实时剪切波弹性成像对不同程度儿童肝纤维化的诊断价值

摘要/Abstract

摘要： 目的分析实时剪切波弹性成像(shear wave elastography,SWE)评价儿童肝纤维化程度的临床价值。方法选择2018年1月至2020年12月医院收治的85例慢性肝病或胆道闭锁患儿,所有患儿均行常血清学及实时剪切波弹性成像检查,以病理学检测结果为肝纤维化诊断“金标准”,比较患儿不同程度肝纤维化血清及SWE指标差异,分析SWE对不同程度儿童肝纤维化的诊断价值。结果四组患儿血清PC Ⅲ、Ⅳ C、HA、LN及弹性模量均存在统计学差异,且随着肝纤维化分期增加,血清PC Ⅲ、Ⅳ C、HA、LN及弹性模量均显著增加(P<0.05)。患儿SWE弹性模量与PC Ⅲ、Ⅳ C、HA、LN及肝纤维化程度分期均呈显著正相关性(P<0.05)。SWE弹性模量对≥S1、≥S2、≥S3、S4分期儿童肝纤维化诊断AUC分别为0.818、0.821、0.837、0.829,最佳截断值分别为5.57 kPa、7.21 kPa、8.33 kPa和9.62 kPa;敏感度分别为64.77%、63.21%、59.87%和65.13%;特异度分别为94.37%、92.32%、90.11%和87.48%。结论 SWE技术可定量反映肝纤维化及其分期,对儿童不同程度肝纤维化具有较好的诊断效能,可为儿童肝纤维化的临床诊疗提供参考依据。

关键词: 实时剪切波弹性成像, 慢性肝病, 病理学, 儿童, 肝纤维化, 诊断价值

Abstract: Objective To analyze the clinical value of real-time shear wave elastography (SWE) in evaluating the stages of liver fibrosis in children. Methods Eighty-five children with chronic liver diseases or biliary atresia admitted from January 2018 to December 2020 were selected. Routine serological tests and real-time shear wave elastography were performed in all children. The pathological results of liver biopsies were used as the "Gold standard" for diagnosing liver fibrosis, and in the comparison between the efficacies of serum markers and SWE indexes in evaluating the stages of liver fibrosis, as well as the diagnostic value of SWE. Results There were significant differences in serum procollagen III (PC III), collagen type IV (IV C), hyaluronic acid (HA), laminin (LN) and elastic modulus among children with fibrosis ≥ S1, ≥ S2, ≥ S3 and S4 stages, and the serum PC III, IV C, HA, LN and elastic modulus increased significantly (P<0.05). SWE elastic modulus was positively correlated with PC III, IV C, HA, LN and the stage of liver fibrosis (P<0.05). The AUC (area under the curve) of SWE elastic modulus for the diagnosis of liver fibrosis in children ≥S1, ≥S2, ≥S3 and S4 stages were 0.818, 0.821, 0.837 and 0.829, and the best cut-off values were 5.57 kPa, 7.21 kPa, 8.33 kPa and 9.62 kPa, respectively. The sensitivity was 64.77%, 63.21%, 59.87% and 65.13%, and the specificity was 94.37%, 92.32%, 90.11% and 87.48%, respectively. Conclusion SWE technique quantitatively detects liver fibrosis with good diagnostic efficacy for different stages of liver fibrosis in children, and provides a reference for the diagnosis and treatment of liver fibrosis in children with chronic liver diseases.

Key words: Real time shear wave elastography, Chronic liver diseases, Pathology, Children, Hepatic fibrosis, Diagnostic value

唐文静, 朱婷, 方静, 王松平. 实时剪切波弹性成像对不同程度儿童肝纤维化的诊断价值[J]. 肝脏, 2021, 26(12): 1356-1359.

TANG Wen-Jing, ZHU Ting, FANG Jin, WANG Song-Ping. Diagnostic value of real-time shear wave elastography for different stages of hepatic fibrosis in children[J]. Chinese Hepatolgy, 2021, 26(12): 1356-1359.

参考文献

[1] 郭津生.肝纤维化研究热点及进展——2019年视点.中华肝脏病杂志,2019,27:401-402.
[2] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会.肝纤维化诊断及治疗共识(2019年).中华肝脏病杂志,2019,27:657-667.
[3] 宫颖新,王萍,白玉坤, 等.胆道闭锁患儿血清MMP-7和uPAR水平与肝纤维化和预后的关系研究.国际检验医学杂志,2020,41:2155-2158.
[4] Schellhaas B, Strobel D, Wildner D, et al.Two-dimensional shear-wave elastography: a new method comparable to acoustic radiation force impulse imaging?.Eur J Gastroenterol Hepatol,2017,29:723-729.
[5] 吴欣,杜霄壤,丁金芳, 等.儿童先天性肝纤维化临床分型及特征.中国当代儿科杂志,2016,18:335-339.
[6] 卞锦花,周琦,姜珏, 等.实时二维定量剪切波弹性成像对肝纤维化程度的评估价值研究.河北医学,2019,25:186-189.
[7] 高洋,王娟,肖欢, 等.声辐射力脉冲成像评价儿童肝纤维化的临床应用价值.临床超声医学杂志,2019,21:354-357.
[8] 李向珍,房秀霞.实时剪切波弹性成像对乙型肝病诊断价值及其与肝纤维化分期关系的研究.内蒙古医科大学学报,2019,41:365-367.
[9] 汤晓艳,刘晓宇,叶俊, 等.超声造影与剪切波弹性成像评估慢性乙型肝炎肝纤维化的对比研究.临床超声医学杂志,2020,22:229-232.
[10] Alhashmi GH, Gupta A, Trout AT, et al. Two-dimensional ultrasound shear wave elastography for identifying and staging liver fibrosis in pediatric patients with known or suspected liver disease: a clinical effectiveness study.Pediatr radiol,2020,50:1255-1262.
[11] Farmakis SG, Buchanan PM, Guzman MA,et al. Shear wave elastography correlates with liver fibrosis scores in pediatric patients with liver disease.Pediatr radiol,2019,49:1742-1753.
[12] 段星星,彭娅,杨柳, 等.剪切波弹性成像评估胆道闭锁Kasai术前肝纤维化程度.中华超声影像学杂志,2020,29:143-148.
[13] 徐朝阳,牛高华.实时剪切波弹性成像技术评估肝纤维化程度及其分期的临床意义.实用医院临床杂志,2020,17:123-126.
[14] 李昶玥,郑颖,张嫄, 等.实时二维剪切波弹性成像技术无创评价肝纤维化程度及其与病理分期的相关性研究.临床超声医学杂志,2018,20:518-521.
[15] 彭娅,段星星,刘金桥, 等.剪切波弹性成像和血清肝纤维化标志物检测对婴儿肝炎综合征肝纤维化的预测价值.医学临床研究,2017,34:2116-2119,2123.