發(fā)布時(shí)間：2018-02-10 02:13

  本文關(guān)鍵詞： 肝硬化 肝纖維化 超聲檢查 診斷 超聲輻射脈沖成像 實(shí)時(shí)剪切波彈性成像　出處：《中國全科醫(yī)學(xué)》2017年30期 　論文類型：期刊論文

【摘要】：目的探討聲脈沖輻射力成像(ARFI)、實(shí)時(shí)剪切波彈性成像(SWE)診斷肝纖維化程度的價(jià)值,以期為臨床工作提供參考。方法選擇2015年1月—2016年5月于上海市東方醫(yī)院吉安醫(yī)院就診的符合納入標(biāo)準(zhǔn)的慢性肝病患者149例為研究對象。收集患者一般資料,分別采用ARFI、SWE檢測患者的肝實(shí)質(zhì)硬度(LS)。根據(jù)ARFI、SWE檢查結(jié)果,將患者分別分為ARFI檢測到LS組、ARFI未檢測到LS組和SWE檢測到LS組、SWE未檢測到LS組。收集并比較ARFI檢測到LS組與ARFI未檢測到LS組、SWE檢測到LS組與SWE未檢測到LS組患者性別、年齡、BMI、丙氨酸氨基轉(zhuǎn)移酶(ALT)水平。采用多因素Logistic回歸分析計(jì)算ARFI、SWE聯(lián)合的多因素Logistic回歸方程;以超聲引導(dǎo)下肝臟穿刺活檢結(jié)果為金標(biāo)準(zhǔn),分別繪制ARFI、SWE及其聯(lián)合診斷慢性肝病患者肝纖維化程度(≥S2、≥S3、S4期)的受試者工作特征曲線(ROC曲線),計(jì)算ROC曲線下面積(AUC)、靈敏度、特異度。結(jié)果 ARFI檢測到LS率高于SWE(P0.05)。ARFI檢測到LS組與ARFI未檢測到LS組患者性別、年齡、BMI、ALT水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。SWE檢測到LS組與SWE未檢測到LS組患者性別、年齡、ALT水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);SWE檢測到LS組患者BMI低于SWE未檢測到LS組(P0.05)。ARFI、SWE及其聯(lián)合診斷慢性肝病患者肝纖維化≥S2期的AUC分別為0.936[95%CI(0.895,0.978)]、0.837[95%CI(0.754,0.919)]、0.972[95%CI(0.949,0.995)],臨界值分別為1.32 m/s、17.14 kPa、-9.228,靈敏度分別為87.8%、80.0%、91.1%,特異度分別為97.3%、83.8%、91.9%。ARFI、SWE及其聯(lián)合診斷慢性肝病患者肝纖維化≥S3期的AUC分別為0.915[95%CI(0.859,0.970)]、0.867[95%CI(0.796,0.938)]、0.910[95%CI(0.851,0.968)],臨界值分別為1.45 m/s、25.36 kPa、7.114,靈敏度分別為90.9%、85.5%、90.9%,特異度分別為88.9%、87.5%、91.7%。ARFI、SWE及其聯(lián)合診斷慢性肝病患者肝纖維化S4期的AUC分別為0.860[95%CI(0.746,0.974)]、0.948[95%CI(0.902,0.993)]、0.975[95%CI(0.949,1.000)],臨界值分別為1.52 m/s、38.54 kPa、1.878,靈敏度分別為88.0%、96.0%、96.0%,特異度分別為92.2%、93.1%、91.2%。ARFI單獨(dú)診斷慢性肝病患者肝纖維化≥S2、≥S3期的AUC大于SWE,診斷慢性肝病患者肝纖維化S4期的AUC小于SWE(P0.05)。ARFI單獨(dú)診斷慢性肝病患者肝纖維化≥S2、S4期的AUC小于ARFI、SWE聯(lián)合(P0.05);ARFI單獨(dú)診斷慢性肝病患者肝纖維化≥S3期的AUC與ARFI、SWE聯(lián)合比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。SWE單獨(dú)診斷慢性肝病患者肝纖維化≥S2、≥S3、S4期的AUC小于ARFI、SWE聯(lián)合(P0.05)。結(jié)論 ARFI、SWE聯(lián)合診斷肝纖維化程度的價(jià)值較單獨(dú)ARFI、SWE好。
[Abstract]:Objective to evaluate the diagnostic value of acoustic pulse radiation force imaging (ARFI) and real time shear wave elastic imaging (SWE) in the diagnosis of hepatic fibrosis. Methods from January 2015 to May 2016, 149 patients with chronic liver disease who met the inclusion criteria in Ji'an Hospital of Oriental Hospital of Shanghai were selected as the study objects. The general data of the patients were collected. The hardness of liver parenchyma was detected by ARFI SWE. The patients were divided into two groups: ARFI detected LS group not detected LS group and SWE group detected LS group not detected LS group. Collected and compared ARFI detected LS group and ARFI group not detected LS group detected LS group and SWE group did not detect sex of LS group. The multivariate Logistic regression analysis was used to calculate the multivariate Logistic regression equation of ARFISWE combined with ARFISWE, and the results of liver biopsy guided by ultrasound were used as the gold standard. The operating characteristic curves of patients with chronic liver disease (鈮，

本文編號：1499417