CAJ | 학술논문

目的探讨声辐射力脉冲成像（ARFI）技术评估肝移植术后缺血型胆道病变（ITBL）的临床应用价值。方法选择2012年7月至2013年1月解放军总医院肝移植术后复查患者41例，其中15例超声诊断为ITBL。对所有患者进行常规超声检查，并采用ARFI技术测量检测深度为4、5 cm的肝脏剪切波速度（SWV）值，同时检查患者肝功能。采用独立样本t检验比较ITBL患者与非ITBL患者同一检测深度SWV值差异；采用配对样本t检验比较同一ITBL患者不同检测深度SWV值差异。采用Pearson相关分析分别分析所有患者不同检测深度SWV值与肝功能指标的相关性。结果 ITBL患者、非ITBL患者检测深度为4 cm时SWV值分别为（1.561±0.425）、（1.121±0.160） m/s，差异有统计学意义（t=-3.173，P=0.01）；检测深度为5 cm时SWV值分别为（1.608±0.545）、（1.175±0.173） m/s，差异也有统计学意义（t=-2.454，P=0.034）。同一ITBL患者不同检测深度SWV值差异无统计学意义。所有患者不同检测深度SWV值均与碱性磷酸酶浓度相关（r值分别为0.656、0.667， P值均为0.000）；同时均与γ-谷酰转肽酶浓度相关（r=0.482，P=0.007；r=0.508，P=0.004）。结论 ARFI技术对肝移植术后ITBL评估有一定的临床应用价值。
목적탐토성복사력맥충성상（ARFI）기술평고간이식술후결혈형담도병변（ITBL）적림상응용개치。방법선택2012년7월지2013년1월해방군총의원간이식술후복사환자41례，기중15례초성진단위ITBL。대소유환자진행상규초성검사，병채용ARFI기술측량검측심도위4、5 cm적간장전절파속도（SWV）치，동시검사환자간공능。채용독립양본t검험비교ITBL환자여비ITBL환자동일검측심도SWV치차이；채용배대양본t검험비교동일ITBL환자불동검측심도SWV치차이。채용Pearson상관분석분별분석소유환자불동검측심도SWV치여간공능지표적상관성。결과 ITBL환자、비ITBL환자검측심도위4 cm시SWV치분별위（1.561±0.425）、（1.121±0.160） m/s，차이유통계학의의（t=-3.173，P=0.01）；검측심도위5 cm시SWV치분별위（1.608±0.545）、（1.175±0.173） m/s，차이야유통계학의의（t=-2.454，P=0.034）。동일ITBL환자불동검측심도SWV치차이무통계학의의。소유환자불동검측심도SWV치균여감성린산매농도상관（r치분별위0.656、0.667， P치균위0.000）；동시균여γ-곡선전태매농도상관（r=0.482，P=0.007；r=0.508，P=0.004）。결론 ARFI기술대간이식술후ITBL평고유일정적림상응용개치。
Objective To study the clinical value of acoustic radiation force impulse imaging (ARFI) in patients with ischemic type biliary lesion (ITBL) after orthotopic liver transplantation. Methods Between July 2012 to January 2013, forty-one patients in General Hospital of the People′s Liberation Army were enrolled in this study who were admitted for post-transplantation follow-up. Among them, 15 patients were diagnosed as ITBL by ultrasonography. Besides conventional ultrasonography, ARFI was used to detect the shear wave velocity (SWV) of liver tissue at depth of 4 cm and 5 cm respectively. Simultaneously liver function test was performed. Independent-samples t test was performed to compare the difference of SWV between ITBL and non-ITBL group at the same depth. Paired-sample t test was performed to compare the difference of SWV for the same ITBL patient. Pearson correlation analysis was used in analyzing the relation between SWV and liver function. Results The average SWV in depth of 4 cm was (1.561±0.425) m/s and (1.121±0.160) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-3.173, P=0.01). The average SWV in depth of 5 cm was (1.608±0.545) m/s and (1.175±0.173) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-2.454, P=0.034). There was no signiifcant difference between SWV measurements at different depth for the same ITBL patient. For all patients, SWV at different depths were both strongly correlated with alkaline phosphatase (r=0.656, 0.667, respectively;both P=0.000) andγ-glutamyl transpeptidase (r=0.482, P=0.007;r=0.508, P=0.004). Conclusion The liver stiffness measurement is valuable for the clinical evaluation of post-transplantation ITBL.