| 摘要: |
| ［］目的 探讨超声分级结合瞬时弹性检测仪FibroScan对脑死亡器官捐献供肝评估中的临床应用价值。方法 回顾性分析我院37例DBD(脑死亡器官捐献brain death donor)供肝影像学资料,肝移植术前对供肝进行FibroScan、超声检查分级及相关实验室检查,对于相应受者,术后一周内每天行腹部超声和实验室检查以筛查EAD (早期同种异体移植物功能障碍 early allograft dysfunction),将其分为EAD组和非EAD组,统计分析两组CAP(受控衰减参数controlled attenuation parameter)、LS(肝脏硬度值liver stiffness),超声分级和EAD之间的相关性,利用ROC(受试者工作特征receiver operating characteristic)曲线分析超声分级联合FibroScan预测EAD的价值。结果 EAD组CAP值及LS值均较非EAD组高,差异有统计学意义(P值均＜0.05)；CAP值是EAD的独立影响因素(P＜0.05),EAD组供肝超声分级高于非EAD组,差异有统计学意义(P=0.003)。将供肝CAP值、LS值及超声分级进行ROC曲线分析,供肝CAP值预测EAD的AUC (ROC曲线下面积the area under the ROC curve,)为0.854(P<0.001),最佳阈值206 dB/m,(敏感性82.4％,特异性80％),超声分级的AUC为0.807(P=0.002),最佳阈值为3.5级(敏感性81.3％,特异性77.78％),超声分级联合CAP的AUC为0.906(P＜0.001),(敏感性81.2％,特异性94.4％)。结论 FibroScan量化供肝脂肪变性CAP值和纤维化程度LS值及超声分级对肝移植受者术后EAD发生有一定预测价值,超声分级与FibroScan相结合预测肝移植术后EAD具有较高的敏感性,对DBD供肝评估有应用价值。 |
| 关键词: ［］ 肝移植 瞬时弹性成像 超声分级 |
| DOI： |
| 投稿时间：2023-03-09修订日期：2023-05-04 |
| 基金项目:青岛大学附属医院青年科研基金 |
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| Values of combination of sonographic grading and FibroScanin liver grafts from brain death donor |
| YANG Zizhen,WU Xiaodong,CAI Jinzhen,WANG Jianhong |
| (Organ Transplantation Center,Affiliated Hospital of Qingdao University,Shandong Qingdao) |
| Abstract: |
| ［］Objective To explore the application values of combination of sonographic grading and FibroScan in liver grafts from brain death donor (DBD). Methods Liver grafts of 37 DBD cases were underwent FibroScan examination and sonographic grading (grade 0 to grade 5). Blood samples were tested preoperatively. For all recipients, abdominal ultrasonography and blood tests were performed preoperatively and daily postoperatively to screen for early allograft dysfunction (EAD). Based upon early allograft function of liver transplantation (LT) recipients, the donors were classified into EAD and early allograft function normal (non-EAD) groups. Statistical analyses were performed to analyze the correlations among controlled attenuation parameter (CAP), liver stiffness (LS), liver graft sonographic grading and EAD. Receiver operating curve (ROC) was employed for analyzing the diagnostic accuracy of CAP, LS and sonographic grading in EAD. Results The CAP and LS value of EAD group was obviously higher than that of non-EAD group P＜0.05]. CAP value is an independent influencing factor of EAD. sonographic grading of EAD group was also significantly higher than that of non-EAD group (P=0.003).The area under ROC curve (AUROC) of CAP in EAD was 0.854(P<0.001),optimal cut-off value 206 dB/m (sensitivity,82.4%; specificity,80%). AUROC of ultrasonic grading 0.807(P=0.002) and optimal cut-off value level 3.5(sensitivity,81.3%;specificity, 77.78%). Conclusions FibroScan quantifies fibrosis and steatosis in liver grafts from DBD, combination of FibroScan and sonographic grading can predict postoperative EAD in LT recipients with high sensitivity. FibroScan and sonographic grading may improve the assessments of liver grafts of DBD. |
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