声脉冲辐射力成像技术与肝癌术后并发症的相关性分析

目的 探讨声脉冲辐射力成像技术(Acoustic Radiation Force Impulse,ARFI)与肝纤维化的关系,以降低肝癌患者术后并发症的可能。 方法 纳入我院150例行肝癌手术切除的患者,对其手术前后的临床资料进行分析。依据肝纤维化分期标准,将肝纤维化S0、S1、S2、S3、S4分别对应的剪切波值进行单因素方差分析,再分析剪切波值与肝纤维化的相关性;进一步利用剪切波值构建ROC曲线分析肝纤维化的鉴别能力;最后通过剪切波值与病理结果检验肝癌术后并发症的敏感度、特异度对比,反应ARFI的应用的价值。 结果 S0、S1、S2、S3、S4分别对应的剪切波值显著升高,差异有统计学意义 (F=54.678,P﹤0.05)。剪切波值与肝纤维化程度呈正相关关系(r=0.76,P=0.000); ROC曲线得到ARFI鉴别判断肝纤维化的AUC为0.885,最佳临界值为1.315,敏感度94.6%以及特异度为64.5%。进一步的分析发现,ARFI判断术后并发症敏感度和特异度与病理结果近似(ARFI：敏感度94.4%、特异度92.7%;病理：敏感度98.1%、特异度94.8%)。结论 ARFI有助于提高术前判断肝癌患者肝纤维化准确度,为今后肝癌患者减少术后并发症的发生提供参考依据。     

Serial change of liver stiffness measured by acoustic radiation force impulse imaging in chronic liver disease: correlation with biochemical markers

Purpose

In patients with chronic diffuse liver diseases, liver fibrosis severity is an important element for prognosis and for selecting therapy. Acoustic radiation force impulse (ARFI) imaging techniques were recently developed to measure liver fibrosis, but their specificity is impaired by cholestasis, inflammation, or edema in acute hepatitis. Herein, our objectives were to evaluate serial changes in shear wave velocity (SWV) and to correlate these changes with biochemical activity.

Methods

This study included 108 patients who underwent ARFI because of viral hepatitis [hepatitis B (HBV) or C (HCV)] with serial follow-up after 3–6 months at our institution between August 2011 and May 2013. Based on baseline and follow-up ARFI, we divided patients with HBV and HCV into two groups: a decreasing SWV group and a non-decreasing SWV group. We evaluated serial SWV changes and correlated these changes with biochemical activity changes.

Results

The patients were divided into SWV groups as follows: decreasing SWV group (HBV, n = 23; HCV, n = 7) and non-decreasing SWV group (HBV, n = 40; HCV, n = 38). In both HBV and HVC patients, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly decreased at follow-up in the decreasing SWV group.

Conclusions

The liver stiffness value assessed by ARFI became lower over time in patients who had decreasing AST and ALT levels. According to this study, ARFI overestimates fibrosis grade in patients with high AST and ALT. Thus, assessment of liver fibrosis by ARFI elastography should include consideration of biochemical markers such as AST and ALT levels and additional follow-up using ARFI elastography.     

声脉冲辐射力成像技术鉴别诊断肝脏良恶性局灶性病变

目的探讨声脉冲辐射力成像技术(ARFI)对肝脏良恶性局灶性病变的鉴别诊断价值。方法对64例患者76个肝脏局灶性病变进行ARFI检查并分析,包括声触诊组织成像技术(VTI)和声触诊组织量化技术(VTQ)。所有患者均经手术或穿刺病理证实或两种增强影像学检查(CEUS、CT、MRI)确诊。采用ROC曲线评价剪切波速(SWV)对肝脏局灶性病变良恶性的鉴别诊断价值,并确定临界点。结果 VTI声像图中,31个(31/40,77.50%)恶性病灶和13个(13/36,36.11%)良性病灶呈灰黑色(P<0.05);良性病灶SWV明显低于恶性病灶[(1.67±0.61)m/s vs(2.80±1.07)m/s,P<0.01)。以SWV=2.04m/s为临界点鉴别肝脏局灶性病变的良恶性,其敏感度、特异度和准确率分别是82.50%、80.60%和81.58%。结论 ARFI有助于鉴别诊断肝脏良恶性局灶性病变,具有良好的临床应用前景。     

Acoustic Radiation Force Impulse Elastography for Chronic Liver Disease: Comparison with Ultrasound-Based Scores of Experienced Radiologists,Child-Pugh Scores and Liver Function Tests

The purpose of our study was to investigate whether acoustic radiation force impulse (ARFI) elastography provides better diagnostic performance for diagnosis of chronic liver disease and correlates better with Child-Pugh scores and liver function tests, compared with an ultrasound (US) scoring system based on visual assessment of conventional B-mode US images by experienced radiologists. Five hundred and twenty-one patients with clinically proven chronic liver disease (n = 293), fatty liver (n = 95) or normal liver (n = 133) were included in this study. B-mode liver US and ARFI elastography were performed in all patients. ARFI elastography was performed at least five times, with each measurement obtained at a different area of the right hepatic lobe; mean shear wave velocity (SWV) was calculated for each patient. The mean SWV was compared with US-based scores from two radiologists (based on liver surface nodularity, parenchyma echotexture and hepatic vein contour), Child-Pugh scores and liver function tests. The mean SWV of the normal liver group was 1.08 m/s ± 0.15; of the fatty liver group, 1.02 m/s ± 0.16; and of the chronic liver disease group, 1.66 m/s ± 0.60 (p < 0.001). The area under the receiver operating characteristics curve of the mean SWV in ARFI elastography was significantly higher than that of the conventional B-mode US-based scores by two radiologists (0.89 vs. 0.74 and 0.77, p < 0.05), with a sensitivity of 75.4% and a specificity of 89.5% at the cut-off value of 1.22 m/s. The sensitivity of the mean SWV was significantly higher than the US-based scores (p < 0.001), although the specificity was not (p > 0.05). The mean SWV was better correlated with Child-Pugh scores and all liver function tests (except total protein) than the US-based scores from two radiologists. In conclusion, ARFI elastography showed better diagnostic performance than visual assessment of experienced radiologists for diagnosis of chronic liver disease, as well as for evaluation of the severity of chronic liver disease. (E-mail: leejy4u@snu.ac.kr)     

声脉冲辐射力弹性成像评价儿童肾小球疾病肾脏损害

目的：探索声脉冲辐射力弹性成像在小儿肾小球疾病中的应用价值。方法：采用声脉冲辐射力弹性成像（ARFI）技术,对228例病例组及200例健康儿童分别进行弹性成像检测及血清学检测,其中,病例组均为经肾脏穿刺活检并经病理结果证实为肾小球疾病的患儿,将测得的剪切波速度（SWV）值与血清学指标及肾脏损害程度进行统计学分析。 结果：肾小球疾病组与正常肾脏组的肾脏SWV值差异无统计学意义（P>0.05）;肾小球疾病组肾脏不同损害程度的肾脏SWV值差异无统计学意义（P>0.05）;肾小球疾病组不同血清学检测结果间肾脏SWV值差异无统计学意义（P>0.05）。 结论：ARFI技术在早期儿童肾小球疾病的评估中有一定局限性,ARFI技术在慢性肾脏疾病终末期中的应用前景尚需进一步探索。     

声辐射力脉冲成像技术检测大鼠非酒精性脂肪肝剪切波速率与胰岛素抵抗的相关性

目的 采用声辐射力脉冲（ARFI）成像技术检测大鼠非酒精性脂肪肝（NAFLD）肝脏剪切波速率（SWV）与胰岛素抵抗（IR）的相关性。方法 将32只雄性SD大鼠随机分为正常组（16只）与模型组（16只）,检测大鼠血清丙氨酸氨基转移酶（ALT）、天门冬氨基酸氨基转移酶（AST）、甘油三酯（TG）、总胆固醇（TC）、空腹血糖（FBG）及空腹胰岛素（FINS）水平,计算稳态模型胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（ISI）;采用ARFI检测肝脏SWV,分析SWV与上述各指标的相关性;光镜下观察大鼠肝脏病理改变情况。结果 模型组大鼠血清ALT、AST、TG、TC、FBG及FINS均明显高于正常组（P均<0.05）,并随造模时间延长而升高（P均<0.05）;模型组HOMA-IR明显高于正常组（P<0.05）,ISI明显低于正常组（P<0.05）;模型组大鼠肝脏SWV明显高于正常组（P均<0.01）,且随造模时间延长而升高（P<0.05）。SWV与ALT、AST、TG、TC、FBG、FINS、HOMA-IR及ISI具有明显相关性（P均<0.05）。结论 NAFLD大鼠模型中存在IR现象,其程度与肝脏SWV呈正相关。     

声辐射力脉冲弹性成像技术评估肝占位患者肝脏储备功能的临床价值

目的探讨声辐射力脉冲弹性成像（ARFI）技术评估肝占位患者肝脏储备功能的临床价值。方法选择2011年9月至2012年8月解放军总医院86例肝占位患者。其中肝功能Child-PughA级54例,B级18例,C级14例;70例患者进行手术治疗,16例患者采用非手术治疗。采用ARFI技术测量患者肝脏剪切波速度值（SWV）;同时对患者进行吲哚氰绿（ICG）排泄实验,记录ICG血浆清除速率及ICG 15min滞留率。SWV值与ICG血浆清除速率、ICG 15min滞留率的相关性采用Pearson相关分析;SWV值与Child．Pugh分级的相关性采用Spearman等级相关分析。手术治疗患者与非手术治疗患者SWV值比较采用独立样本t检验以患者的临床决策作为金标准,采用受试者操作特性（ROC）曲线评价ARFI技术判断肝占位患者手术可行性的应用价值。结果SWV值与ICG 15min滞留率、ICG血浆清除速率、Child．Pugh分级有相关性（r=0．764,P〈0．001;P0．686,P=-0．000：r=0．864,P=-0．000）。手术治疗患者SWV值为（2．46±0．45）m／s,非手术治疗患者SwV值为（1．54±0．36）m／s,差异有统计学意义（t=-0．80,P=0．000）。ROC曲线显示,当诊断界值为2．06m／s时,约登指数最高为0．775,其相对应的ARFI技术判断肝占位患者手术可行性的敏感度为87．5％,特异度为90．0％。结论ARFI技术可有效评估肝占位患者肝脏储备功能,为临床治疗方式的决策提供帮助。     

声脉冲辐射力弹性成像与生化S指数评定兔肝纤维化的实验研究

目的探讨声脉冲辐射力弹性成像(ARFI)技术与血清生化指标S指数在兔肝纤维化分期中的诊断价值。方法 32只家兔皮下注射5%硫代乙酰胺制备肝纤维化模型(实验组),8只家兔于颈背部皮下注射生理盐水(对照组)。于造模第4、8、12周末行ARFI和血清实验室检查,获取肝脏剪切波速度(SWV),计算S指数,取肝脏制作标本行病理肝纤维化分期,比较SWV与S指数在兔肝纤维化分期中的诊断价值。结果实验组中29只家兔造模成功,肝纤维化分期S1、S2、S3、S4期分别为10只、8只、7只、4只;另3只家兔肝脏严重炎症坏死而无纤维化。SWV与S指数均随着纤维化程度的加重而增大,各组间差异均有统计学意义(P﹤0.05);SWV较S指数与肝纤维化病理分期具有更显著的相关性(r=0.724、0.472,P﹤0.05);应用SWV和S指数诊断肝纤维化程度≥S1、≥S2、≥S3、S4对应的ROC曲线下面积分别为0.92、0.87、0.82、0.89和0.76、0.75、0.71、0.74。结论 ARFI较生化S指数能更准确地诊断兔肝纤维化程度。     

慢性乙型肝炎肝硬化患者超声辐射力脉冲成像参数与肝功能Child-Pugh分级的相关性

目的 探讨乙型肝炎肝硬化患者肝功能Child-Pugh分级与声辐射力脉冲成像(ARFI)定量参数剪切波速度(SWV)之间的相关性.方法 对临床诊断为肝硬化的40例慢性乙型肝炎患者及40名健康体检者行ARFI,测量肝脏SWV;检测肝硬化患者血清学指标,根据结果及临床表现进行肝功能Child-Pugh分级.比较肝硬化患者与健康人及不同Child-Pugh分级患者间SWV的差异,分析肝脏SWV与Child-Pugh分级及血清学指标之间的相关性.结果 健康人肝脏SWV 显著低于肝硬化患者;随Child-Pugh分级上升,SWV明显增加(P<0.001),SWV与Child-Pugh分级呈正相关(r=0.62,P<0.001).肝硬化患者SWV与凝血酶原时间呈正相关(r=0.65,P<0.001),与血清白蛋白水平呈负相关(r=-0.59,P<0.001).结论 肝硬化患者SWV显著高于健康人,并与肝功能Child-Pugh分级呈正相关.     

声辐射力脉冲成像技术评估肝移植术后缺血型胆道病变的临床应用价值

目的探讨声辐射力脉冲成像（ARFI）技术评估肝移植术后缺血型胆道病变（ITBL）的临床应用价值。方法选择2012年7月至2013年1月解放军总医院肝移植术后复查患者41例,其中15例超声诊断为ITBL。对所有患者进行常规超声检查,并采用ARFI技术测量检测深度为4、5cm的肝脏剪切波速度（SWV）值,同时检查患者肝功能。采用独立样本t检验比较ITBL患者与非ITBL患者同一检测深度SWV值差异;采用配对样本t检验比较同一ITBL患者不同检测深度SWV值差异。采用Pearson相关分析分别分析所有患者不同检测深度SWV值与肝功能指标的相关性。结果ITBL患者、非ITBL患者检测深度为4cm时SwV值分别为（1．561±0．425）、（1．121±0．160）m／s,差异有统计学意义（t=-3．173,P=0．01）;检测深度为5cm时SWV值分别为（1．608±0．545）、（1．175±0．173）m／s,差异也有统计学意义（t=-2．454,P=-0．034）。同一ITBL患者不同检测深度SWV值差异无统计学意义。所有患者不同检测深度SWV值均与碱性磷酸酶浓度相关（r值分别为0．656、0．667,P值均为0．000）;同时均与γ-谷酰转肽酶浓度相关（r=0．482,P=0．007;r=0．508,P=0．004）。结论ARFI技术对肝移植术后ITBL评估有一定的临床应用价值。     

Evaluation of Non-alcoholic Fatty Liver Disease Using Acoustic Radiation Force Impulse Imaging Elastography in Rat Models

The aim of this study is to evaluate the utility of acoustic radiation force impulse (ARFI) elastography for assessing hepatic fibrosis stage and non-alcoholic fatty liver disease (NAFLD) severity, as well as the relationship among hepatic histologic changes using shear wave velocity (SWV). Animal models with various degrees of NAFLD were established in 110 rats. The right liver lobe was processed and embedded in a fabricated gelatin solution (porcine skin). Liver mechanics were measured using SWV induced by acoustic radiation force. Among the histologic findings, liver elasticity could be used to differentiate normal rats from rats with simple steatosis (SS) as well as distinguish SS from non-alcoholic steatohepatitis (NASH), with areas under the receiver operating characteristic curves (AUROC) of 0.963 (95% confidence interval = 0.871–0.973) and 0.882 (95% confidence interval = 0.807–0.956), respectively. For NAFLD rats, the diagnostic performance of ARFI elastography in predicting significant fibrosis (F ≥ 2) had an AUROC of 0.963. For evaluating steatosis severity, we found a progressive increase in ARFI velocity proportional to steatotic severity in NAFLD rat models, but we observed no significant differences for steatotic severity after excluding the rats with fibrosis. ARFI elastography may be used to differentiate among degrees of severity of NAFLD and hepatic fibrotic stages in NAFLD rat models.     

声脉冲辐射力成像技术评价大鼠脂肪性肝炎的研究

目的探讨声脉冲辐射力成像(ARFI)技术无创评价大鼠脂肪性肝炎(NASH)的价值。方法将26只健康成年雄性无特定病原体级的SD大鼠分为对照组8只和脂肪肝组18只,根据不同喂养时间和单纯性脂肪肝(SS)、NASH诊断标准将脂肪肝组分为SS组9只和NASH组9只,分别行ARFI和CT检查,记录肝剪切波速度(SWV)和肝、脾CT值。实验到期后取其肝计算肝脏指数,并行病理分析。分析SWV值、CT值及肝脏指数与病理之间的关系,对SWV的诊断效率行ROC曲线分析,计算其敏感性和特异性。结果 SS组和NASH组肝SWV值分别为(1.01±0.02)m/s和(1.16±0.04)m/s,对照组肝SWV值(1.03±0.05)m/s,SS组与对照组间SWV值比较差异无统计学意义,SS组与NASH组间比较差异有统计意义(P﹤0.01)。SWV值与NASH有显著相关性(r=0.688)。应用SWV诊断NASH对应的ROC曲线下面积为0.91,SWV临界值为1.09 m/s,敏感性为85.7%,特异性为100%。结论 ARFI技术判断大鼠NASH有一定价值,且具有简便、无创的优势。     

Combined Acoustic Radiation Force Impulse and Conventional Ultrasound in the Quantitative Assessment of Immunoglobulin a Nephropathy

We investigated the value of combined acoustic radiation force impulse (ARFI) imaging and conventional ultrasound (US) in identifying renal histopathological fibrosis with immunoglobulin A nephropathy. A total of 146 patients with immunoglobulin A nephropathy, pathologically confirmed by renal biopsy were grouped according to Oxford classification and Katafuchi grading, were included in the test group, and 39 healthy volunteers were included in the control group. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI, renal lengths, parenchymal thicknesses and interlobular arterial resistance index (RI) and their combinations in identifying Katafuchi grading at renal biopsy. Shear wave velocity (SWV), renal length, renal parenchyma thickness and the interlobular arterial RI were correlated with Katafuchi grading, mesangial hypercellularity (M) and tubular atrophy/interstitial fibrosis (T) (r = –0.504 to –0.407, p < 0.01) but were not correlated with endocapillary hypercellularity (E) or segmental glomerulosclerosis (S). The area under the curves of SWV value + conventional US index (renal length, renal parenchyma thickness and interlobular arterial RI) was higher than those of the SWV value or of the conventional US index alone. The combination of ARFI imaging and conventional US can improve the diagnostic performance in quantitative evaluation pathologic damage in patients with immunoglobulin A nephropathy.     

TECAI型生物人工肝支持系统治疗急性肝衰竭犬的实验研究

目的评价经改进的TECAI型生物人工肝脏支持系统（bioartificial liver supportsyst em,BALSS）治疗醋氨酚诱发急性肝衰竭(acute liver failure,ALF)犬的有效性和安全性。方法采用多次皮下注射醋氨酚的方法建立ALF模型犬。分离中国实验用小型猪肝细胞并培养于BALSS中,对ALF犬进行6小时的治疗,观察治疗前后犬生理、生化和组织学的变化,与常规药物治疗组和对照组进行比较。结果注射醋氨酚48小时后,可建立ALF犬模型,模型成功率为63.16%。应用我们改进的酶消化法,平均从每只小型猪的肝脏可得到（0.8～3.0）×10     

声辐射力脉冲成像定量评价非酒精性脂肪性肝病与病理对照研究

目的 本研究应用声脉冲辐射力成像技术(ARFI)对非酒精性脂肪性肝病(NAFLD)患者进行检测和分析,探讨该技术在无创定量评价NAFLD的临床应用价值.方法 对67例NAFLD患者应用ARFI技术对肝脏的实时超声弹性进行测量,所有患者均进行超声引导下肝脏穿刺活检,以病理结果为金标准,对肝脏的ARFI测值与肝脏脂肪变性、小叶内炎症及肝纤维化程度关系进行统计分析.结果 NAFLD患者不同脂肪变性和小叶内炎症程度间ARFI测值差异无统计学意义(P>0.05),肝纤维化分期为S0~S4期的ARFI测值分别为(1.18±0.28)m/s,(1.25±0.31)m/s,(1.44±0.52)m/s,(1.54±0.50)m/s和(1.86±0.73)m/s,组间比较差异具有统计学意义(P<0.05).肝脏ARFI测值与肝纤维化分期存在相关性,相关系数为0.42(P<0.001).ARFI技术诊断NAFLD肝纤维化S≥1,S≥2,S≥3和S=4的受试者工作特征曲线下面积分别为0.631、0.714、0.765和0.853.结论 声脉冲辐射力成像技术作为一种实时超声弹性成像技术,可较准确的无创定量评价NAFLD肝纤维化程度,具有良好的临床应用前景.     

声辐射力脉冲弹性成像诊断干燥综合征涎腺病变

目的 探讨声辐射力脉冲弹性成像（ARFI）诊断干燥综合征（SS）涎腺病变的价值。方法 收集SS患者38例（SS组）及同期健康志愿者29名（对照组）,以声触诊组织量化（VTQ）技术对所有受检者双侧腮腺和颌下腺行ARFI,检测其剪切波速度（SWV）;绘制ROC曲线,获得SWV诊断SS的最佳阈值,采用Pearson相关系数分析SWV值与实验室指标的相关性。结果 SS组腮腺、颌下腺SWV值均高于对照组（P均<0.01）。ARFI诊断腮腺SS的最佳阈值2.14 m/s,敏感度、特异度、Youden指数及曲线下面积（AUC）分别为94.7%、86.2%、0.809及0.971。ARFI诊断颌下腺SS的最佳阈值1.94 m/s,敏感度、特异度、Youden指数及AUC分别为86.8%、82.8%、0.696及0.899。腮腺SWV值与SS患者的血沉（ESR）、IgG、类风湿因子水平呈正相关（P均<0.05）;颌下腺SWV值与SS患者的IgA、ESR、IgG水平呈正相关（P均<0.05）。结论 ARFI诊断SS具有较高价值,可定量提供SS腺体的硬度值,并可反映疾病活动状况,进而对疗效进行评估。     

声辐射力脉冲成像技术对脑梗死患者颈动脉粥样软斑块质地的检测

目的 应用声辐射力脉冲成像(acoustic radiation force imaging,ARFI)技术定量评价脑梗死和非脑梗死患者颈动脉粥样软斑块的质地.方法 71例颈动脉粥样软斑块患者分为脑梗死组(31例)与非脑梗死组(40例),分别对各个斑块行ARFI检查,记录各斑块的剪切波传播速度(shear wave velocities,SWV).对两组斑块的SWV进行比较.结果 脑梗死组软斑的SWV比非脑梗死组慢,差异有统计学意义(P=0.027).绘制ROC曲线,以斑块组织SWV=1.262 m/s为截点预测脑梗死的敏感性和特异性分别为67.7％和70.0％.结论 ARFI技术可对颈动脉粥样软斑块质地进行定量检测,以预测脑梗死的发生.     

声辐射力脉冲成像鉴别诊断肾肿瘤

目的 探讨声辐射力脉冲成像(ARFI)鉴别诊断肾良恶性肿瘤的价值,以及ARFI所示肿瘤硬度与CEUS反映的肿瘤灌注之间的关系。 方法 对经手术或穿刺病理证实的35例肾肿瘤患者依次行ARFI及CEUS检查,运用声触诊组织量化(VTQ)技术测量肿瘤组织的剪切波速度(SWV),采用ROC曲线评价SWV对肾良恶性肿瘤的鉴别诊断价值并确定界值,并将ARFI所示肿瘤硬度与CEUS反映的肿瘤灌注情况进行对比。 结果 35例肾肿瘤患者中,VTQ测量的肾良恶性肿瘤的SWV值分别为(2.25±0.33)m/s和(2.72±0.46)m/s(P<0.05);以SWV=2.355 m/s为界值,鉴别诊断肾良恶性肿瘤的敏感度为83.30%,特异度为72.70%。22例(22/35,62.86%)肾肿瘤SWV值高于肾皮质,其中CEUS表现为高强化19例,低强化3例;13例(13/35,37.14%)肾肿瘤SWV值低于肾皮质,其中CEUS表现为高强化5例,低强化8例。不同硬度的肾肿瘤血流灌注程度不同,质地硬者灌注较高,质地软者灌注较低(P<0.05)。 结论 ARFI技术有助于鉴别良恶性肾肿瘤,其所示肾肿瘤硬度与血流灌注有关。     

Intact thrombin generation and decreased fibrinolytic capacity in patients with acute liver injury or acute liver failure

Summary. Background: It has been well established that hemostatic potential in patients with chronic liver disease is in a rebalanced status due to a concomitant decrease in pro‐ and antihemostatic drivers. The hemostatic changes in patients with acute liver injury/failure (ALI/ALF) are similar but not identical to the changes in patients with chronic liver disease and have not been studied in great detail. Objective: To assess thrombin generation and fibrinolytic potential in patients with ALI/ALF. Methods: We performed thrombin generation tests and clot lysis assays in platelet‐poor plasma from 50 patients with ALI/ALF. Results were compared with values obtained in plasma from 40 healthy volunteers. Results and conclusion: The thrombin generation capacity of plasma from patients with ALI/ALF sampled on the day of admission to hospital was indistinguishable from that of healthy controls, provided thrombomodulin was added to the test mixture. Fibrinolytic capacity was profoundly impaired in patients with ALI/ALF on admission (no lysis in 73.5% of patients, compared with 2.5% of the healthy controls), which was associated with decreased levels of the plasminogen and increased levels of plasminogen activator inhibitor type 1. The intact thrombin generating capacity and the hypofibrinolytic status persisted during the first week of admission. Patients with ALI/ALF have a normal thrombin generating capacity and a decreased capacity to remove fibrin clots. These results contrast with routine laboratory tests such as the PT/INR, which are by definition prolonged in patients with ALI/ALF and suggest a bleeding tendency.     

定量型声辐射力脉冲弹性成像评价慢性心力衰竭患者肝脏弹性

目的 探讨定量型声辐射力脉冲弹性成像（ARFI）评估慢性心力衰竭（简称心衰）患者肝脏弹性的应用价值。方法 对30例左心衰患者（左心衰组）、30例右心衰患者（右心衰组）及30名健康志愿者（对照组）行常规超声检查及血液生化指标检测,并以定量型ARFI检测肝脏杨氏模量值。分析慢性心衰患者肝脏杨氏模量值与生化指标、下腔静脉内径、肝静脉内径及肝右叶最大斜径的相关性。结果 左心衰组、右心衰组肝脏杨氏模量值均高于对照组（P均<0.05）,且右心衰组高于左心衰组（P<0.05）。心衰患者肝脏杨氏模量值与脑钠肽、总胆红素、γ-谷氨酰基转移酶、碱性磷酸酶、下腔静脉内径、肝左静脉内径、肝中静脉内径及肝右静脉内径均呈正相关（r=0.325、0.382、0.355、0.379、0.451、0.445、0.395、0.645,P均<0.05）,与左心室射血分数、肝右叶最大斜径无明显相关（P均>0.05）。结论 定量型ARFI可用于评估慢性心衰患者肝脏弹性,且肝脏弹性与心衰严重程度相关。