实时剪切波弹性成像诊断血吸虫病肝纤维化
|
摘要
目的探讨超声实时剪切波弹性成像诊断血吸虫病肝纤维化的效能。方法采用SurperSonic Imagine AixPlorer型实时剪切波弹性超声诊断仪,检测128例血吸虫肝病患者肝实质弹性模量平均值,根据不同肝纤维化分期将其分为5组,比较5组间弹性模量平均值的差异,并与血清肝纤维化4项指标(血清透明质酸、层黏连蛋白、Ⅲ型前胶原、Ⅳ型胶原)及肝穿刺病理检查结果进行相关性分析;绘制ROC曲线,评价弹性模量平均值诊断肝纤维化的效能。结果血吸虫肝病肝纤维化S0期、S1期、S2期、S3期、S4期肝实质弹性模量平均值总体差异有统计学意义(F=60.810,P=0.035);S0期弹性模量平均值与S2期、S3期、S4期比较差异均有统计学意义(P均<0.05)。肝实质弹性模量平均值与血清血清透明质酸、层黏连蛋白、Ⅲ型前胶原、Ⅳ型胶原及肝纤维化病理分期均呈正相关(r=0.461、0.522、0.452、0.381、0.721,P均<0.05)。肝实质弹性模量平均值对肝纤维化≥S1期、≥S2期、≥S3期和S4期的诊断阈值分别为6.8、8.9、11.5和14.6kPa,AUC分别为0.941、0.931、0.925和0.912。结论实时剪切波超声弹性成像可较准确、无创地诊断血吸虫病肝纤维化。
Objective To investigate the efficacy of real-time ultrasonic shear wave elastic(SWE)imaging in diagnosis of liver fibrosis caused by schistosomiasis.Methods The elastic modulus of hepatic parenchyma in 128 patients with schistosomiasis liver disease was detected using SurperSonic Imagine AixPlorer real-time shear wave elastic ultrasonic diagnostic instrument.The values of elastic modulus were compared with results of four indexes of serum fibrosis(hyaluronic acid,laminin,serum type Ⅲ procollagen,collagen Ⅳ)as well as the pathology of liver biopsy,and the diagnostic efficacy of mean value for liver fibrosis was calculated.Results There was significant difference among elastic modulus values measured at S0,S1,S2,S3 and S4 stages(F=60.810,P=0.035).The elastic modulus values of S0 elastic modulus was statistically significant compared with S2,S3 and S4(P<0.05).A positive correlation was observed between the elastic modulus of liver and hyaluronic acid,laminin,serum typeⅢprocollagen,collagenⅣof serum fibrosis,as well as pathological stage of liver fibrosis(r=0.461,0.522,0.452,0.381,all P<0.05).The threshold values of realtime ultrasonic shear wave elastic imaging in diagnosis for fibrosis≥S1,≥S2,≥S3 and S4 stage were determined as 6.8 kPa,8.9 kPa,11.5 kPa and 14.6 kPa,respectively,and the AUC values were 0.941,0.931,0.925 and 0.912,respectively.Conclusion Real-time ultrasonic elastography can be used to accurately and non-invasively diagnose liver fibrosis caused by schistosomiasis.
Objective To investigate the efficacy of real-time ultrasonic shear wave elastic(SWE)imaging in diagnosis of liver fibrosis caused by schistosomiasis.Methods The elastic modulus of hepatic parenchyma in 128 patients with schistosomiasis liver disease was detected using SurperSonic Imagine AixPlorer real-time shear wave elastic ultrasonic diagnostic instrument.The values of elastic modulus were compared with results of four indexes of serum fibrosis(hyaluronic acid,laminin,serum type Ⅲ procollagen,collagen Ⅳ)as well as the pathology of liver biopsy,and the diagnostic efficacy of mean value for liver fibrosis was calculated.Results There was significant difference among elastic modulus values measured at S0,S1,S2,S3 and S4 stages(F=60.810,P=0.035).The elastic modulus values of S0 elastic modulus was statistically significant compared with S2,S3 and S4(P<0.05).A positive correlation was observed between the elastic modulus of liver and hyaluronic acid,laminin,serum typeⅢprocollagen,collagenⅣof serum fibrosis,as well as pathological stage of liver fibrosis(r=0.461,0.522,0.452,0.381,all P<0.05).The threshold values of realtime ultrasonic shear wave elastic imaging in diagnosis for fibrosis≥S1,≥S2,≥S3 and S4 stage were determined as 6.8 kPa,8.9 kPa,11.5 kPa and 14.6 kPa,respectively,and the AUC values were 0.941,0.931,0.925 and 0.912,respectively.Conclusion Real-time ultrasonic elastography can be used to accurately and non-invasively diagnose liver fibrosis caused by schistosomiasis.
引文
[1]Colley DG,Bustinduy AL,Secor WE,et al.Human schistosomiasis.Lancet,2014,383(9936):2253-2264.
[2]杨凯华,葛士骝,张美华,等.超声观察血吸虫肝病致肝右叶萎缩的原因.中国医学影像技术,2013,29(5):850-851.
[3]蔡卫民.认识肝纤维化与晚期血吸虫病的过去与未来.中国血吸虫病防治杂志,2008,20(3):235-237.
[4]Lewis FA,Tucker MS.Schistosomiasis.Adv Exp Med Biol,2014,766:47-75.
[5]姚光弼.临床肝脏病学.上海:上海科学技术出版社,2004:128-130
[6]乔晓慧,邢晋放.剪切波超声弹性成像的原理及临床应用现状.中国介入影像与治疗学,2015,12(8):512-515.
[7]中华人民共和国卫生行业标准.WS261-2006血吸虫病诊断标准.[2016-08-08].htpp://www.nhc.gov.cn
[8]中华肝脏病学会肝纤维化组.肝纤维化诊断及疗效评估共识.中华肝病杂志,2002,10(5):327-328.
[9]王娴默.血吸虫病导致的肝纤维化血清学检测研究进展.检验医学与临床,2017,14(A01):362-365.
[10]沈霞.临床免疫学与免疫学检验新技术.北京:人民军医出版社,2002:256-260.
[11]Crossan C,Tsochatzis EA,Longworth L,et al.Costeffectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK:Systematic review and economic evaluation.J Viral Hepat,2016,23(2):139-149.
[12]王红卫,史华宁.肝脏剪切波弹性成像影响因素的研究进展.中国医学影像技术,2016,32(9):1452-1456.
[13]Clark PJ,Patel K.Noninvasive tools to assess liver disease.Curr Opin Gastroenterol,2011,27(3):210-216.
[14]Ferraioli G,Tinelli C,Dalbello B,et al.Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C:A pilot study.Hepatology,2012,56(6):2125-2133.
[15]曾婕,吴莉莉,郑荣琴,等.实时剪切波弹性成像检测肝脏弹性模量与肝纤维化分期的相关性研究.中华医学超声杂志(电子版),2012,9(9):781-784.
[16]Ferraioli G,Tinelli C,Dal Bello B,et al.Accuracy of real-time shear wave elastography for assessing liver fibrosis in Chronic hepatitis C:A pilot study.Hepatology,2012,56(6):2125-2133.
[2]杨凯华,葛士骝,张美华,等.超声观察血吸虫肝病致肝右叶萎缩的原因.中国医学影像技术,2013,29(5):850-851.
[3]蔡卫民.认识肝纤维化与晚期血吸虫病的过去与未来.中国血吸虫病防治杂志,2008,20(3):235-237.
[4]Lewis FA,Tucker MS.Schistosomiasis.Adv Exp Med Biol,2014,766:47-75.
[5]姚光弼.临床肝脏病学.上海:上海科学技术出版社,2004:128-130
[6]乔晓慧,邢晋放.剪切波超声弹性成像的原理及临床应用现状.中国介入影像与治疗学,2015,12(8):512-515.
[7]中华人民共和国卫生行业标准.WS261-2006血吸虫病诊断标准.[2016-08-08].htpp://www.nhc.gov.cn
[8]中华肝脏病学会肝纤维化组.肝纤维化诊断及疗效评估共识.中华肝病杂志,2002,10(5):327-328.
[9]王娴默.血吸虫病导致的肝纤维化血清学检测研究进展.检验医学与临床,2017,14(A01):362-365.
[10]沈霞.临床免疫学与免疫学检验新技术.北京:人民军医出版社,2002:256-260.
[11]Crossan C,Tsochatzis EA,Longworth L,et al.Costeffectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK:Systematic review and economic evaluation.J Viral Hepat,2016,23(2):139-149.
[12]王红卫,史华宁.肝脏剪切波弹性成像影响因素的研究进展.中国医学影像技术,2016,32(9):1452-1456.
[13]Clark PJ,Patel K.Noninvasive tools to assess liver disease.Curr Opin Gastroenterol,2011,27(3):210-216.
[14]Ferraioli G,Tinelli C,Dalbello B,et al.Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C:A pilot study.Hepatology,2012,56(6):2125-2133.
[15]曾婕,吴莉莉,郑荣琴,等.实时剪切波弹性成像检测肝脏弹性模量与肝纤维化分期的相关性研究.中华医学超声杂志(电子版),2012,9(9):781-784.
[16]Ferraioli G,Tinelli C,Dal Bello B,et al.Accuracy of real-time shear wave elastography for assessing liver fibrosis in Chronic hepatitis C:A pilot study.Hepatology,2012,56(6):2125-2133.