关键词: 急性药物性肝损伤, 超声检查, 声脉冲辐射力成像, 剪切波速度

Abstract: Objective To investigate the application value of acoustic pulse radiation force imaging (ARFI) in acute drug-induced liver injury.Methods Eight-nine patients with acute drug-induced liver injury (liver injury group) admitted from January 2013 to November 2015 in our hospital and 60 healthy persons (healthy control group) were randomly enrolled as the study objects. Among all cases, ultrasound contrast examination and ARFI examination were performed, and liver function indexes were detected, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-alanine aminotransferase (GGT), albumin (Alb), and so on. Shear wave speeds of left, right anterior and right posterior liver lobes were compared between the 2 groups, respectively. Furthermore, patients in liver injury group were divided into 3 subgroups, among which comparisons of the shear wave speed and liver function indexes were conducted, respectively. And correlation analysis between shear wave speed and liver function indexes was carried out by Spearman correlation coefficient.Results The shear wave speeds of the left lobe, right anterior lobe and right posterior liver lobes in liver injury group were higher than those in healthy control group, respectively, which showed significant difference (P<0.05). However, the comparisons of shear wave speeds among left lobe, right anterior lobe and right posterior lobe within each group had no significant difference (P>0.05), respectively. Comparisons of shear wave speed and liver function indexes among the three subgroups showed significant differences (P<0.05). Shear wave speed showed a rising trend from group C to group B and to group A, so did ALT, AST, GGT, alkaline phosphatase (ALP), Alb; gamma globulin (GLB) showed a rising trend from group A to group B and to group C. Moreover, the shear wave speed had a positive correlation with ALT, AST, GGT, ALP and ALb (r values were respectively 0.518, 0.309, 0.715, 0.474 and 0.691, P<0.05), respectively, and a negative correlation with GLB (r=-0.412, P<0.05), which revealed that shear wave speed increased with aggravation of liver function injury. For acute drug-induced liver injury diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accurate rate of ARFI were 89.9% (80/89), 90.0% (54/60), 90.3% (80/86), 85.7% (54/63), 89.9% (134/149), respectively.Conclusion AFRI might be helpful in differential diagnosis and pathological typing of acute drug-induced liver injury, which is worthy of clinical promotion and application.

Key words: Acute drug-induced liver injury; Ultrasonic examination; Acoustic pulse radiation force imaging; Shear wave speed