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1.
目的比较实时二维剪切波弹性成像(2D-SWE)、瞬时弹性成像(TE)、实时组织弹性成像(RTE)评估肝纤维化的诊断效能。方法选取2013年10月至2014年5月在中山大学附属第三医院就诊的慢性肝病患者138例,同时行肝脏2D-SWE、TE及RTE检查,以病理学结果为"金标准",病理肝纤维化分期4组间弹性成像肝硬度检测比较采用方差分析,比较2D-SWE、TE及RTE 3者与肝纤维化分期的Spearman相关系数,相关系数的比较采用Z检验;构建受试者工作特征(ROC)曲线分析诊断效能,计算曲线下面积(AUC),AUC的比较采用De Long法。结果 2D-SWE、TE及RTE与病理肝纤维化分期的相关系数分别为0.707、0.694、0.424,2D-SWE与TE比较差异无统计学意义(Z=0.210,P0.05),但均优于RTE(Z=3.521、3.312,P值均0.01)。2D-SWE、TE及RTE诊断显著肝纤维化(S2)与肝硬化(S4)的AUC分别为0.853与0.903、0.861与0.913、0.713与0.719,2D-SWE与TE诊断效能相当(S2:Z=0.296,S4:Z=0.613,P值均0.05),但均优于RTE(S2:Z=2.003、2.197,S4:Z=1.986、1.983,P值均0.05)。结论 2D-SWE、TE诊断肝纤维化效能相当,但均优于RTE。  相似文献   

2.
目的比较二维剪切波弹性成像(2D-SWE)与瞬时弹性成像(TE)对慢性乙型肝炎(CHB)患者肝纤维化分期诊断价值。方法选取我院临床确诊的148例CHB患者,分别行2D-SWE及TE检查,以超声引导下肝组织穿刺活检病理结果为金标准,比较分析两种弹性成像评估肝纤维化分期的诊断效能。结果 2D-SWE及TE所测弹性值与肝纤维化分期均呈显著正相关(r=0.914、0.783,均P0.05);两种检查方法所测不同肝纤维化分期的弹性值比较差异均有统计学意义(均P0.05),且均随肝纤维化分期的加重而增加;2D-SWE诊断显著性肝纤维化(S2~S4期)的受试者工作特征(ROC)曲线的曲线下面积分别为0.973、0.976及0.972,均优于TE诊断的曲线下面积(0.903、0.909及0.904),差异均有统计学意义(Z=3.062、3.379、2.539,均P0.05)。结论 2D-SWE与TE技术在无创诊断CHB患者肝纤维化程度方面具有相似的诊断价值,但2D-SWE技术优于TE,更具有临床应用价值。  相似文献   

3.
目的对比分析声脉冲辐射力成像(ARFI)技术和瞬时弹性成像(TE)技术诊断慢性乙型肝炎(CHB)肝纤维化的临床应用价值。方法应用ARFI和TE技术检测189例CHB患者的肝脏弹性,以病理结果为金标准,比较ARFI和TE技术对不同肝纤维化分期的诊断价值。结果 ARFI技术检测成功率为100%,TE技术检测成功率为95.23%,差异有统计学意义(P=0.007)。ARFI和TE测值均与肝纤维化分期呈正相关,相关系数分别为0.60和0.63(P0.01)。ARFI和TE技术诊断肝纤维化S2期的ROC曲线下面积分别为0.764和0.813(P=0.302);S3期的ROC曲线下面积分别为0.852和0.852(P=1.000);S4期的ROC曲线下面积分别为0.825和0.799(P=0.655)。结论 ARFI和TE技术在无创诊断CHB肝纤维化程度方面具有相似的诊断价值,但ARFI技术成功率高,适用范围广,更具有临床应用优势。  相似文献   

4.
目的评估声脉冲辐射力成像(ARFI)技术联合瞬时弹性成像(TE)技术对慢性乙型肝炎(CHB)肝纤维化的诊断价值。 方法选取2015年10月至2017年6月在哈尔滨医科大学附属第四医院就诊的121例CHB患者,进行肝脏穿刺活检、常规生化检查、ARFI及TE检查。采用方差分析比较肝纤维化各组的年龄、AST、ALT、ARFI值及TE值,进一步比较采用SNK-q检验,并与病理结果做相关性分析。以肝纤维化病理学分期为"金标准",采用工作特征曲线(ROC)对比分析ARFI及TE技术对CHB肝纤维化分期的准确性,并应用Logistic回归进行联合诊断的风险预测,并通过预测值绘制ROC曲线,比较ARFI、TE及两者联合对肝纤维化S≥1期及S≥2期的诊断价值。 结果ARFI及TE值均与肝纤维化分期具有较好的正相关性(r=0.789、0.845,P均<0.0001)。ARFI及TE技术诊断肝纤维化S≥1期的AUROC分别为0.849及0.903(P=0.424);S≥2期的AUROC分别为0.874及0.923(P=0.191);S≥3期的AUROC分别为0.938及0.954(P=0.526);S=4期的AUROC分别为0.913及0.926 (P=0.842)。ARFI及TE技术联合诊断肝纤维化S≥1期的AUROC为0.925,与两者单独诊断相比,差异均无统计学意义(P均>0.05),但联合后的敏感度、特异度及准确性均提高;联合诊断S≥2期的AUROC为0.949,与两者单独诊断相比,仅优于ARFI的单独诊断,差异有统计学意义(P=0.009),但联合后的敏感度及准确性均有所提高。 结论ARFI技术联合TE技术有助于提高肝纤维化S≥1期及S≥2期的诊断。  相似文献   

5.
目的探讨二维剪切波弹性成像(2D-SWE)对病毒性肝炎与非病毒性肝炎肝纤维化程度的诊断效能,为2D-SWE的临床应用提供科学依据。方法将2D-SWE应用于2011年4月至2013年1月于中山大学附属第三医院就诊的73例病毒性肝炎与60例非病毒性肝炎患者,以肝穿刺活检病理结果为金标准,分别比较病毒性肝炎与非病毒性肝炎不同纤维化程度肝杨氏模量值及其与病理分期的相关性、2D-SWE诊断肝纤维化的受试者操作特性曲线(ROC曲线)下面积。结果病毒性肝炎患者S0~1期、S2~3、S4期肝脏杨氏模量值分别为6.1(4.8~6.6)、10.3(7.6~14.0)和24.7(17.4~32.1)k Pa;非病毒性肝炎患者S0~1期、S2~3、S4期肝脏杨氏模量值分别为7.4(6.0~8.4)、10.7(8.0~13.5)、26.8(16.5~31.7)k Pa。病毒性肝炎与非病毒性肝炎患者S0~1期肝脏杨氏模量值的差异有统计学意义(Z=-3.45,P=0.001),而S2~3期和S4期的差异均无统计学意义(Z=-0.40、-0.06,P=0.686、0.956)。病毒性肝炎与非病毒性肝炎患者肝脏杨氏模量值与纤维化病理分期的Spearman相关系数分别0.864和0.705(P=0.000,0.000),两者比较差异有统计学意义(Z=-2.42,P=0.015)。2D-SWE诊断病毒性肝炎与非病毒性肝炎患者显著肝纤维化(S≥2)的ROC曲线下面积为0.964和0.817,两者比较差异有统计学意义(Z=-2.47,P=0.014);诊断肝硬化(S=4)的ROC曲线下面积为0.930和0.900,两者比较差异无统计学意义(Z=-0.502,P=0.616)。结论 2D-SWE诊断病毒性肝炎与非病毒性肝炎患者肝纤维化的效能在无/轻度纤维化阶段存在差异,在显著/严重纤维化和肝硬化阶段,两者诊断效能相当。  相似文献   

6.
目的 探讨实时剪切波弹性成像及肝纤维化血清学指标评估实验性兔肝纤维化程度的价值。方法 新西兰大白兔48只,随机分成实验组40只(皮下注射四氯化碳橄榄油溶液);对照组8只(皮下注射生理盐水)。在实验的第4、8、12、16周末分别从实验组随机抽取8只和对照组2只,行肝实时剪切波弹性成像、纤维化血清学指标和病理检查,分析Emean 值及纤维化血清学指标与纤维化病理分期的相关性,并采用ROC曲线评估两者对肝纤维化程度的诊断效能。结果 32只造模成功的大白兔肝脏病理呈不同程度的纤维化。任两期之间Emean值差异具有统计学意义,且Emean 值与肝纤维化分期的相关性大于肝纤维化血清学指标(P<0.05)。Emean 值诊断肝纤维化分期≥S1、≥S2、≥S3、=S4 的曲线下面积均大于0.90,大于IV型胶原、Ⅲ型前胶原氨基端肽和层粘蛋白,在诊断肝纤维化病理分期≥S2、≥S3、=S4的曲线下面积大于透明质酸,P均<0.05。Emean值除了与透明质酸值在诊断肝纤维化病理分期≥S1的特异度比较差异无统计学意义外,Emean 值在诊断肝纤维化病理各分期的灵敏度、特异度均大于89%,大于肝纤维化血清学指标,P均<0.05。结论 实验性兔实时剪切波弹性成像Emean 测值对肝纤维化程度的诊断效能高于肝纤维化血清学指标。  相似文献   

7.
目的探讨声触诊弹性成像(STE)两种取值方法诊断慢性乙型肝炎(CHB)肝纤维化的应用价值。方法对122例CHB患者行STE检查,获得各病理分期肝弹性模量值的均值和中位数,计算均值、中位数两种取值方法与病理分期的相关系数;绘制受试者工作特征(ROC)曲线分析两种取值方法对肝纤维化的诊断效能,比较曲线下面积的差异。结果均值、中位数两种取值方法的弹性模量值在各病理分期间比较差异均有统计学意义(F=36.894、28.667,均P<0.001);均值、中位数两种取值方法与病理分期均呈正相关(r=0.641、0.598,均P<0.001)。以均值为取值方法诊断肝纤维化≥S2期及S4期的曲线下面积稍高于以中位数为取值的方法,差异均无统计学意义;以均值为取值方法诊断肝纤维化≥S3期的曲线下面积高于以中位数为取值的方法,差异有统计学意义(P<0.05)。结论 STE诊断CHB患者肝纤维化具有一定的应用价值,选择肝弹性模量值均值为检查参数较中位数的诊断价值更高。  相似文献   

8.
目的 采用实时组织弹性成像(RTE)及剪切波弹性成像(SWE)联合血清学模型评估乙型肝炎(CHB)患者肝纤维化分期。方法 针对112例谷丙转氨酶(GPT)≤2倍正常值上限(ULN) CHB患者行RTE、SWE及血清学检查,记录其剪切波速度(Vs)、肝纤维化指数(LF指数、F指数)、GPT、谷草转氨酶(GOT)、γ-谷氨酰转移酶(GGT)及血小板(PLT)等。以肝活检结果作为"金标准",绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),比较各指标及血清学模型GOT/PLT比值、GGT/PLT比值等诊断肝纤维化分期的效能。结果 Vs、LF指数及F指数诊断≥F2期肝纤维化的AUC分别为0.952、0.889及0.938;诊断F4期的AUC分别为0.930、0.858及0.918;三者联合诊断≥F2期及F4期的AUC分别为0.975、0.951。3个弹性成像指标与筛选出的血清学模型GOT/PLT比值、GGT/PLT比值联合诊断≥F2期及F4期的AUC分别为0.979、0.954。结论 RTE、SWE联合血清学模型可提高诊断GPT轻度升高CHB患者肝纤维化分期效能。  相似文献   

9.
目的探讨实时二维剪切波弹性成像(2D-SWE)技术诊断慢性乙型肝炎患者≥S2期肝纤维化的应用价值。方法选取2013年1月至2015年12月在宁波市鄞州第二医院就诊的慢性乙型肝炎患者595例,均行2D-SWE及超声引导下穿刺活检,以病理结果为"金标准",分析弹性模量值与肝纤维化病理分期之间的相关性,采用受试者工作特征(ROC)曲线分析2D-SWE诊断≥S2期肝纤维化的效能。2位不同年资的医师盲法检测同一患者肝脏硬度弹性模量值,采用组内一致性检验(ICC)评价测量值的重复性。结果肝纤维化S0~S4期的弹性模量值分别为(5.6±0.7)k Pa、(6.5±0.9)k Pa、(8.4±2.1)k Pa、(11.6±3.6)k Pa、(14.8±3.7)k Pa,组间比较差异有统计学意义(F=181.370,P0.01),与纤维化病理分期的Spearman相关系数为0.731。2D-SWE诊断肝纤维化(≥S2期)的ROC曲线下面积为0.900,阈值为7.43 k Pa,对应的敏感度与特异度分别为79.9%、84.8%。不同医师采用2D-SWE技术诊断同一组慢性乙型肝炎患者的一致性较高,相关系数为0.864~0.979。结论 2D-SWE技术可定量测量肝脏硬度,是无创性评估慢性乙型肝炎≥S2期肝纤维化的重要诊断方法,有利于指导及时抗病毒治疗。  相似文献   

10.
目的探讨三维剪切波弹性成像(3D-SWE)在甲状腺良恶性结节鉴别诊断中的应用价值。 方法选取2018年12月至2019年10月因甲状腺结节于四川省肿瘤医院就诊的患者75例,共计94个结节。对其行常规超声及2D-SWE、3D-SWE检查,测量最大弹性值(Emax)、平均弹性值(Emean),取样框内弹性数据离散度值(Esd)。所有结节均经手术取得病理结果。以病理结果为"金标准",绘制2D-SWE、3D-SWE不同弹性参数鉴别诊断甲状腺良恶性结节的受试者工作特征(ROC)曲线,分析比较2D-SWE与3D-SWE不同弹性参数的诊断效能。 结果本研究中经病理证实良性结节共24个,恶性结节共70个。在2D-SWE横断面、矢状面及3D-SWE横断面、矢状面、冠状面,恶性结节的Emax、Emean、Esd均较良性结节大,差异均有统计学意义(P均<0.05)。2D-SWE横断面、矢状面以及3D-SWE横断面、矢状面、冠状面的Emax诊断甲状腺结节的ROC曲线下面积(AUC)分别为0.753、0.797、0.790、0.811、0.806,差异均无统计学意义(P均>0.05);Emean诊断甲状腺结节的AUC分别为0.740、0.745、0.771、0.780、0.802,差异均无统计学意义(P均>0.05);2D-SWE横断面的Esd鉴别诊断甲状腺良恶性结节的AUC小于2D-SWE矢状面、3D-SWE矢状面以及冠状面(0.675 vs 0.803/0.805/0.774),且差异均有统计学意义(Z=2.540、1.971、1.963,P均<0.05)。 结论3D-SWE能够通过定量评估甲状腺结节的硬度鉴别甲状腺结节良恶性,3D-SWE矢状面及冠状面Esd综合诊断效能优于2D-SWE横断面,可作为甲状腺结节诊断的一种有效方法。  相似文献   

11.
This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.  相似文献   

12.
目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高<20%视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P<0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P<0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P<0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.  相似文献   

13.
The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.  相似文献   

14.
15.
Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.  相似文献   

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Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.  相似文献   

18.
ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.  相似文献   

19.
Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.  相似文献   

20.
目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。  相似文献   

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