声脉冲辐射力成像评价肝纤维化与临床病理的对照研究

目的 探讨声脉冲辐射力成像评价临床肝病患者肝纤维化的价值.方法 对99例欲行肝外科手术的患者术前进行声脉冲辐射力成像检查,得出反映肝组织硬度的剪切波速度(shear wave velocity,Vs).对患者肝组织病理进行肝纤维化分期、炎症活动程度分级以及脂肪变程度分级.将Vs与病理结果做比较.结果 肝纤维化S0～S4期的Vs值分别为(1.14±0.22) m/s、(1.30±0.22)m/s、(1.36±0.38)m/s、(1.47±0.37)m/s以及(1.87±0.08) m/s,各组间差异具有统计学意义(P＜0.001);Vs与肝纤维化分期之间具有一定的相关性(r=0.541,P＜0.001),Vs预测3期及以上肝纤维化的ROC曲线下面积为0.812(P＜0.001),以1.40 m/s为最佳临界值,敏感性、特异性分别为73.2％和81.4％.炎症活动程度分级G0～G3的Vs值分别为(1.17±0.16)m/s、(1.43±0.36)m/s、(1.59±0.53) m/s以及(1.89±0.59)m/s,各组间差异有统计学意义(P＜0.001);Vs与炎症活动程度分级之间具有一定的相关性(r =0.383,P＜0.001).脂肪变程度分级F0～F4的Vs值分别为(1.61±0.42)m/s、(1.47±0.58)m/s、(1.56±0.71)m/s、1.13 m/s以及(0.94±0.95) m/s,各组间差异不具有明显统计学意义(P=0.286);Vs与脂肪变程度分级之间亦不存在明显相关性(r=-0.177,P=0.080).结论 声脉冲辐射力成像评价肝纤维化具有一定的价值,但炎症活动程度对结果具有显著的影响.     

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.     

声脉冲辐射力成像技术定量评价肾功能不全患者肾脏纤维化临床研究

目的 探讨声脉冲辐射力成像技术(ARFI)检测肾功能不全的价值.方法 使用超声的声脉冲辐射力成像技术检测261例受检者右肾皮质,包括对照组122例、疑似肾功能不全而行肾穿刺活检的患者81例和已经确诊尿毒症的行血液透析治疗的患者58例.比较肾穿刺组患者剪切波速度Vs与穿刺病理结果.结果 三组受检者的右肾皮质剪切波速度(Vs)相互之间有显著差异(P＜0.05),随着肾脏纤维化程度的加重,Vs增加.Vs对诊断肾功能不全患者的ROC曲线下面积为0.85,分别以Vs 1.64 m/s,1.75 m/s作为肾功能不全诊断界值,诊断的敏感度、特异度分别为74％、91％; 84％、81％.结论 声脉冲辐射力成像技术可无创反映肾脏组织的弹性硬度,间接评估肾纤维化,具有潜在的临床应用价值.     

肝动静脉渡越时间及剪切波速评估肝纤维化程度的对比研究

目的探讨超声造影测量肝动静脉渡越时间(HAVTT)及声脉冲辐射力技术测量剪切波速(SWV)在评估慢性乙型肝炎患者肝纤维化程度中的应用价值。方法 83例S0~S4期慢性乙型肝炎肝病患者,对其肝脏行超声造影及弹性超声检查。超声造影采用目测法测量并计算HAVTT1和HAVTT2;利用声脉冲辐射力技术测量SWV。结果运用ROC曲线得到≥S1期、≥S2期、≥S3期和S4期的SWV参考阈值分别为1.41 m/s、1.81 m/s、2.14 m/s、2.40 m/s,HAVTT1参考阈值分别为11.6 s、10.5 s、9.5 s、7.4 s,HAVTT2参考阈值分别为14.1 s、12.4 s、11.6 s、9.4 s。SWV、HAVTT1、HAVTT2对肝纤维化分期诊断正确率分别为89.2%、72.3%、77.1%,前者高于后两者(P0.05)。结论超声造影测量HAVTT可反映肝脏微循环的变化,可用于对S2期和S3期肝纤维化的鉴别诊断。超声弹性成像测量SWV能够反映肝纤维化分期的弹性硬度差异,较超声造影使用更方便、更无创,可作为评判肝纤维化程度及治疗疗效的一种新方法。     

丙氨酸氨基转移酶水平对ARFI技术评价酒精性肝病肝纤维化程度的影响

目的 评价丙氨酸氨基转移酶（ALT）水平对声辐射力脉冲成像（ARFI）技术诊断酒精性肝病（ALD）肝纤维化程度的影响。方法 选取经肝脏穿刺活检确诊的ALD患者99例,根据ALT水平分为ALT升高组55例和ALT正常组,应用ARFI技术检测其肝脏弹性,以病理诊断结果为金标准,探讨不同ALT水平对ARFI技术诊断ALD肝纤维化程度的影响;绘制ARFI诊断ALD肝纤维化程度的受试者工作特征曲线,确定其诊断界值并计算诊断效能,分析ALT水平对ARFI诊断ALD肝纤维化的影响。结果 ALD患者肝脏ARFI测值与肝纤维化程度和肝脏炎症程度均呈正相关（r=0.685、0.636,均P＜0.001）。ALT正常组在诊断肝纤维化程度≥S3期和S4期的曲线下面积均稍高于ALT升高组（0.979 vs.0.837, 0.981 vs.0.839）,差异均无统计学意义。在ALT正常组ARFI诊断肝纤维化≥S2期、≥S3期和S4期的界值分别为1.237 m/s、1.269 m/s、1.413m/s,ALT升高组相应界值分别为1.330 m/s、1.395 m/s、1.653 m/s。结论 肝脏ALT水平对ARFI技术诊断ALD患者肝纤维化程度有一定影响,建议临床应用ARFI诊断时需综合考虑患者的肝功能水平。     

声脉冲辐射力弹性成像评价儿童肝纤维化的临床应用

目的：探讨声脉冲辐射力弹性成像评价儿童肝纤维化程度的临床应用价值。 方法：采用声脉冲辐射力弹性成像技术对70例患有儿童常见肝病的患儿及50例健康志愿者分别进行弹性成像检测及血清学检测,血清学检查的主要指标为谷草转氨酶（AST）与血小板计数（PLT）之比（APRI）,将病例组弹性成像测值SWV值及血清学检测APRI比值分别与肝纤维化METAVIR分级进行相关性分析,并将SWV值与APRI比值进行比较,评价弹性成像SWV值在评价儿童肝纤维化的临床应用价值。 结果：SWV值与儿童肝纤维化程度成正相关（相关系数0.71,P＜0.05）,SWV值随着肝纤维化程度的加重而增加,各病理肝纤维化分级的肝脏平均SWV值分别为：F1 1.57±0.30 m/s,F2 1.89±0.32 m/s,F3 2.14±0.36 m/s,F4 2.59±0.22 m/s。APRI值与肝纤维化程度不相关（相关系数=-0.02,P＞0.05）。肝纤维化分级≥F1时,最大约登指数对应的的SWV值为1.73 m/s（se 54.30%,sp 100.00%）;肝纤维化分级≥F2时,最大约登指数对应的的SWV值为1.67 m/s（se 89.50%,sp 74.50%）;肝纤维化分级≥F3时,最大约登指数对应的的SWV值为1.83 m/s（se 84.60%,sp 83.30%）。受试者工作特征曲线下面积(AUROC)分别为0.823,0.895,0.907。 结论：声脉冲辐射力弹性成像在无创评价儿童肝纤维化方面有较高的临床价值,尤其能更精准评价中重度肝纤维化程度,为儿童肝病的诊断、治疗及疾病随访提供重要影像学依据。     

声辐射力脉冲成像评价不同丙氨酸氨基转移酶水平酒精性肝病肝纤维化程度的研究

目的探讨声辐射力脉冲成像(ARFI)技术评价不同丙氨酸氨基转移酶(ALT)水平酒精性肝病患者肝纤维化程度的临床价值。方法选取经肝脏穿刺活检确诊的酒精性肝病患者99例,根据血清ALT水平分为ALT升高组55例和ALT正常组44例,应用ARFI技术检测两组肝脏弹性,以病理诊断结果为金标准,比较不同ALT水平的酒精性肝病患者的肝脏弹性值;绘制ARFI诊断酒精性肝病肝纤维化程度的受试者工作特征曲线并计算曲线下面积,确定其诊断界值,分析ARFI值与肝纤维化程度和炎症程度的相关性。结果 99例患者中,肝纤维化S0期～S4期的ARFI值分别为(0.99±0.11)m/s、(1.15±0.12)m/s、(1.42±0.36)m/s、(1.89±0.67)m/s、(2.11±0.54)m/s,差异有统计学意义(P0.01);除S0期与S1期、S3期与S4期外其余各期两两比较差异均有统计学意义(均P0.05)。ALT正常组中诊断肝纤维化程度≥S3期和S4期的曲线下面积均稍高于ALT升高组(0.979 vs. 0.837,0.981 vs. 0.839),但差异均无统计学意义。ALT正常组ARFI诊断肝纤维化≥S2期、≥S3期和S4期的界值分别为1.237 m/s、1.269 m/s、1.413 m/s,ALT升高组相应界值分别为1.330 m/s、1.395 m/s、1.653 m/s。相关性分析结果表明,肝脏ARFI测值与肝纤维化程度和肝脏炎症程度均呈正相关(r=0.685、0.636,均P0.001)。结论酒精性肝病患者肝脏ALT水平对ARFI技术诊断其肝纤维化程度有一定影响,建议临床应用ARFI诊断时需综合考虑患者的肝功能水平。     

声辐射力脉冲成像与APRI指数评价慢性丙型肝炎肝纤维化的临床价值

目的 探讨声辐射力脉冲成像(acoustic radiation force impulse,ARFI)技术和天门冬氨酸氨基转移酶与血小板比值指数(AST/PLT ratio index,APRI)无创评价慢性丙型肝炎肝纤维化程度的临床应用价值.方法 对107例慢性丙型肝炎患者应用ARFI技术检测肝实时弹性,并计算APRI指数,所有患者均于检测后1周内行肝穿刺活检,以病理检查结果为金标准,比较ARFI测值和APRI指数对慢性丙型肝炎肝纤维化的诊断价值.结果 慢性丙型肝炎患者肝纤维化分期为S1～S4期的ARFI分别为(1.26±0.27) m/s、(1.45±0.51)m/s、(2.03±0.54) m/s和(2.29±0,82) m/s,APRI分别为0.30±0.46、0.29±0.21、0.59±0.56和0.63±0.35.ARFI和APRI测值均与肝纤维化分期存在相关,相关系数分别为0.61和0.49(P＜0.001).ARFI和APRI诊断慢性丙型肝炎肝纤维化S≥2的ROC曲线下面积分别为0.779、0.724;S≥3的曲线下面积分别为0.866、0.786;S=4的曲线下面积分别为0.790、0.779.结论 ARFI技术较APRI指数能更准确地定量评价慢性丙肝肝纤维化程度,具有良好的临床应用前景.     

声触诊组织成像量化技术无创评价慢性肝病肝纤维化程度的初步临床研究

目的 探讨声触诊组织成像量化(VTQ)技术无创评价慢性肝病患者肝纤维化程度的临床价值.方法 应用VTQ技术对115例拟行超声引导下肝穿刺活检慢性肝病患者和80例健康成人行肝检查,并对检查结果进行对比分析.结果 慢性肝病组和健康组之间VTQ值差异有显著统计学意义(P=0.0000);慢性肝病患者不同病理分期间的VTQ值除S0与S1外,其他病理分期间差异均有统汁学意义(P=0.0212或P=0.0000);将S0-S2合并为轻度肝纤维化,S3-S4合并为中一重度肝纤维化,用ROC曲线分析阈值,当VTQ值≥1.4 m/s时,诊断中-重度肝纤维化的敏感度和特异度分别为85.4%和64.7%.结论 VTQ检查作为无创、量化的检查手段,可用来评价慢性肝病患者的肝纤维化程度.     

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。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

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.     

Digital imaging among medical facilities

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.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.