声脉冲辐射力成像评价肝纤维化和肝硬化的临床价值

 目的  探讨声脉冲辐射力成像(acoustic radiation force impulse,ARFI)技术在无创评估慢性肝病患者肝纤维化及肝硬化严重程度的临床应用价值。方法  采用ARFI技术检测159例患者的肝脏弹性参数 (Vs),以肝纤维化病理分期为金标准进行分组,其中69例肝硬化患者根据Child Pugh评分进一步分为代偿期或失代偿期肝硬化组。比较肝弹性参数与肝纤维化程度和肝静脉压力梯度 (hepatic vein pressure gradient,HVPG) 的相关性。结果  ARFI所测各组肝Vs分别为：S0期 (1.06±0.13) m/s、S1期 (1.16±0.07) m/s、S2期 (1.30±0.18) m/s、S3期 (1.52±0.26) m/s和肝硬化组 (1.88±0.41) m/s ［代偿组 (1.87±0.13) m/s、失代偿组 (212±041) m/s］。除S0与S1期外,其余各组间弹性参数差异均有统计学意义 (P<0.05)。ARFI诊断不同分期的受试者工作特征曲线下面积分别为0.952 (S≥S2)、0.942 (S≥S3)、0.914(肝硬化)和0.740(失代偿期肝硬化);对应的肝Vs最优值分别为1.26、1.37、1.50和1.84 m/s,相应的敏感度分别为85.2%、88.9%、80.0%和72.0%,特异度分别为99.7%、86.2%、87.8%和70.5%。对肝失代偿期患者,肝Vs与HVPG相关系数为0748,以203 m/s为截点值判断临床严重门脉高压(HVPG≥16 mmHg)的曲线下面积为0.964,敏感度和特异度分别为93.3%和99.3%。结论  ARFI技术不仅可间接评估慢性肝病患者的肝纤维化程度,并可进一步评估肝硬化严重程度,为临床提供重要的治疗和预后指导信息。

Acoustic radiation force impulse elastography: evaluation of liver fibrosis and cirrhosis

Objective  To explore the value of non-invasive acoustic radiation force impulse (ARFI) technique in the assessment of chronic liver fibrosis and cirrhosis.Methods  One hundred and fifty-nine patients were enrolled and divided into five groups by pathological staging system in our research,in which 69 cirrhotic patients were further divided into compensated cirrhosis group and decompensated cirrhosis group according to the Child-Pugh grade standard All the patients were examined with ARFI technique to obtain the liver elastography parameter (Vs),which were compared to the severity of liver fibrosis and cirrhosis and hepatic vein pressure gradient (HVPG),respectively.Results  The average liver Vs were (1.06±0.13) m/s for fibrosis stage S0,(1.16±0.07) m/s for S1,(130±0.18) m/s for S2,(1.52±0.26) m/s for S3,and (1.88±0.41) m/s for cirrhosis［ (1.87±0.13) m/s for compensated cirrhosis,(2.12±0.41) m/s for decompensated cirrhosis］. The comparison of Vs between all groups showed statistical difference (P<0.05) expect for S0 and S1 group. The areas under the receiver operating characteristics curve (AUROC) for the diagnosis of fibrosis S≥S2,S≥S3,cirrhosis and decompensated cirrhosis were 0.952,0.942,0.914 and 0.740,respectively.The cut-off values obtained were 1.26 m/s,1.37 m/s,1.50 m/s,and 1.84 m/s,with the corresponding sensitivity of 85.2%,88.9%,87.8%,72.0% and specificity of 99.7%,86.2%,80.0%,70.5%. For decompensated cirrhotic patients,the correlation coefficient between hepatic elastography parameter and HVPG was 0.748. And the cut-off value of predicating clinical severe portal hypertension (HVPG≥16 mmHg) was 2.03 m/s (AUROC 0.964),with the sensitivity and specificity of 93.3% and 99.3%.Conclusions  As a non-invasive elastography technique for the evaluation of liver stiffness,ARFI could not only be used to analyze the stage of liver fibrosis in patients with chronic liver diseases, but also to assess the severity of cirrhosis,which offer valuable information for better therapeutic strategies and prognosis of chronic liver diseases.