ARFI定量成像技术评估不同类型肝损伤治疗效果的价值研究

doi:10.3877/cma.j.issn.1674-0785.2022.03.013

目的

探讨声辐射力脉冲（ARFI）成像技术对药物性肝损伤（DILI）与病毒性肝炎（VH）治疗效果评价的价值。

方法

选择2017年1月至2020年8月来河北省保定市第二医院消化科就诊并住院治疗的诊断为DILI或HV且符合入选标准者患者共74例。每例患者治疗前及治疗后1、3个月均行常规超声检查及ARFI检查，获得肝脏的声触诊组织定量（VTQ）值。同时选取100名健康志愿者，获得其肝脏VTQ值，作为对照。

结果

DILI患者34例，VH患者40例。治疗前DILI组与VH组肝脏VTQ值差异无统计学意义［（1.74±0.18）m/s vs（1.70±0.41）m/s，P＞0.05］，但两者肝脏VTQ值均高于正常志愿者［（1.12±0.16）m/s］，差异有统计学意义（P＜0.05）。DILI组治疗后1个月与治疗后3个月的肝脏VTQ值差异无统计学意义［（1.14±0.23）m/s vs（1.06±0.40）m/s，P＞0.05］，均低于治疗前肝脏VTQ值，差异有统计学意义（P＜0.05）。VH组治疗前与治疗后1个月的肝脏VTQ值［（1.59±0.16）m/s］差异无统计学意义（P＞0.05），均高于治疗后3个月的肝脏VTQ值［（1.12±0.23）m/s］，差异有统计学意义（P＜0.05）。治疗后1个月2组间肝脏VTQ值差异有统计学意义（P＜0.05）。

结论

ARFI技术作为一种无创定量的超声弹性成像技术，可以客观地评价肝组织硬度，动态观察DILI及VH治疗前后肝脏的硬度变化，并可根据患者的恢复周期为临床肝炎的病因诊断提供依据。

关键词: 声辐射力脉冲成像技术, 药物性肝损伤, 病毒性肝炎

Objective

To explore the value of acoustic radiation force pulse (ARFI) imaging in the evaluation of therapeutic effects for drug induced liver injury (DILI) and viral hepatitis (VH).

Methods

Seventy-four inpatients diagnosed with DILI or VH at Department of Gastroenterology of the No. 2 Hospital of Baoding from January 2017 to August 2020 who met the inclusion criteria were included in this study. Conventional ultrasound and ARFI examinations were performed for each patient before treatment, one month after treatment, and three months after treatment, and virtual touch tissue quantification (VTQ) values were acquired and recorded. One hundred healthy volunteers were included as controls and VTQ values of the liver were also acquired and recorded.

Results

There were 34 cases of DLIL and 40 cases of VH included in this study. There was no significant difference in VTQ values between the DILI group and HV group before treatment (1.74±0.18 m/s vs 1.70±0.41 m/s, P＞0.05), while they were both significantly higher than those of normal volunteers (1.12±0.16 m/s, P＜0.05). There was no significant difference in VTQ values between one month and three months after treatment in the DILI group (1.14±0.23 m/s vs 1.06±0.40 m/s, P＞0.05), while they were both significantly lower than those before treatment (P＜0.05). There was no significant difference in VTQ values between before treatment and one month after treatment (1.59±0.16 m/s) in the HV group (P＞0.05), while they were both significantly higher than those three months after treatment (1.12±0.23 m/s, P＜0.05). There was a significant difference in VTQ values between DILI group and HV group one month after treatment (P＞0.05).

Conclusion

As a non-invasive and quantitative method, ARFI can assess liver stiffness objectively and observe the stiffness changes in DILI and HV after treatment dynamically. It may provide information about the cause of liver injury according to the patients' recovery cycle.

Key words: Acoustic radiation force pulse imaging, Drug-induced liver injury, Viral hepatitis

表1 药物性肝损伤患者治疗前后肝功能变化情况（

x ˉ

±s）

时间	AST	ALT	TBIL	DBIL
治疗前	217.78±41.42	289.64±38.45	135.38±50.32	108.56±55.28
治疗后1个月	97.60±30.31^a	114.32±29.81^a	78.67±32.81^a	63.92±31.08^a
治疗后3个月	47.72±24.41^ab	53.61±23.40^ab	40.78±27.68^ab	29.70±17.80^ab
F值	241.313	525.719	52.852	36.763
P值	＜0.001	＜0.001	＜0.001	＜0.001

表1 药物性肝损伤患者治疗前后肝功能变化情况（

x ˉ

±s）

时间	AST	ALT	TBIL	DBIL
治疗前	217.78±41.42	289.64±38.45	135.38±50.32	108.56±55.28
治疗后1个月	97.60±30.31^a	114.32±29.81^a	78.67±32.81^a	63.92±31.08^a
治疗后3个月	47.72±24.41^ab	53.61±23.40^ab	40.78±27.68^ab	29.70±17.80^ab
F值	241.313	525.719	52.852	36.763
P值	＜0.001	＜0.001	＜0.001	＜0.001

表2 急性病毒性肝炎患者治疗前后肝功能变化情况（

x ˉ

±s）

时间	AST	ALT	TBIL	DBIL
治疗前	249.58±37.38	379.27±50.36	74.90±32.79	61.31±30.78
治疗后1个月	130.51±30.03^a	215.98±34.76^a	66.37±29.86	56.20±28.12
治疗后3个月	69.74±20.96^ab	92.36±21.23^ab	52.41±20.96^a	41.07±23.42^ab
F值	366.735	592.419	6.429	5.814
P值	＜0.001	＜0.001	0.002	0.004

表2 急性病毒性肝炎患者治疗前后肝功能变化情况（

x ˉ

±s）

时间	AST	ALT	TBIL	DBIL
治疗前	249.58±37.38	379.27±50.36	74.90±32.79	61.31±30.78
治疗后1个月	130.51±30.03^a	215.98±34.76^a	66.37±29.86	56.20±28.12
治疗后3个月	69.74±20.96^ab	92.36±21.23^ab	52.41±20.96^a	41.07±23.42^ab
F值	366.735	592.419	6.429	5.814
P值	＜0.001	＜0.001	0.002	0.004

表3 2组受试者治疗前后声触诊组织定量值比较（m/s，

x ˉ

±s）

组别	例数	治疗前	治疗1个月	治疗3个月	F值	P值
DILI组	34	1.74±0.18	1.14±0.23^a	1.06±0.40^a	57.438	0.000
VH组	40	1.70±0.41	1.59±0.16	1.12±0.23^ab	46.180	0.000
t值		0.527	9.882	0.805
P值		0.600	＜0.001	0.423

表3 2组受试者治疗前后声触诊组织定量值比较（m/s，

x ˉ

±s）

组别	例数	治疗前	治疗1个月	治疗3个月	F值	P值
DILI组	34	1.74±0.18	1.14±0.23^a	1.06±0.40^a	57.438	0.000
VH组	40	1.70±0.41	1.59±0.16	1.12±0.23^ab	46.180	0.000
t值		0.527	9.882	0.805
P值		0.600	＜0.001	0.423

图1 药物性肝损伤患者治疗前后ARFI成像图。图a为治疗前，声触诊组织定量（VTQ）值为1.48 m/s；图b为治疗后1个月，VTQ值下降为1.15 m/s；图c为治疗后3个月，VTQ值为1.09 m/s

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Evaluation of therapeutic effects for drug induced liver injury and viral hepatitis using quantitative ARFI technology

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Evaluation of therapeutic effects for drug induced liver injury and viral hepatitis using quantitative ARFI technology