实时弹性成像定量诊断脂肪肝患者肝纤维化程度的研究

摘要

目的：探讨实时弹性成像（RTE）技术定量诊断肝纤维化的价值。方法应用RTE定量分析技术对86例新疆地区中、重度脂肪肝患者进行肝脏超声检查（S0，n=18、S1，n=18、S2，n=20、S3，n=10、S4，n=20），通过自带分析软件得到12个弹性参数，并与肝纤维化病理分级结果对比分析。结果应变均值（MEAN）、蓝色领域%（AREA％）及弹性指数（LF）与肝纤维化程度高度相关，相关系数分别为－0．677（P＜0．05）、0．662（P＜0．05）及0．637（P＜0．05）；分别绘制ROC曲线判断其诊断肝纤维化分期的准确性，并得出区分肝纤维化分期的截断值，MEAN、％AREA及LF在S0、S1、S2、S3期时ROC曲线下面积分别为0．896、0．839、0．823、0．875（MEAN）；0．890、0．844、0．822、0．783（％AREA）；0．892、0．844、0．838、0．853（LF）。 MEAN、％AREA、LF在区分S0、S1、S2期时的截断值分别为102．60、88．20、86．30（MEAN）；31．26、38．86、40．28（％AREA）；3．10、3．20、3．87（LF）。结论 RTE在定量诊断肝纤维化中有一定的临床应用价值。%Objective To evaluate the value of real-time tissue elastography(RTE) with a new quantitative technology in the assessment of hepatic fibrosis. Methods RTE was performed in 86 patients with moderate or severe fatty liver (S0,n=18, S1,n=18,S2,n=20,S3,n=10,S4,n=20). Twelve parameters were recorded automatically, and then each parameter was compared between different pathological stages confirmed by liver biopsies. Results Among these parameters, MEAN, LF and%AREA were highly correlated to hepatic fibrosis degress. The correlation coefficients were -0.677, 0.662 and 0.637, respectively(all P<0.05). The areas under the ROC curve were depicted and the cutoff values for the differentiation of S0,S1,S2,S3 stages were 0.896,0.839,0.823,0.875(MEAN),0.890,0.844,0.822,0.783(%AREA) and 0.892,0.844,0.838,0.853(LF), respectively. The cutoff values for the differentiation of S0, S1, S2 were 102.60,88.20,86.30(MEAN), 31.26,38.86,40.28(%AREA), 3.10,3.20,3.87(LF), respectively. Conclusion RTE has a high clinical value in the quantitative diagnosis of liver fibrosis.