| 摘要: |
| 目的 评价丙氨酸氨基转移酶（ALT）水平对声辐射力脉冲成像（ARFI）技术诊断酒精性肝病（ALD）肝纤维化程度的影响。方法 选取经肝脏穿刺活检确诊的ALD患者99例，根据ALT水平分为ALT升高组55例和ALT正常组，应用ARFI技术检测其肝脏弹性，以病理诊断结果为金标准，探讨不同ALT水平对ARFI技术诊断ALD肝纤维化程度的影响；绘制ARFI诊断ALD肝纤维化程度的受试者工作特征曲线，确定其诊断界值并计算诊断效能，分析ALT水平对ARFI诊断ALD肝纤维化的影响。结果 ALD患者肝脏ARFI测值与肝纤维化程度和肝脏炎症程度均呈正相关（r=0.685、0.636，均P＜0.001）。ALT正常组在诊断肝纤维化程度≥S3期和S4期的曲线下面积均稍高于ALT升高组（0.979 vs.0.837， 0.981 vs.0.839），差异均无统计学意义。在ALT正常组ARFI诊断肝纤维化≥S2期、≥S3期和S4期的界值分别为1.237 m/s、1.269 m/s、1.413m/s，ALT升高组相应界值分别为1.330 m/s、1.395 m/s、1.653 m/s。结论 肝脏ALT水平对ARFI技术诊断ALD患者肝纤维化程度有一定影响，建议临床应用ARFI诊断时需综合考虑患者的肝功能水平。 |
| 关键词: 声辐射力脉冲成像 丙氨酸氨基转移酶 酒精性肝病 肝纤维化 |
| DOI： |
| 投稿时间：2017-11-15修订日期：2018-10-04 |
| 基金项目:首都临床特色应用研究专项课题 |
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| The effect of alanine transaminase levels on liver elastography assessed by acoustic radiation force impulse in patients with alcoholic liver disease |
| zhang dakun |
| () |
| Abstract: |
| Objective To investigate the effect of elevated alanine transaminase（ALT） levels on liver stiffness assessed by acoustic radiation force impulse（ARFI） elastography for quantitative evaluating the degree of liver fibrosis in patients with alcoholic liver disease（ALD）.Methods We included 99 patients with ALD in which liver biopsy，ARFI elastography and ALT measurements were performed.The measurements of ultrasonic elastography by ARFI technology using a ultrasonic instrument named ACUSON S2000.Referring to the histologic fibrosis stage on liver biopsy，all the ARFI values were assessed by using Receiver Operating Characteristic（ROC） curve analysis.The corresponding cut-off values，sensitivity and specificity were also calculated and compared. Results ARFI elastography correlated significantly with liver histological fibrosis（r =0.685，P < 0.001） and necroinflammatory activity（r =0.636，P < 0.001） in patients with ALD. By comparing the performance of ARFI elastography in both normal ALT level and high ALT level groups，it appears that ARFI elastography performed better for patients with normal ALT than for those with high ALT for predict severe fibrosis（≥S3） and cirrhosis（=S4）（AUROC，0.979 vs.0.837 for S≥3 and 0.981 vs.0.839 for cirrhosis，respectively） .The optimum cutoff values for ARFI elastography were1.330 m/s for S≥2，1.395 m/s for S≥3 and 1.653 m/s for S=4 when patients with elevated alanine aminotransferase（ALT） levels ； these decreased to1.237 m/s for S≥2，1.269 m/s for S≥3 and 1.413 m/s for S=4 when patients with normal ALT.Conclusion ARFI technology has potential value for quantitatme evaluation of the liver fibrosis for ALD.ARFI elastography is influenced by elevated ALT levels in ALD. |
| Key words: Acoustic Radiation Force ImPulse Alanine Transaminase Alcoholic liver disease Liver fibrosis |
