剪切波弹性成像技术对兔脂肪肝硬度的研究

目的采用剪切波弹性成像技术探讨兔脂肪肝硬度的变化。 方法将25只雄性新西兰大白兔随机分为2组，17只采用高脂饲料喂养，8只采用普通饲料喂养，21周时分别检测2组兔肝脏杨氏模量最大值（MAX）、最小值（MIN）、平均值（MEAN）及肝功能指标，包括丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）、白蛋白与球蛋白比（A/G）、白蛋白（ALB）、球蛋白（GLB）、总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）。将高脂饲料喂养组兔处死，并做肝脏病理切片，将符合脂肪肝的纳入研究作为实验组。实验组与对照组的杨氏模量值及肝功能指标比较采用独立样本t检验；实验组肝功能指标与杨氏模量值相关性采用Pearson相关分析。 结果实验组纳入研究13只，正常对照组8只。实验组肝脏杨氏模量MAX、MIN、MEAN值均比正常对照组增高，差异具有统计学意义（11.35±3.18）kPa vs （8.61±1.19）kPa，t=2.800，P=0.013；（3.78±1.41）kPa vs （2.52±0.37）kPa，t=2.448，P=0.024；（6.92±1.76）kPa vs （5.07±0.49）kPa，t=3.558，P=0.003]。实验组肝功能指标AST、ALT、ALP、GGT、TBIL、DBIL、IBIL较对照组升高（82.00±25.52）U/L vs （10.37±13.09）U/L，t=2.209，P=0.040；（43.91±20.76）U/L vs （24.85±4.77）U/L，t=2.533，P=0.020；（49.92±13.42）g/L vs （31.40±8.26）g/L，t=3.913，P=0.002；（9.27±3.82）U/L vs （5.40±1.66）U/L，t=2.694，P=0.014；（3.63±0.26）μmol/L vs （0.21±0.09）μmol/L，t=44.206，P=0.000；（0.84±0.52）μmol/L vs （0.03±0.04）μmol/L，t=4.322，P=0.000；（2.98±0.43）μmol/L vs （0.30±0.14）μmol/L，t=20.682，P=0.000]。ALB、GLB、A/G较对照组降低（33.71±3.56）g/L vs （43.10±2.62）g/L，t=6.937，P=0.000；（42.88±15.48）g/L vs （23.45±1.80） g/L，t=3.500，P=0.002；0.88±0.21 vs 1.84±0.14，t=11.290，P=0.000]；杨氏模量平均值与ALP、A/G具有相关性（r=-0.676，P=0.011；r=-0.632，P=0.021），最小值与A/G、GGT具有相关性（r=-0.549，P=0.050，r=0.589，P=0.034），最大值与ALB、TBIL具有相关性（r=-0.583，P=0.037；r=0.600，P=0.03）。 结论脂肪肝硬度增加，杨氏模量值与肝脏功能指标具有相关性；通过剪切波弹性成像技术可检测脂肪肝硬度的变化，可为脂肪肝的临床诊断提供一种方法。

Preliminary study of liver stiffness assessment of hepatic steatosis in rabbit model using real-time shear wave elastography imaging

ObjectiveTo explore the hardness of hepatic steatosis of rabbit model by real-time shear wave elastography imaging (SWE). MethodsTwenty-five healthy male rabbits were divided into two groups, one group was feed high diet (n=17) and the other group was feed normal diet (n=8). For 21 weeks, detected the Young′s modulus value of two groups rabbits by SWE and hepatic function: alanine aminotransferase (ALT), aspatate aminotransferase( AST), glutamyltransferase (GGT), alkaline phosphatase (ALP), albumin/globulin (A/G), albumin (ALB), globulin (GLB), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL). And the rabbits of high diet group were put to death, detected the pathology of liver by microscope, the rabbit up to fatty liver standard was the experimental group, and the group feed normal diet was control group. And then comparison the Young′s modulus value and hepatic function value between two group rabbits by t-test. Analyzed the relationship of Young′s modulus value between hepatic function value of model rabbits by Pearson′s correlation test. ResultsThe model group has 13 rabbits, the control group has 8 rabbits. The Young′s modulus value of model group is higher compare to the control group (11.35±3.18) kPa vs (8.61±1.19) kPa, t=2.800, P=0.013; (3.78±1.41) kPa vs (2.52±0.37) kPa, t=2.448, P=0.024; (6.92±1.76) kPa vs (5.07±0.49) kPa, t=3.558, P=0.003]. AST, ALT, ALP, GGT, TBIL, DBIL, IBIL of model group is higher compare to the control group (82.00±25.52) U/L vs (10.37±13.09) U/L, t=2.209, P=0.040; (43.91±20.76) U/L vs (24.85±4.77) U/L, t=2.533, P=0.020; (49.92±13.42) g/L vs (31.40±8.26) g/L, t=3.913, P=0.002; (9.27±3.82) U/L vs (5.40±1.66) U/L, t=2.694, P=0.014; (3.63±0.26) μmol/L vs (0.21±0.09) μmol/L, t=44.206, P=0.000; (0.84±0.52) μmol/L vs (0.03±0.04) μmol/L, t=4.322, P=0.000; (2.98±0.43) μmol/L vs (0.30±0.14) μmol/L, t=20.682, P=0.000]. ALB, GLB, A/G were lower than that of the control group (33.71±3.56) g/L vs (43.10±2.62) g/L, t=6.937, P=0.000; (42.88±15.48) g/L vs (23.45±1.80) g/L, t=3.500, P=0.002; 0.88±0.21 vs 1.84±0.14, t=11.290, P=0.000]. There was significant positive correlation between MEAN and ALP, A/G (r=-0.676, P=0.011; r=-0.632, P=0.021), between MIN and A/G, GGT (r=-0.549, P=0.050, r=0.589, P=0.034), and between MAX and ALB, TBIL (r=-0.583, P=0.037; r=0.600, P=0.03). ConclusionsThe Young′s modulus value of hepatic steatosis is higher than healthy. SWE is a convenience and shortcut method for detection the change in consistency of fatty liver.