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目的探讨声触诊组织量化技术(VTQ)无创评价肝纤维化程度的临床应用价值。方法对37例肝纤维化(S1)患者、42例肝纤维化(S2)患者、39例肝纤维化(S3)患者、36例肝硬化(S4)患者及70例健康对照组,采用VTQ技术定量测量肝实质剪切波速度(SWV)。以病理结果为金标准,构建受试者工作曲线(ROC曲线),均数间多重比较采用(LSD-t法)。结果 S1~S4期平均肝脏剪切波速分别为1.22m/s、1.37m/s、1.69m/s、2.36m/s,对照组平均剪切波速为1.12m/s,各组肝脏SWV存在显著性差异(P<0.05)。S1~S4期ROC曲线下面积分别为0.716、0.785、0.856、0.969。以1.26m/s为界值,诊断≥S1期的灵敏度为68%、特异度为79%;以1.35m/s为界值,诊断≥S2期的灵敏度为79%、特异度为82%;以1.58m/s为界值,诊断S3期的灵敏度为85%、特异度为80%,以1.79m/s为界值,诊断S4期的灵敏度为90%、特异度为91%。结论 VTQ可无创测量肝实质剪切波速度,客观反映肝组织的弹性模量,有望为定量评估肝纤维化分期提供一项客观准确的新方法。
Objective To investigate the clinical value of non-invasive evaluation of the degree of liver fibrosis by acoustic palpation tissue quantification (VTQ). Methods Thirty-seven patients with liver fibrosis (S1), 42 patients with liver fibrosis (S2), 39 patients with liver fibrosis (S3), 36 patients with cirrhosis (S4) and 70 healthy controls were enrolled in this study. VTQ Quantitative measurement of hepatic parenchymal shear wave velocity (SWV). The pathological results as the gold standard, the construction of the working curve (ROC curve), multiple comparison between the use of (LSD-t method). Results The average hepatic shear wave velocities in S1 ~ S4 phase were 1.22m / s, 1.37m / s, 1.69m / s and 2.36m / s, respectively. The average shear wave velocity in control group was 1.12m / s, Sex differences (P <0.05). The area under the ROC curves of S1 ~ S4 were 0.716, 0.785, 0.856 and 0.969, respectively. The sensitivity of ≥S1 was 68% and the specificity was 79% at the threshold of 1.26m / s. The sensitivity and specificity of 79% and 82% were respectively 1.35m / s. To 1.58m / s as the cutoff value, the sensitivity of S3 diagnosis was 85% and the specificity was 80%. The cutoff value of 1.79m / s was S4. The sensitivity and specificity of S3 were 90% and 91% respectively. Conclusion VTQ can noninvasively measure hepatic parenchymal shear wave velocity and objectively reflect the elastic modulus of liver tissue. It is expected to provide a new objective and accurate method for the quantitative assessment of liver fibrosis staging.