摘要
目的：本研究应用声辐射力脉冲成像（Acoustic radiation force impulse, ARFI）技术和APRI（AST/PLT ratio index）指数对非酒精性脂肪性肝病（Nonalcoholic fatty liver disease, NAFLD）患者进行检测，探讨和对比上述两项无创技术在诊断NAFLD肝纤维化程度上的临床应用价值。方法：对67例NAFLD患者应用ARFI技术检测肝脏超声弹性，并计算APRI指数，所有患者均于检测后1周内行肝脏穿刺活检，以病理检查结果为金标准，比较ARFI技术和APRI指数对NAFLD肝纤维化的诊断价值。结果：NAFLD患者肝纤维化分期为S0~S4期的ARFI和APRI平均值分别为（1.177±0.281） m/s（APRI 0.192±0.155），（1.249±0.308） m/s（APRI 0.190±0.097），（1.436±0.521） m/s（APRI 0.306±0.195），（1.538±0.496） m/s（APRI 0.224±0.094）和（1.857±0.729） m/s（APRI 0.373±0.295），两种技术测值均与肝纤维化分期存在相关，相关系数分别ARFI 0.416（P<0.01）和APRI指数0.254（P<0.05）。ARFI和APRI诊断NAFLD肝纤维化S≥2的ROC曲线下面积分别为0.714、0.653；S≥3的面积分别为0.765、0.577；S=4的面积分别为0.853、0.611。结论：ARFI技术作为实时超声弹性成像技术，较APRI指数能更准确的无创定量评价NAFLD肝纤维化程度，具有良好的临床应用前景。
Abstract
Objective: To investigate the diagnostic value of the acoustic radiation force impulse(ARFI) imaging technology and AST/PLT ratio index(APRI) for the assessment of the liver fibrosis in NAFLD patients. Methods: Sixty-seven patients with non-alcoholic fatty liver disease(NAFLD) were included, the subjects were underwent liver biopsy, liver function, blood count, as well as real-time ultrasonic elastography examination. The measurements of real-time ultrasonic elastography by ARFI technology using a ultrasonic instrument ACUSON S2000. The APRI was calculated according to the following formula, APRI=AST(ULN)/PLT(109 /L). ARFI and APRI were compared by correlation with liver fibrosis stage in NAFLD. Referring to the histologic fibrosis stage on liver biopsy, all the ARFI and the APRI value were assessed by using receiver operating characteristic(ROC) curve analysis. The corresponding cut-off values, sensitivity and specificity were also calculated and compared. Results: The mean values of ARFI and APRI were (1.177±0.281) m/s and (0.192±0.155) for the patients with S0, (1.249±0.308) m/s and (0.190±0.097) for those with S1, (1.436±0.521) m/s and (0.306±0.195) for those with S2, (1.538±0.496) m/s and (0.224±0.094) for those with S3, (1.857±0.729) m/s and (0.373±0.295) for those with S4, respectively. ARFI(r=0.416, P＜0.01) had a better correlation with liver fibrosis stage in NAFLD than APRl(r=0.254, P＜0.05). The areas under the ROC curves(AUC) for ARFI and APRI were 0.714 and 0.653 for S≥2, 0.765 and 0.577 for S≥3, 0.853 and 0.611 for S=4, respectively. Conclusions: As a non-invasive technology, ARFI is more accurate when applied to evaluate liver fibrosis in patients with NAFLD than APRI. ARFI technology has potential value for quantitative evaluation of the liver fibrosis for NAFLD.
关键词
脂肪肝 /
肝硬化 /
超声检查 /
多普勒 /
脉冲
Key words
Fatty liver /
Liver cirrhosis /
Ultrasonography /
Doppler /
pulsed
张大鹍;陈 敏;刘 阳;王瑞芳;周光德;董晓宇.
ARFI与APRI指数对非酒精性脂肪性肝病肝纤维化的诊断价值[J]. 中国临床医学影像杂志. 2013, 24(3): 178-181
ZHANG Da-kun;CHEN Min;LIU Yang;WANG Rui-fang;ZHOU Guang-de;DONG Xiao-yu.
The diagnostic value of ARFI imaging and APRI for quantitative evaluatingthe degree of liver fibrosis in NAFLD patients[J]. Journal of China Clinic Medical Imaging. 2013, 24(3): 178-181
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