超声增强造影与肝酶水平在肝损伤分级中的意义

目的探讨超声增强造影和血清肝酶在肝损伤检查和分级中的价值和意义。方法 20只健康新西兰大白兔,雌雄不限,体重为(2.15±0.23)kg。随机制作不同级别的肝损伤模型。建模前后抽取静脉血进行血清肝酶检查,建模后分别使用通用16排螺旋CT和Philip公司IU22临床超声仪对实验动物进行增强CT和超声增强造影检查,然后根据美国创伤外科协会(AAST)分级标准对肝脏损伤进行分级,最后将超声造影的分级结果与增强CT分级结果进行Spearman相关性分析,将血清肝酶的结果与CT分级结果进行Pearson相关性分析。结果按照AAST诊断标准,超声增强造影和增强CT检查对肝损伤等级的分类具有很高的一致性,Spearman相关系数为0.888(P0.0001),Kappa值为0.71;天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氨酶(LDH)、AST/ALT比值与肝损伤的等级呈正相关,Pearson相关系数分别为0.664(P=0.0014)、0.704(P=0.0005)、0.503(P=0.024),γ-谷氨酰基转移酶(GGT)水平与肝损伤等级呈负相关(r=-0.467,P=0.038)。结论超声增强造影和血清肝酶检查在对肝损伤的检查与分级上与增强CT检查的结果有较好的一致性,可作为肝损伤诊断及治疗中监测手段。

Significance of contrast-enhanced ultrasound and serum liver enzyme levels in the classification of liver injury

Objective To investigate the value and significance of contrast-enhanced ultrasound (CEUS) and serum liver enzyme levels in the diagnosis and classification of blunt liver injury. Methods Twenty rabbits of (2.15±0.23)kg were made into blunt liver injury models and were performed contrast-enhanced computed tomography (CECT), CEUS and serum liver enzyme assay.Venous blood was drawn for serum liver enzyme assay.According to AAST scale, the degree of liver trauma was evaluated, then result of CEUS and CECT was analyzed using Spearman's correlation analysis, whereas result of serum liver enzyme and CECT was analyzed using Pearson's correlation analysis. Results According to AAST scale, the CEUS and CECT were highly consistent with the classification of liver injury.Coefficient of Spearman's rank correlation was 0.888 (P<0.0001), and Kappa value was 0.71.AST and LDH levels, as well as AST/ALT ratio were positively correlated with the grade of liver injury, and the coefficients of Pearson correlation were 0.664 (P=0.0014), 0.704 (P=0.0005) and 0.503 (P=0.024), respectively.GGT level was statistically negatively correlated with the grade of liver injury (r =-0.467, P=0.038). Conclusion CEUS and serum liver enzyme have high consistency with CECT both in the detection and grading of liver injury.It can be used as a tool for the diagnosis and monitor in the treatment of liver injury.