CAJ | 학술논문

目的：探讨声辐射力脉冲弹性成像（ARFI）技术评估肝占位患者肝脏储备功能的临床价值。方法选择2011年9月至2012年8月解放军总医院86例肝占位患者。其中肝功能Child-Pugh A级54例，B级18例，C级14例；70例患者进行手术治疗，16例患者采用非手术治疗。采用ARFI技术测量患者肝脏剪切波速度值（SWV）；同时对患者进行吲哚氰绿（ICG）排泄实验，记录ICG血浆清除速率及ICG 15 min滞留率。SWV值与ICG血浆清除速率、ICG 15 min滞留率的相关性采用Pearson相关分析；SWV值与Child-Pugh分级的相关性采用Spearman等级相关分析。手术治疗患者与非手术治疗患者SWV值比较采用独立样本t检验；以患者的临床决策作为金标准，采用受试者操作特性（ROC）曲线评价ARFI技术判断肝占位患者手术可行性的应用价值。结果 SWV值与ICG 15 min滞留率、ICG血浆清除速率、Child-Pugh分级有相关性（r=0.764，P＜0.001；r=-0.686，P=0.000；r=0.864， P=0.000）。手术治疗患者SWV值为（2.46±0.45）m/s，非手术治疗患者SWV值为（1.54±0.36）m/s，差异有统计学意义（t=-0.80，P=0.000）。ROC曲线显示，当诊断界值为2.06 m/s时，约登指数最高为0.775，其相对应的ARFI技术判断肝占位患者手术可行性的敏感度为87.5%，特异度为90.0%。结论 ARFI技术可有效评估肝占位患者肝脏储备功能，为临床治疗方式的决策提供帮助。
목적：탐토성복사력맥충탄성성상（ARFI）기술평고간점위환자간장저비공능적림상개치。방법선택2011년9월지2012년8월해방군총의원86례간점위환자。기중간공능Child-Pugh A급54례，B급18례，C급14례；70례환자진행수술치료，16례환자채용비수술치료。채용ARFI기술측량환자간장전절파속도치（SWV）；동시대환자진행신타청록（ICG）배설실험，기록ICG혈장청제속솔급ICG 15 min체류솔。SWV치여ICG혈장청제속솔、ICG 15 min체류솔적상관성채용Pearson상관분석；SWV치여Child-Pugh분급적상관성채용Spearman등급상관분석。수술치료환자여비수술치료환자SWV치비교채용독립양본t검험；이환자적림상결책작위금표준，채용수시자조작특성（ROC）곡선평개ARFI기술판단간점위환자수술가행성적응용개치。결과 SWV치여ICG 15 min체류솔、ICG혈장청제속솔、Child-Pugh분급유상관성（r=0.764，P＜0.001；r=-0.686，P=0.000；r=0.864， P=0.000）。수술치료환자SWV치위（2.46±0.45）m/s，비수술치료환자SWV치위（1.54±0.36）m/s，차이유통계학의의（t=-0.80，P=0.000）。ROC곡선현시，당진단계치위2.06 m/s시，약등지수최고위0.775，기상대응적ARFI기술판단간점위환자수술가행성적민감도위87.5%，특이도위90.0%。결론 ARFI기술가유효평고간점위환자간장저비공능，위림상치료방식적결책제공방조。
Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in the evaluation of liver functional reserve in patients with hepatic focal lesions. Methods Eighty-six patients with hepatic focal lesions in General Hospital of the People′s Liberation Army from September 2011 to August 2012 were studied. According to Child-Pugh score, 54 of them were classified as grade A, 18 patients were classiifed as grade B, and 14 patients were classiifed as grade C. Seventy patients underwent surgery and 16 patients underwent non-surgical treatment. Shear wave velocity (SWV) values were measured using ARFI technique, and indocyanine green (ICG) clearance tests were also performed to achieve ICG clearance rate constant (ICGK) and ICG retention rate at 15 minutes (ICG15). Correlation between SWV and ICGK, SWV and ICG15 were studied using Pearson correlation, and correlation between SWV and Child-Pugh score were analyzed using Spearman rank correlation. Difference between SWV values of patients underwent surgery and those of patients underwent non-surgical treatment was compared using t-test for independent samples. Analyses of receiver operating characteristic (ROC) curve were performed to investigate the value of ARFI in the evaluation of surgical feasibility for patients with hepatic focal lesion, with the clinical decisions serving as the golden standard. Results There was correlations between SWV and ICGR15, SWV and ICGK, and SWV and Child-Pugh scores (r=0.764,P <0.001;r=-0.686,P=0.000;r=0.864,P=0.000). The SWV of patients who underwent surgery was (2.46±0.45) m/s, and the SWV of patients who underwent non-surgical treatment was (1.54±0.36) m/s, with a signiifcant difference (t=-0.80, P=0.000). The ROC curve analysis demonstrated a highest Youden′s index of 0.775 when the cut-off was 2.06m/s. The corresponding sensitivity was 87.5% and the specificity was 90.0% for ARFI in the diagnosis liver functional reserve deficiency. Conclusion ARFI can effectively evaluate the liver functional reserve in patients with hepatic focal lesions and thus could be beneifcial in the decision of clinical treatment.