| 摘要: |
| 目的 探讨应用声触诊组织量化技术（virtual touch tissue quantification，VTQ）动态检测肝脏剪切波速（shearwave velocity，SWV）变化无创评估急性肝炎肝损害及预测预后的临床应用价值。方法 选择42例急性肝炎患者（实验组）及55例乙型病毒性肝炎携带患者（对照组）作为研究对象，次日收集凝血及肝功生化等血清学指标，同日行超声检查，同时行肝脏SWV检测，计算超声评分。随访12个周，每2周检测肝脏SWV，直至好转出院（好转组）或持续进展总胆红素（total bilirubin，TB）大于正常值上限10倍且凝血酶原活动度（prothrombin time activitypercentage，PTA）≤40%（恶化组）。结果 两组肝脏SWV总检测成功率为92.78%（90/97）, 7例检测失败（实验组3例、对照组4例），实际纳入统计的患者共计90例，实验组39例，对照组51例。实验组肝脏SWV值高于对照组［（1.95±0.78）m/s VS（1.13±0.15）m/s，P＜0.05］；实验组肝脏SWV值与AST、ALT、TB间呈正相关（ｒ＝0.303、0.415、0.512，P＜0.05），与GGT 、ALP和PTA无相关性（ｒ＝0.115、0.109、0.118， P值均＞0.05）。恶化组的肝脏SWV高于好转组［（2.35±0.89）m/s VS（1.66±0.78）m/s，P＜0.05］。以肝脏SWV 2.18m/s作为急性肝炎预后不良的阈值，敏感度为0.82，特异度为0.75,评估急性肝炎患者预后的受试者操作特征曲线下面积（AUROC）为0.891。动态检测肝脏SWV，好转组维持在1.87m/s以下并呈下降趋势，恶化组则持续高于2.18m/s。结论 急性肝炎患者肝脏SWV值持续高于2.18 m/s者预后较差，应用VTQ技术检测肝脏SWV无创评估急性肝炎患者预后具有较高准确性，动态检测急性肝炎肝脏SWV变化对于患者预后评估更具潜在临床应用价值。 |
| 关键词: 肝炎 预后 声触诊组织量化技术 超声检查 |
| DOI： |
| 投稿时间：2018-11-22修订日期：2019-03-22 |
| 基金项目:国家自然科学基金重点项目(61031003)；深圳市科技计划项目(卫生类)编号：2016013 |
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| Non-invasive evaluation of liver damage and prognosis in acute hepatitis based on changes in liver shear wave velocity |
| baomingwen |
| (the Third People’s Hospital of Shenzhen，) |
| Abstract: |
| Objective Exploring the application of acoustic palpation organization quantitative technology (virtual touch Tissue quantification (VTQ) Dynamic detection of shear wave velocity (SWV) changes in non-invasive assessment of acute hepatitis liver damage and predictive prognosis. Methods A total of 42 patients with acute hepatitis (experimental group) and 55 patients with hepatitis B virus (control group) were enrolled as the study subjects. The next day, serum markers such as blood coagulation and liver function biochemistry were collected. Ultrasound was performed on the same day. SWV detection, calculation of ultrasound scores. After 12 weeks of follow-up, liver SWV was measured every 2 weeks until the hospital was discharged (in the improved group) or the continuous progress of total bilirubin (TB) was greater than 10 times the upper limit of normal and prothrombin time activity percentage (PTA). ) ≤ 40% (deterioration group). Results The total success rate of SWV in the two groups was 92.78% (90/97), and 7 cases failed (3 in the experimental group and 4 in the control group). The total number of patients in the survey was 90, and the experimental group was 39. The control group 51 cases. The SWV value of the liver in the experimental group was higher than that in the control group [(1.95±0.78) m/s VS(1.13±0.15) m/s, P<0.05]; the SWV value of the liver in the experimental group was positively correlated with AST, ALT and TB (r= 0.303, 0.415, 0.512, P<0.05), no correlation with GGT, ALP and PTA (r=0.115, 0.109, 0.118, P value>0.05). The SWV of the liver in the worsening group was higher than that in the improved group [(2.35±0.89) m/s VS (1.66±0.78) m/s, P<0.05]. The SWV 2.18m/s was used as the threshold for poor prognosis of acute hepatitis. The sensitivity was 0.82 and the specificity was 0.75. The area under the operating characteristic curve (AUROC) of the prognosis of patients with acute hepatitis was 0.891. The liver SWV was dynamically detected, and the improved group maintained below 1.87 m/s and showed a downward trend, while the worse group continued to be higher than 2.18 m/s. Conclusion The prognosis of patients with acute hepatitis patients with SWV values ??above 2.18 m/s is poor. The use of VTQ technique to detect liver SWV non-invasive evaluation of acute hepatitis patients with high prognosis has high accuracy. Dynamic detection of acute hepatitis liver SWV changes has a better prognosis for patients. Potential clinical application value. |
| Key words: Hepatitis Prognosis VTQ Ultrasonography |
