【摘要】：目的探討聲脈沖輻射力成像技術(shù)(ARFI)與肝纖維化積分(FibroScore,由結(jié)合珠蛋白、γ-谷氨酰轉(zhuǎn)肽酶和血小板計(jì)數(shù)3項(xiàng)指標(biāo)構(gòu)成的肝纖維化無(wú)創(chuàng)性預(yù)測(cè)模型)評(píng)價(jià)家兔肝纖維化的價(jià)值。 方法應(yīng)用硫代乙酰胺(TAA)對(duì)32只家兔以皮下注射的方法建立肝纖維化模型,8只家兔作為對(duì)照組。于首次注射后第4,8,12周分批進(jìn)行聲脈沖輻射力成像檢查,獲取反映肝剪切波速度的聲觸診組織量化值(shear wave velocity, Vs),并計(jì)算FibroScore。隨后處死家兔,取其肝臟行病理學(xué)分析。計(jì)量資料(偏態(tài))用中位數(shù)(四分位間距)表示；采用Spearman相關(guān)分析檢驗(yàn)FibroScore、Vs與肝纖維化病理分級(jí)間的相關(guān)性,采用多組間秩和檢驗(yàn)檢測(cè)不同肝纖維化組間的FibroScore、Vs的差別并用最小顯著差異法進(jìn)一步行兩兩比較,對(duì)FibroScore和Vs的診斷效率行受試者工作特征(ROC)曲線(xiàn)分析。以病理檢查結(jié)果為金標(biāo)準(zhǔn),比較分析聲觸診組織量化值和FibroScore對(duì)家兔肝纖維化分期的診斷價(jià)值。 結(jié)果29只家兔造模成功,其中肝纖維化分期為S1、S2、S3和S4期的分別有10、8、7和4只。聲觸診組織量化值和FibroScore均隨纖維化程度的增加而增大,各組間差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。Vs判別顯著纖維化(S≥2)、嚴(yán)重纖維化(S≥3)、肝硬化(S=4)和任何程度纖維化(S≥1)的曲線(xiàn)下面積(AUC)分別為0.87、0.82、0.89、0.92,準(zhǔn)確率分別為84%、73%、75%和87%。FibroScore判別顯著纖維化(S≥2)、嚴(yán)重纖維化(S≥3)、肝硬化(S=4)和任何程度纖維化(S≥1)的曲線(xiàn)下面積(AUC)分別為0.86、0.79、0.82、0.84,準(zhǔn)確率分別為81%、66%、70%和83%。 結(jié)論ARFI與FibroScore均能較準(zhǔn)確預(yù)測(cè)顯著肝纖維化,ARFI具有更高的預(yù)測(cè)價(jià)值,二者聯(lián)合應(yīng)用可以提高診斷率。
[Abstract]:Objective to evaluate the value of acoustic pulse radiography (ARFI) and hepatic fibrosis score (FibroScore, a noninvasive predictive model of hepatic fibrosis in rabbits, which consists of three indexes: binding globin, 緯 -glutamyl transpeptidase and platelet count). Methods Hepatic fibrosis model was established by subcutaneous injection of thioacetamide (TAA) in 32 rabbits as control group. Acoustic pulse radiography was performed in batches at 812 weeks after the first injection to obtain the quantitative value of acoustic palpation tissue (shear wave velocity, Vs),) which reflected the velocity of liver shear wave and to calculate FibroScore. Then the rabbits were killed and their liver was taken for pathological analysis. The quantitative data (skewness) were expressed as median (quartile spacing), and the correlation between FibroScoreus Vs and pathological grade of hepatic fibrosis was examined by Spearman correlation analysis. Multigroup rank sum test was used to detect the difference of FibroScoreVs in different liver fibrosis groups and the least significant difference method was used to further compare them. The diagnostic efficiency of FibroScore and Vs was analyzed by (ROC) curve. The quantitative value of acoustic palpation and FibroScore in the diagnosis of hepatic fibrosis stage in rabbits were compared and analyzed according to the results of pathological examination as gold standard. Results the models of 29 rabbits were successfully established, of which there were 10 7 and 4 hepatic fibrosis stages in S _ (1) S _ (2) S _ (2) S _ (3) and S _ (4), respectively. The quantitative value of acoustic palpation tissue and FibroScore increased with the increase of fibrosis degree. There were significant differences among the three groups (P < 0. 05). Vs discriminating marked fibrosis (S 鈮，

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