摘要
目的:应用剪切波弹性成像(SWE)技术对非酒精性脂肪肝病(NAFLD)兔肝脏进行检测,并与病理结果对照,探讨SWE技术在NAFLD诊断及肝纤维化(LF)分级过程中的应用价值。方法:新西兰兔45只,按随机分为2组,一组10只,给予普通饲喂;一组35只,给予高脂饲喂。分别在16周及24周时应用SWE检测2组兔肝组织硬度值(LSM),24周检测结束后取出肝脏做病理检测,将符合NAFLD诊断的动物纳入研究作为实验组。结果:高脂组存活28只,全部纳入实验组,正常对照组10只,16周及24周实验组LSM均高于对照组,差异具有统计学意义(P均<0.05),高脂喂养组中24周高于16周时的LSM,差异具有统计学意义(P<0.05);对照组中24周的LSM高于16周,但差异不具有统计学意义(P>0.05);病理组织学检测,S0期15只,S1期7只,S2期11只,S3期3只,S4期2只,各病理分期的LSM差异具有统计学意义(F=390.381,P=0.000)。LSM与LF病理分期具有显著相关性(r=0.934,P=0.000)。SWE技术诊断LF>S0、S1、S2、S3的曲线下面积(AUC)分别为0.918、0.933、0.966、0.974。结论:SWE可定量测量NAFLD肝脏硬度及准确评估LF级别。
Abstract
Objective: To explore the application value of shear wave elastography(SWE) in diagnosis of nonalcoholic fatty liver disease(NAFLD), by detection and analysis the liver stiffness measurement(LSM) of rabbits with NAFLD by SWE, in order to provide a practical and noninvasive clinical diagnosis technology of NAFLD. Methods: The 45 New Zealand white rabbits were divided randomly into the experimental group(n=35, with high fat diet) and the control group(n=10, with normal diet). The total test time was 24 weeks. We tested the LSM of all the rabbits in time of 16th and 24th week then killed all the rabbits and observed the liver histopathology after the ultrasonic test at the time of 24th weekend. Independent samples T-test of the various indexs of the rabbits in the two groups was performed using SPSS statistical software, version 22(SPSS Inc., Chicago, IL, USA) with all the data displayed as means±standard deviation. Pearson’s correlation coefficient was used for analysis the LSM with the liver fibrosis(LF), and the receiver operating characteristic curve(ROC) was constructed to analyze the detection efficiency of LSM in the diagnosis of LF. Results: All the 28 high fat diet rabbits survived were involved in the experiment group, and the 10 rabbits in normal control group were all survived. LSM in experimental group were higher than the control group in time of 16th and 24th week respectively(P all<0.05). And the LSM in the experimental group in time of 24th week was higher than the LSM in time of 16th week(t=10.857, P<0.05). The pathological in the experiment group results show that there were 5 rabbits at stage S0, 7 rabbits at stage S1, 11 rabbits at stage S2, 3 rabbits at stage S3, 2 rabbits at stage S4. The difference of LSM between different level of LF had statistical significance(F=390.381, P<0.001), the degree of LF and LSM showed a linear correlation(r=0.940, P=0.000). The areas under the ROC curve(AUC) was 0.918 when LSM diagnosis LF>S0, AUC was 0.933 when LF>S1, AUC was 0.966 when LF>S2, AUC was 0.974 when LF>S3 (early cirrhosis). Conclusion: SWE has high accuracy in the diagnosis and grading of NAFLD in rabbits, and may have a good application value in the evaluation of patients with NAFLD.
关键词
脂肪肝 /
肝硬化 /
超声检查 /
多普勒 /
彩色
Key words
Fatty liver /
Liver cirrhosis /
Ultrasonography, Doppler, color
贺 鹏,任 波,李 玲,唐 盈,郑小艳,顾 鹏.
剪切波弹性成像技术在非酒精性脂肪性肝病诊断及肝纤维化分级中应用的初步研究[J]. 中国临床医学影像杂志. 2017, 28(9): 637-641
HE Peng, REN Bo, LI Ling, TANG Ying, ZHENG Xiao-yan, GU Peng.
Preliminary study of shear wave elastography in the application in diagnosis and grading of nonalcoholic fatty liver disease[J]. Journal of China Clinic Medical Imaging. 2017, 28(9): 637-641
中图分类号:
R575.5
R575.2
R445.1
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]曾民德. 非酒精性脂肪性肝病:回顾历史,展望未来[J]. 实用肝脏病杂志,2016,19(2):129-131.
[2]张帆,黄一沁,保志军. 非酒精性脂肪性肝病在我国城市地区的流行现状[J]. 中华消化杂志,2014,34(6):430-432.
[3]Wang F, Fan J, Zhang Z, et al. The global burden of liver disease: The major impact of China[J]. Hepatology, 2014, 60(6): 2099-2108.
[4]Ferraioli G, Tinelli C, Zicchetti M, et al. Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity[J]. Eur J Radiol, 2012, 81(11): 3102-3106.
[5]中华医学会肝病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南(2010年修订版)[J]. 中华肝脏病杂志,2010,18(3):163-166.
[6]Ferraioli G, Tinelli C, Dal Bello B, et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study[J]. Hepatology, 2012, 56(6): 2125-2133.
[7]Ludwig J, Viggiano TR, McGill DB, et al. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease[J]. Mayo Clin Proc, 1980, 55(7): 434-438.
[8]Schaffner F, Thaler H. Nonalcoholic fatty liver disease[J]. Prog Liver Dis, 1986, 8(3): 283-298.
[9]刘洪满,李欣,王晶晶,等. 非酒精性脂肪性肝病研究现状[J]. 中国老年学杂志,2015,35(2):567-570.
[10]吕子平,马苏美,曹文芳. 剪切波组织定量技术联合代谢指标定量评估非酒精性单纯性脂肪肝的探索性研究[J]. 中国超声医学杂志,2015,31(7):608-611.
[11]Lu Y, Wei J, Tang Y, et al. Evaluation of fatty liver fibrosis in rabbits using real-time shear wave elastography[J]. Exp Ther Med, 2014, 8(2): 355-362.
[12]李定国,刘清华. 雌激素与肝纤维化研究现状[J]. 国外医学(消化系疾病分册),2004,24(4):195-197.
[13]张大鹍,陈敏,刘阳,等. 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.
[14]汪惠鹏,韩秀梅,王学梅. 不同病因肝硬化患者肝实时剪切波弹性成像测值范围比较[J]. 中华超声影像学杂志,2015,24(6):512-514.
[15]张红君,郑剑,任杰,等. 二维剪切波弹性成像评估病毒性肝炎与非病毒性肝炎肝纤维化的效能比较[J]. 中华医学超声杂志:电子版,2015,12(3):218-222.
[16]范建高,曾民德,李继强,等. 肝内脂肪和脂质过氧化与肝纤维化关系的实验研究[J]. 中华内科杂志,1997,36(12):14-17.
基金
四川省科技厅支撑项目(2012SZ0072);四川省医学会青年创新课题计划(Q15006)。