超声弹性成像评估肝移植术后稳定状态受者不同时期肝脏弹性的应用价值

李沁园; 姜伟; 冯程; 赵宁波; 王新发; 董常峰

doi:10.3969/j.issn.1674-7445.2021.01.016

超声弹性成像评估肝移植术后稳定状态受者不同时期肝脏弹性的应用价值

doi: 10.3969/j.issn.1674-7445.2021.01.016

524000 广东湛江，广东医科大学（李沁园、董常峰）；华中科技大学协和深圳医院超声科（姜伟、王新发）；深圳市第三人民医院超声科（冯程、赵宁波、董常峰）

基金项目:

国家自然科学基金面上项目 61031003

详细信息

作者简介:
李沁园，女，1995年生，硕士研究生，研究方向为腹部超声，Email：lqydyx@163.com

通讯作者:
董常峰，男，1977年生，硕士，主任医师，研究方向为腹部超声及移植肝、肾的超声诊断，Email：dongchangfeng7@163.com

中图分类号: R617, R445.1
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出版历程
- 收稿日期: 2020-09-05
- 网络出版日期: 2021-01-19
- 刊出日期: 2021-01-19

Application value of ultrasound elastography in evaluating liver elasticity of stable recipients at different stages after liver transplantation

Guangdong Medical University, Zhanjiang 524000, China

More Information

Corresponding author: Dong Changfeng, E-mail:dongchangfeng7@163.com

摘要

摘要: 目的探讨超声弹性成像技术无创性监测肝移植术后稳定状态受者不同时期肝脏弹性的价值。方法收集73例肝移植术后稳定状态受者的临床资料，根据肝移植术后时间分为早期组（25例）和中长期组（48例），同时选取38名健康体检者作为对照组。比较各组研究对象的超声指标和肝功能指标；分析各组研究对象的肝脏和脾脏弹性成像指标，并分析其与肝功能指标的相关性。结果与对照组比较，早期组的各项超声指标和丙氨酸转氨酶（ALT）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）升高，差异均有统计学意义（均为P < 0.05），中长期组的各项超声指标升高，GGT降低，差异均有统计学意义（均为P < 0.05）；与早期组比较，中长期组的肝脏右斜径和ALT、GGT、ALP降低，差异均有统计学意义（均为P < 0.05）。与对照组比较，早期组和中长期组肝脏声触诊弹性成像（STE）值、声触诊弹性测量（STQ）值与脾脏STE值均升高，差异均有统计学意义（均为P < 0.05）；与早期组比较，中长期组的肝脏和脾脏弹性成像指标均降低，差异均有统计学意义（均为P < 0.05）。肝脏弹性成像指标与ALT、天冬氨酸转氨酶（AST）、GGT呈弱相关性，与ALP呈强相关性。脾脏STE值与ALP呈弱相关性。肝脏STE值与肝脏STQ值呈强相关性，肝脏STE值、STQ值与脾脏STE值均呈弱相关性。结论肝移植术后稳定状态受者不同时期的肝脏弹性特征不同，持续监测肝脏弹性可能为肝移植术后随访提供全新的无创性监测方式。
- 肝移植 /
- 声触诊弹性成像（STE） /
- 声触诊弹性测量（STQ） /
- 丙氨酸转氨酶 /
- 天冬氨酸转氨酶 /
- 总胆红素 /
- γ-谷氨酰转移酶 /
- 碱性磷酸酶
Abstract: Objective To explore the value of ultrasound elastography in the non-invasive monitoring of liver elasticity of stable recipients at different stages after liver transplantation. Methods Clinical data of 73 stable recipients after liver transplantation were collected. According to the time after liver transplantation, all patients were divided into the early group (n=25) and medium-to-long group (n=48). In addition, 38 healthy subjects were assigned into the control group. The ultrasound indexes and liver function indexes were statistically compared among each group. The ultrasound elastography indexes of liver and spleen were analyzed, and their correlation with liver function indexes was analyzed. Results Compared with the control group, the ultrasound indexes, alanine aminotransferase (ALT), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were significantly increased in the early group (all P < 0.05), and the ultrasound indexes in the medium-to-long group were significantly increased, whereas the GGT level was significantly decreased (all P < 0.05). Compared with the early group, the right oblique diameter of liver, ALT, GGT and ALP levels were significantly decreased in the medium-to-long group (all P < 0.05). Compared with the control group, the sound touch elastography (STE) and sound touch quantify (STQ) values of liver and STE value of spleen in the early group and medium-to-long group were significantly increased (all P < 0.05). Compared with the early group, the ultrasound elastography indexes of liver and spleen in the medium-to-long group were remarkably decreased (all P < 0.05). The ultrasound elastography indexes of liver were weakly correlated with the ALT, aspartate aminotransferase (AST) and GGT levels, significantly correlated with ALP level. The STE value of spleen was weakly correlated with the ALP level. The STE value of liver was significantly correlated with the STQ value of liver. The STE and STQ values of liver were weakly correlated with the STE value of spleen. Conclusions The characteristics of liver elasticity in stable recipients after liver transplantation are various among different stages. Persistent monitoring of liver elasticity may provide a novelnon-invasive monitoring method during follow-up after liver transplantation.
- Liver transplantation /
- Sound touch elastography (STE) /
- Sound touch quantify (STQ) /
- Alanine aminotransferase /
- Aspartate aminotransferase /
- Total bilirubin /
- γ-glutamyl transferase /
- Alkaline phosphatase

HTML全文

图 1 各组研究对象的肝脏STE图像

注：A图为对照组；B图为早期组；C图为中长期组。

Figure 1. Liver STE images of subjects in each group

下载: 全尺寸图片幻灯片

表 1 各组研究对象的超声指标分析

Table 1. Ultrasonic indexes analysis of subjects in each group (x±s, mm)

组别	n	肝脏右斜径	门静脉内径	脾脏厚度	脾脏长度
对照组	38	131±10	10.9±1.0	32±4	99±15
早期组	25	147±10^a	11.9±2.1^a	42±9^a	124±22^a
中长期组	48	137±11^{a, b}	12.1±1.9^a	41±7^a	120±19^a
F值		43.2	38.6	55.9	45.3
P值		< 0.001	< 0.001	< 0.001	< 0.001
注：与对照组比较，^aP < 0.05；与早期组比较，^bP < 0.05。

下载: 导出CSV

表 2 各组研究对象的肝功能指标分析

Table 2. Liver function indexes analysis of subjects in each group [M(Q₂₅, Q₇₅), U/L]

组别	n	TB	ALT	AST	GGT	ALP
对照组	38	14（11, 17）	22（17, 42）	24（19, 29）	48（24, 76）	83（56, 112）
早期组	25	15（14, 27）	44（24, 79）^a	30（23, 35）	111（80, 190）^a	137（92, 206）^a
中长期组	48	14（10, 19）	24（16, 32）^b	22（19, 29）	29（21, 41）^{a, b}	76（65, 109）^b
H值		4.43	9.76	8.98	31.53	11.54
P值		0.109	0.007	0.011	< 0.001	0.003
注：与对照组比较，^aP < 0.05；与早期组比较，^bP < 0.05。

下载: 导出CSV

表 3 各组研究对象肝脏和脾脏弹性成像指标的比较

Table 3. Comparison of liver and spleen elastography indexes of subjects in each group(x±s, kPa)

组别	n	肝脏STE值	肝脏STQ值	脾脏STE值
对照组	38	5.9±0.7	6.2±1.2	16.2±2.2
早期组	25	10.7±2.1^a	10.7±2.3^a	19.3±5.1^a
中长期组	48	6.7±1.7^{a, b}	7.3±1.5^{a, b}	17.7±3.6^{a, b}
F值		8.403	8.306	12.355
P值		< 0.001	< 0.001	< 0.001
注：与对照组比较，^aP < 0.05；与早期组比较，^bP < 0.05。

下载: 导出CSV

表 4 弹性成像指标与肝功能指标的相关性分析

Table 4. Correlation analysis of indexes of elastography and liver function

弹性成像指标	TB		ALT		AST		GGT		ALP
弹性成像指标	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值
肝脏STE值	0.091	0.392	0.290	0.005	0.309	0.005	0.380	0.001	0.434	< 0.001
肝脏STQ值	0.090	0.398	0.306	0.003	0.256	0.014	0.290	0.005	0.389	< 0.001
脾脏STE值	0.061	0.507	0.153	0.146	0.134	0.207	0.209	0.050	0.334	0.003

下载: 导出CSV

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