| 摘要: |
| 目的探讨弹性定量参数在梗阻性黄疸(obstructive jaundice,OJ)中的诊断价值。方法回顾性分析2014年1月-2015年6月于我院诊断为梗阻性黄疸的患者90例,依据血总胆红素水平将患者分别分为梗阻重中轻组(A、B、C三组)同时选取无临床黄疸的对照组30例为D组。分别比较并分析有无黄疸两组、ABCD四组％AREA、MEAN。应用受试者操作特性曲线(receiver operator characteristic curve,ROC)曲线分析％AREA、MEAN鉴别黄疸、轻度黄疸、中重度黄疸的ROC曲线下面积(Area Under Curve,AUC)、最佳界值、敏感度和特异度。应用Pearson相关性分析,评估％AREA、MEAN水平与总胆红素相关性。结果黄疸组％AREA水平(45.09±2.38)显著高于非黄疸组(43.04±1.86),差异有统计学意义(t=8.74；P=0.000)；根据有无黄疸两组%AREA水平制作ROC曲线,AUC为0.729,以44.44作为最佳界值,诊断黄疸的敏感度为58.9％,特异度为83.7％。同时黄疸组MEAN水平(78.43±3.53)显著低于非黄疸组(84.75±3.53),差异有统计学意义(t=-8.56；P=0.000)。根据有无黄疸两组MEAN水平制作ROC曲线,AUC为0.889,以81.04作为最佳界值,诊断黄疸的敏感度为83.3％,特异度为78.9％。四组间两两比较显示,A、B组的％AREA与MEAN水平差异无统计学意义；其他各组比较,胆红素水平越高,％AREA水平越高,而MEAN水平越低。经Pearson相关性分析,％AREA水平与总胆红素水平呈显著正相关；MEAN水平与总胆红素水平呈显著负相关。其中根据C、D两组%AREA水平制作ROC曲线,AUC为0.811,以43.54作为最佳界值,诊断轻度黄疸的敏感度为65％,特异度为86.7％。根据A、B组均值及C组%AREA水平制作ROC曲线,AUC为0.879,以47.21作为最佳界值,鉴别轻度与中重度黄疸的敏感度为68％,特异度为92.5％。根据D、C两组MEAN水平制作ROC曲线,AUC为0.750,以83.07作为最佳界值,诊断轻度黄疸的敏感度为53.3％,特异度为90％。根据A、B组均值及C组MEAN水平制作ROC曲线,AUC为0.791,以79.95作为最佳界值,鉴别轻度与中重度黄疸的敏感度为65％,特异度为98％。结论通过两种弹性定量参数初步能够诊断梗阻性黄疸,并评估患者梗阻程度。 |
| 关键词: 超声弹性成像 弹性定量参数 梗阻性黄疸 |
| DOI： |
| 投稿时间：2016-07-17修订日期：2016-07-17 |
| 基金项目: |
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| Outcome of quantitative ultrasound elastic parameters in obstructive jaundice |
| Wu Yu |
| (Department of ultrasound,Shanghai Hudong hospital,Shanghai,;Department of ultrasound,Shanghai Jiaotong University School of Medicine,Luwan Branch,Shanghai) |
| Abstract: |
| Objective To investigate the value of quantitative ultrasound elastic parameters in OJ. Methods Patients with OJ who met the inclusion criteria (n=90) in our hospital between January 2014 and June 2015 were recruited. They were divided into severe OJ group (Group A), moderate OJ group (Group B)，and slight OJ group (Group C) according to total bilirubin. And 30 cases without clinical jaundice were selected as D group. The ％AREA、MEAN were compared and analyzed. ROC curves were drawn to evaluate the AUC, diagnostic threshold, sensitivity and specificity of OJ, slight, moderate or severe OJ. The correlation between %AREA, MEAN levels and total bilirubin was assessed with Pearson correlation analysis. Results Compared to Group with OJ(45.09±2.38), Group without OJ(43.04±1.86) showed significantly lower levels of ％AREA (t=8.74；P=0.000)．The threshold of ROC Curve with ％AREA in diagnosing OJ was 44.44 with the sensitivity of 58.9％，the specificity of 83.7％ and AUC of 0.729.Compared to Group with OJ(78.43±3.53), Group without OJ (84.75±3.53) showed significantly higher levels of MEAN (t=-8.56；P=0.000)．The threshold of ROC Curve with MEAN in diagnosing OJ was 81.04 with the sensitivity of 83.3％，the specificity of 78.9％ and AUC of 0.889. There was no significant difference in the level of %AREA and MEAN between A and B group. %AREA level was significantly positively correlated with total bilirubin level, and MEAN level was negatively correlated with total bilirubin level. The threshold of ROC Curve with %AREA in diagnosing slight OJ was 43.54 with the sensitivity of 65％，the specificity of 86.7％ and AUC of 0.811. And the threshold of ROC Curve with %AREA in diagnosing moderate and severe OJ was 47.21 with the sensitivity of 68％，the specificity of 92.5％ and AUC of 0.879.The threshold of ROC Curve with MEAN in diagnosing slight OJ was 83.07 with the sensitivity of 53.3％，the specificity of 90％ and AUC of 0.750. And the threshold of ROC Curve with MEAN in diagnosing moderate and severe OJ was79.95 with the sensitivity of 65％，the specificity of 98％ and AUC of 0.791. Conclusion Quantitative ultrasound elastic parameters can effectively identify OJ and degree of obstruction. |
| Key words: Elastography Quantitative ultrasound elastic parameters OJ |
