超声剪切波弹性成像技术对诊断婴儿胆道闭锁的临床价值

摘要/Abstract

摘要： 目的探讨超声剪切波弹性成像技术(SWE)对诊断婴儿胆道闭锁(BA)的临床价值。方法选择2017年1月至2019年7月期间我院收治住院的胆汁淤积性肝病疑似病例72例,男性42例,女性30例,年龄在25 d至160 d间,平均年龄(82.6±16.8) d。选取60例健康患者作为对照组。计量资料以(±s)表示,t检验作比较;计数资料以绝对值表示,卡方检验作比较。绘制ROC曲线获得诊断相关指标。结果 72例胆汁淤积性肝病疑似病例中经手术取得病理结果确定BA患者38例(BA组),余下34例划为非BA组。BA组患者男性26例,女性12例,平均年龄(84.3±19.8)d;非BA组患者男性22例,女性12例,平均年龄(78.9±26.4)d。BA组、非BA组及对照组患者性别、年龄均无明显差异(P>0.05)。BA组患者肝脏硬度值(LSM)平均值为(14.6±6.2)kPa,非BA组患者LSM平均值为(8.3±2.3)kPa,对照组患者LSM平均值为(5.8±1.1)kPa,三组患者LSM值之间存在显著差异(P<0.05)。三组中男性、女性患者LSM平均值之间无明显差异(P>0.05)。BA组中30 d内患者LSM平均值显著低于90天内患者(P<0.05),而非BA组及对照组中30 d内、90 d内患者LSM平均值并无统计学差异(P>0.05)。绘制ROC曲线后可知,LSM对BA诊断时最佳临界值为12.8 kPa,敏感度为73.4%,特异度为88.7%,ROC曲线下面积为0.83。结论 SWE可以较为准确地反映婴儿BA患者LSM值的变化情况,对婴儿BA患者鉴别诊断有重要的临床值。

关键词: 胆道闭锁, 超声剪切波弹性成像技术, 肝脏硬度值, ROC曲线

Abstract: Objective To explore the clinical value of ultrasonic shear wave elastography (SWE) in the diagnosis of infantile biliary atresia (BA). Methods From January 2017 to July 2019, 72 suspected cases of cholestatic liver disease were treated in our hospital, including 42 males and 30 females, aged from 25 days to 160 days, with an average age of (82.6 ±16.8) days. 60 healthy patients were selected as control group. The measurement data were expressed as (±s), the t-test was used for comparative analysis, the counting data was expressed as absolute value, and the chi-square test was used for comparative analysis. The diagnostic indexes were obtained by drawing ROC curve. Results Among the 72 suspected cases of cholestatic liver disease, 38 cases of BA (BA group) were confirmed by operation, and the remaining 34 cases were included in non-BA group. There were 26 males and 12 females in BA group, with an average age of (84.3±19.8) days, while in non-BA group, there were 22 males and 12 females with an average age of (78.9±26.4) days. There was no significant difference in sex composition and age among BA group, non-BA group and control group. The average value of liver stiffness weasurement (LSM) in BA group was (14.6±6.2) kPa, the average value of LSM in non-BA group was (8.3±2.3) kPa, the average value of LSM in control group was (5.8±1.1) kPa,. There was significant difference in LSM among the three groups (P<0.05). There was no significant difference in the average value of LSM between male and female patients in the three groups (P>0. 05). The average value of LSM in BA group within 30 days was significantly lower than that in 90 days (P<0.05), but there was no significant difference in LSM between non-BA group and control group within 30 days and 90 days (P>0. 05). After drawing the ROC curve, the optimal critical value of LSM in the diagnosis of BA was 12.8 KPA, the sensitivity was 73.4% and the specificity was 88.7%, and the area under the Roc curve was 0.83. Conclusion SWE can accurately reflect the changes of LSM in infantile BA patients, and has important clinical value for the differential diagnosis of infantile BA patients.

Key words: Biliary atresia, Shear wave elastography, Liver stiffness measurement, Receiver operating characteristic curve

耿兴兰, 王克军, 康有梁. 超声剪切波弹性成像技术对诊断婴儿胆道闭锁的临床价值[J]. 肝脏, 2020, 25(8): 873-875.

GENG Xing-lan, WANG Ke-jun, KANG You-liang. Clinical value of ultrasound shear wave elastography in the diagnosis of biliary atresia in children[J]. Chinese Hepatolgy, 2020, 25(8): 873-875.

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