超声定量评估非酒精性脂肪性肝病患者肝脏ARFI值对显著NASH的诊断价值分析

目的探讨采用声辐射力脉冲成像技术(ARFI)定量评估非酒精性脂肪性肝病(NAFLD)患者肝脏炎症的应用价值。方法在经肝活检病理学检查诊断的非酒精性单纯性脂肪肝(NAFL)患者31例、明显非酒精性脂肪性肝炎(NASH)患者31例和显著NASH患者31例及健康人31例,使用超声检测左肝和右肝4 cm、6 cm和8cm位点ARFI值变化。结果健康人、NAFL、明显NASH和显著NASH患者左肝4 cm、6 cm和8 cm位点ARFI平均值分别为(1.32±0.15) m/s、(1.25±0.12) m/s、(1.18±0.11) m/s和(1.05±0.10) m/s,右肝ARFI平均值分别为(1.08±0.09) m/s、(0.94±0.08) m/s、(0.89±0.09) m/s和(0.84±0.07) m/s,左右肝ARFI平均值分别为(1.19±0.10) m/s、(1.10±0.09) m/s、(1.02±0.08) m/s和(0.93±0.08) m/s,显示显著性NASH患者ARFI值显著降低(P<0.05);四组左肝在8 cm位点ARFI值分别为(1.18±0.14)m/s、(1.02±0.13) m/s、(0.87±0.15) m/s和(0.71±0.11) m/s,右肝在6 cm位点ARFI值分别为(1.06±0.10) m/s、(0.95±0.09) m/s、(0.90±0.08) m/s和(0.85±0.07) m/s,右肝在8 cm位点ARFI值分别为(1.02±0.07) m/s、(0.91±0.06) m/s、(0.81±0.08) m/s和(0.72±0.05) m/s,显示显著NASH患者ARFI值显著降低(P<0.05)。结论 ARFI技术定量评估NAFLD患者肝脏损害程度有助于对显著NASH患者的诊断,可能具有一定的临床意义。

Application of ARFI quantification in the evaluation of liver injuries in patients with non-alcoholic fatty liver disease

Objectiv The aim of this study was to explore the application of acoustic radiation force impulse （ARFI） quantification in the evaluation of liver injuries in patients with non-alcoholic fatty liver disease （NAFLD）. Methods Clinical data of 31 patients with nonalcoholic simple fatty liver（NAFL）,31 with obvious non-alcoholic steatohepatitis（NASH） and 31 with significant NASH,diagnosed by liver pathological examination, and 31 normal persons were retrospectively analyzed. The mean ARFI values at 4 cm,6 cm and 8 cm in left and right livers were detected by sonography. Results The mean ARFI values of 4 cm,6 cm and 8 cm sites in the left liver of patients with normal persons,NAFL,obvious NASH and significant NASH were（1.32±0.15） m/s,（1.25±0.12） m/s,（1.18±0.11） m/s and （1.05±0.10） m/s,in right liver of the three sites were（1.08±0.09） m/s,（0.94±0.08） m/s,（0.89±0.09） m/s and （0.84±0.07） m/s, and the whole liver ARFI of right and left were （1.19±0.10） m/s,（1.10±0.09） m/s,（1.02±0.08） m/s and（0.93±0.08）m/s,showing the significantly decreased ARFI value in patients with significant NASH （P<0.05）;the ARFI of the four groups at 8 cm in left liver were （1.18±0.14）m/s,（1.02±0.13）m/s,（0.87±0.15）m/s and（0.71±0.11） m/s,at 6 cm in right liver were （1.06±0.10） m/s,（0.95±0.09）m/s,（0.90±0.08）m/s and（0.85±0.07）m/s,and at 8 cm in right liver were （1.02±0.07）m/s,（0.91±0.06） m/s,（0.81±0.08）m/s and （0.72±0.05）m/s,all showing decreased ARFI value in patients with significant NASH （all P<0.05）. Conclusions ARFI quantification might be used to evaluate the liver injuries in patients with NAFLD,which needs further investigation.