 80. APRI = 0. 33 脳 10 ~ 90 ~ 0. 43 脳 10 ~ 10 ~ 90. 43 脳 10 ~ 0. 50 脳 10 ~ 9 ~ (9) ROC, respectively. The area under the curve was: 0. 33 脳 10 ~ (90.43) 脳 10 ~ 0 ~ 0. 50 脳 10 ~ 9 ~ (9) ROC, respectively. With a sensitivity of 0. 557 and 58, respectively, the sensitivity is 0. 05 and 0. 71, and the sensitivity is 0. 70, and the specificity is: 60, 75 and 83, respectively. The conformance test of liver VTQ and CT results showed that Kappa was 0. 7721 and P was 0. 007. Conclusion: the quantitative evaluation of liver VTQ, liver / spleen VTQ and APRI index in NAFLD patients with mild, moderate and severe fatty liver is of significance as a real-time ultrasonic elastic imaging technique, which is more accurate and noninvasive than APRI index in evaluating the severity of NAFLD. The VTQ of liver measured by ARFI technique was more accurate than that of liver / spleen VTQ. The comprehensive and quantitative evaluation of NAFLD severity. Kappaa 0.7721 P0. 007, which indicated that the two methods of liver VTQ and CT in ARFI technique were more consistent in quantitative evaluation of non-alcoholic fatty liver disease.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575;R445.1

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本文編號(hào)：2094279