| 摘要: |
| 目的 探讨应用声触诊组织量化技术（Virtual touch tissue quantification，VTQ）检测肝脏剪切波速（Liver shear wave velocity，LSWV）在乙型病毒性肝炎感染所致慢加急性肝衰竭（ Acute-on-chronic hepatitis B liver failure,ACLF-HBV）患者病情评估及预测预后的临床应用价值。 方法 选择ACLF-HBV患者128例，次日收集血常规、凝血及肝肾功生化，同日行超声检查，同时行LSWV测定，计算超声评分、Child-Turcotte-Puge(CTP)评分，终末期肝病模型(Model for end-stage liver disease，MELD)积分。随访12个周，每周复查LSWV，根据临床预后分为好转组、恶化组进行比较。结果 LSWV 总检测成功率为93.75%（120/128）。入组时LSWV为（1.89±0.26）m/s ，随访12周，恶化组LSWV高于好转组［（2.12±0.31）m/s vs（1.57±0.28）m/s，P <0.05］。以LSWV 2.15m/s作为预后不良的阈值，敏感度为74.8%，特异度为65.4%。评估ACLF-HBV患者预后的AUROC为0.87，预测效能高于CTP评分（AUROC：0.69 ，z = 2.2，P =0.028）和MELD积分（AUROC：0.71 ，z = 2.3，P =0.019）。 结论 应用VTQ技术检测LSWV评估ACLF-HBV患者预后的准确性较高，对患者的短期预后有一定临床预测价值。LSWV 测值高于2.15m/s患者预后较差，动态检测LSWV的变化对于患者预后评估更具潜在价值。 |
| 关键词: 剪切波弹性成像 HBV感染 慢加急性肝衰竭 预后 超声检查 |
| DOI： |
| 投稿时间：2018-07-23修订日期：2018-09-10 |
| 基金项目:国家自然科学基金重点项目(61031003)、国家自然科学基金面上项目(81471735,81570552)、 |
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| Clinical Value of VTQ Technique in Measuring the Condition of Liver SWV in Patients with Acute-on-chronic liver failure Caused by HBV Infection and Predicting Prognosis |
| baomingwen,dongchangfeng,feng cheng |
| (Third people''''s Hospital of Shenzhen;the Third People’s Hospital of Shenzhen) |
| Abstract: |
| （Objective） To investigate the use of virtual touch tissue quantification (VTQ) to detect liver shear wave velocity (LSWV) in acute hepatic failure caused by hepatitis B infection ( acute-on-chronic hepatitis) B liver failure, ACLF-HBV) clinical evaluation of patients'' condition assessment and prognosis. Methods 128 patients with ACLF-HBV were enrolled. Blood routine, coagulation and liver and kidney biochemistry were collected the next day. Ultrasound was performed on the same day. LSWV was performed at the same time. Ultrasound score, Child-Turcotte-Puge (CTP) score, and end-stage liver disease model were calculated. (model for end-stage liver disease, MELD) points. After 12 weeks of follow-up, LSWV was reviewed weekly, and the patients were divided into the improved group and the worsened group according to the clinical prognosis. Results The total success rate of LSWV was 93.75% (120/128). The LSWV was (1.89±0.26) m/s at the time of enrollment, and the LSWV in the worsening group was higher than that in the improved group [(2.12±0.31) m/s vs (1.57±0.28) m/s, P <0.05]. With LSWV 2.15m/s as the threshold for poor prognosis, the sensitivity was 74.8% and the specificity was 65.4%. The AUROC for the prognosis of patients with ACLF-HBV was 0.87, and the predictive power was higher than the CTP score (AUROC: 0.69, z = 2.2, P = 0.028) and MELD score (AUROC: 0.71, z = 2.3, P = 0.019). Conclusion The application of VTQ technique to detect LSWV has a high accuracy in evaluating the prognosis of patients with ACLF-HBV, and it has certain clinical predictive value for short-term prognosis. Patients with LSWV values above 2.15 m/s had a poor prognosis, and dynamic changes in LSWV were more potentially valuable for patient prognosis assessment. |
| Key words: shear wave elastography HBV infection chronic acute liver failure prognosis ultrasonography |
