| 摘要: |
| 目的：探讨声脉冲辐射力弹性成像评价儿童肝纤维化程度的临床应用价值。
方法：采用声脉冲辐射力弹性成像技术对70例患有儿童常见肝病的患儿及50例健康志愿者分别进行弹性成像检测及血清学检测，血清学检查的主要指标为谷草转氨酶（AST）与血小板计数（PLT）之比（APRI），将病例组弹性成像测值SWV值及血清学检测APRI比值分别与肝纤维化METAVIR分级进行相关性分析，并将SWV值与APRI比值进行比较，评价弹性成像SWV值在评价儿童肝纤维化的临床应用价值。
结果：SWV值与儿童肝纤维化程度成正相关（相关系数0.71，P＜0.05），SWV值随着肝纤维化程度的加重而增加，各病理肝纤维化分级的肝脏平均SWV值分别为：F1 1.57±0.30 m/s，F2 1.89±0.32 m/s，F3 2.14±0.36 m/s，F4 2.59±0.22 m/s。APRI值与肝纤维化程度不相关（相关系数=-0.02，P＞0.05）。肝纤维化分级≥F1时，最大约登指数对应的的SWV值为1.73 m/s（se 54.30%，sp 100.00%）；肝纤维化分级≥F2时，最大约登指数对应的的SWV值为1.67 m/s（se 89.50%，sp 74.50%）；肝纤维化分级≥F3时，最大约登指数对应的的SWV值为1.83 m/s（se 84.60%，sp 83.30%）。受试者工作特征曲线下面积(AUROC)分别为0.823，0.895，0.907。
结论：声脉冲辐射力弹性成像在无创评价儿童肝纤维化方面有较高的临床价值，尤其能更精准评价中重度肝纤维化程度，为儿童肝病的诊断、治疗及疾病随访提供重要影像学依据。 |
| 关键词: 声脉冲辐射力弹性成像,儿童,肝纤维化 |
| DOI： |
| 投稿时间：2018-10-11修订日期：2019-04-09 |
| 基金项目:重庆市卫生局医学科研项目（2011-2-214） |
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| Evaluation of liver elasticity in children with acoustic radiation force impulse imaging |
| gaoyang,tangyi |
| () |
| Abstract: |
| Methods: 70 children with chronic liver disease comparing ARFI and the aspartate aminotransferase (AST):platelet ratio index (APRI)with histopathological analysis.50 Children with no history of liver disease served as a control group. The gold standard of liver biopsy was referred; ROC curve analysis was used to assess all SWV values and APRI. The corresponding cut-off values,sensitivities,and specificities were calculated and compared. In addition, the correlation analysis of pathological results with SWV and APRI were also tested , to evaluate the clinical value of elastography and liver?fibrosis?serological?examination in children with liver fibrosis.
Results: The SWV correlated positively with the stage of liver fibrosis(r=0.71,P＜0.05) : increasing stiffness with increasing fibrosis. The values of SWV in F1-F4 were 1.57±0.30 m/s,1.89±0.32 m/s,2.14±0.36 m/s,2.59±0.22 m/s, respectively. The APRI values had no correlation with liver fibrosis stages(r=-0.02,P＞0.05) .Diagnostic performance of ARFI for identifying fibrosis stage were : cut-off values of SWV of 1.73 m/s for F1 or higher, 1.67 m/s for F2 or higher, 1.84 m/s for F3 or higher, the Sensitivity were 54.30%,89.50%,84.60%,the Specificity were 100%,74.50%,83.3%,and the areas under the ROC curves were 0.82,0.89,0.91, respectively.
Conclusion: ARFI plays an important role to evaluate the liver fibrosis of children, it could identify stage of liver fibrosis, especially in moderate and severe stage, and it provides a reference for prognosis and cure for children with liver disease. |
| Key words: Acoustic Radiation Force Impulse, Children, Liver fibrosis |
