CAJ | 학술논문

目的探索超声造影无创评估肝纤维化分期的可行性,并评价相关指标的诊断价值.方法对86例慢性肝炎患者行肝超声造影,以肝穿刺活检作为金标准进行对照.取部分肝实质为感兴趣区,通过时间强度曲线计算门静脉-肝动脉曲线下面积比(Qp/Qa)、门静脉-肝动脉灌注强度比(Ip/Ia)、肝实质灌注下降速率(β)和门静脉主干灌注时间(Tp).用单因素方差分析研究不同肝纤维化分期患者上述参数的变化,Spearman秩相关分析上述参数与肝纤维化分期的关系,ROC曲线分析各参数的诊断价值.结果随着肝纤维化程度增加,Tp、β逐渐增加,Ip/Ia和Qp/Qa逐渐减少,各组间差异有统计学意义(P＜0.05),且上述参数与肝纤维化分期显著相关(P＜0.05).分期为≥S1,≥S2,≥S3,S4时Ip/Ia的ROC曲线下面积分别为0.931,0.884,0.820,0.846.分期为≥S1,≥S2,≥S3,S4时Qp/Qa的ROC曲线下面积分别为0.914,0.813,0.845,0.869.结论根据肝实质超声造影时间强度曲线计算的参数Tp、Ip/Ia、Qp/Qa和β与肝纤维化分期相关,其中Ip/Ia和Qp/Qa可作为超声造影无创评估肝纤维化分期的新指标.
목적 탐색초성조영무창평고간섬유화분기적가행성,병평개상관지표적진단개치.방법 대86례만성간염환자행간초성조영,이간천자활검작위금표준진행대조.취부분간실질위감흥취구,통과시간강도곡선계산문정맥-간동맥곡선하면적비(Qp/Qa)、문정맥-간동맥관주강도비(Ip/Ia)、간실질관주하강속솔(β)화문정맥주간관주시간(Tp).용단인소방차분석연구불동간섬유화분기환자상술삼수적변화,Spearman질상관분석상술삼수여간섬유화분기적관계,ROC곡선분석각삼수적진단개치.결과 수착간섬유화정도증가,Tp、β축점증가,Ip/Ia화Qp/Qa축점감소,각조간차이유통계학의의(P＜0.05),차상술삼수여간섬유화분기현저상관(P＜0.05).분기위≥S1,≥S2,≥S3,S4시Ip/Ia적ROC곡선하면적분별위0.931,0.884,0.820,0.846.분기위≥S1,≥S2,≥S3,S4시Qp/Qa적ROC곡선하면적분별위0.914,0.813,0.845,0.869.결론 근거간실질초성조영시간강도곡선계산적삼수Tp、Ip/Ia、Qp/Qa화β여간섬유화분기상관,기중Ip/Ia화Qp/Qa가작위초성조영무창평고간섬유화분기적신지표.
Objective To discuss the feasibility of non-invasive quantitative evaluation of hepatic fibrosis by contrast-enhanced ultrasonography (CEUS) parameters. Methods CEUS of liver and liver biopsy were performed in 86 patients. CEUS parameters including area under curve of portal vein/hepatic artery(Qp/Qa) ,perfusion intensity of portal vein/hepatic artery(Ip/Ia), decreasing rate of liver parenchyma perfusion (β) and perfusion time of portal vein (Tp) were calculated based on CEUS images. Differences of the four parameters among stages of hepatic fibrosis were analyzed by ANOVA and Spearman rank correlation test was applied to analyze correlation between parameters and hepatic fibrosis stages. Areas under receiver operating characteristic (ROC) curves were calculated to evaluate the diagnostic accuracy of parameters. Results Tp and β had increasing tend while Ip/Ia and Qp/Qa had declining tend from S0 to S4.They were significantly correlated with fibrosis stage( P ＜0.05＝. The areas under ROC curves of Ip/Ia were 0.931 (≥S1) ,0.884(≥S2 ) ,0.820(≥S3 ) and 0.846(S4 ) respectively. The areas under ROC curves of Qp/Qa were 0.914(≥S1),0.813(≥S2),0.845(≥S3) and0.869 (S4) respectively. Conclusions CEUS parameters of liver parenchyma Ip/la, Qp/Qa, Tp and β are related to fibrosis stages. Ip/Ia and Qp/Qa provide a reliable,non-invasive method for evaluating fibrosis stages.