声触诊组织量化技术无创评价肝纤维化的临床研究

目的 研究声触诊组织量化(VTQ)技术评价肝纤维化程度的临床价值.方法 使用VTQ技术对271例肝穿刺活检或肝脏手术前后1个月内的患者进行肝硬度测量.男207例,女64例,平均年龄(54.00±12.67)岁.使用ACUSON S2000超声诊断仪测量受检者肝右叶VTQ值5~lO次.肝纤维化病理分期根据Scheuer方案分为S0～S4期.以病理诊断为金标准,评价VTQ技术预测肝纤维化程度的价值及其最佳界限值.结果 271例患者中病理诊断为SO~S4期的病例数分别为28例、29例、41例、52例和121例,VTQ平均值分别为(1.26±0.31)m/s、(1.28±0.28)m/s、(1.31±0.31)m/s、(1.54±O.44)m/s和(1.93±0.50)m/s.SO期与S1期、S1期与S2期的VTQ值之间差异无统计学意义.无或轻度肝纤维化(即S0、S1和S2期)、重度肝纤维化(即S3期)和肝硬化(即S4期)两两之间VTQ值差异均有统计学意义.S≥S3期时,BOC曲线下面积为0.821(95%CI:0.771～0.871);S=S4期时,ROC曲线下面积为0.828(95%CI:0.779~0.877).以1.43 m/s为界值,诊断S≥S3期的敏感度为76%,特异度为77%;以1.52 m/s为界值,诊断S=S4期的敏感度为80%,特异度为73%.结论 VTQ技术是一种间接无创评价肝纤维化的新方法,具有广阔的应用前景.

Noninvasive assessment of liver fibrosis by Virtual touch tissues quantification

Objective To investigate the clinical value of Virtual Touch Tissues Quantification（VTQ）in the assessment of liver fibrosis.Methods Two hundred and seventy-one patients underwent liver biopsy,or before/after liver surgery within one month in our hospital were examined by VTQ.There were 207 males and 64 females with an average age of（54.00±12.67）years old.ACUSON S2000 ultrasound system was used and each subject received VTQ measurements in the right lobe of liver for five to ten times.Liver fibrosis was evaluated according to the Scheuer scoring system for a S0-S4 scale.The pathological diagnosis served as the gold standard,to evaluate VTQ technique in the prediction of staging of liver fibrosis and the optimal cutoff value.Results The cases of different stages（S0～S4）of liver fibrosis were 28,29,41,52 and 121,respectively.The mean values of VTQ in S0-S4 were（1.26±0.31）m/s,（1.28±0.28）m/s,（1.31±0.31）m/s,（1.54±0.44）m/s,and（1.93±0.50）m/s,respectively.There were no significant differences between the mean value of VTQ in the S0 and S1 subgroup,or S1 and S2 subgroup.There were significant differences between the mean value of VTQ in the S0-S2 and S3 subgroup,and S3 and S4 subgroup.The areas under ROC curves were 0.821（95% CI：0.771-0.871）for S≥S3 and 0.828（95% CI：0.779-0.877）for S=S4.In our study,the optimal cutoff value was 1.43 m/s for S0-S2 vs.S3-S4,with a sensitivity of 76%,specificity of 77%,and 1.52 m/s for S0-S3 vs.S4,with a sensitivity of 80%,specificity of 73%.Conclusions VTQ technique is a new,noninvasive and promising method in the assessment of liver fibrosis.