| 范向阳,张艳,贺晓,王紫微,于晶.实时剪切波弹性成像联合生化指标评估慢性肾脏病患者肝损伤[J].中国医学影像技术,2024,40(8):1221~1225 |
| 实时剪切波弹性成像联合生化指标评估慢性肾脏病患者肝损伤 |
| Real-time shear wave elastography combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease |
| 投稿时间：2024-02-18 修订日期：2024-06-08 |
| DOI：10.13929/j.issn.1003-3289.2024.08.024 |
| 中文关键词: 肾功能不全, 慢性 肝功能不全 超声检查 |
| 英文关键词:renal insufficiency, chronic hepatic insufficiency ultrasonography |
| 基金项目: |
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| 中文摘要: |
| 目的 观察实时剪切波弹性成像(SWE)联合生化指标评估慢性肾脏病(CKD)患者肝损伤的价值。方法 回顾性纳入210例CKD患者(CKD组)及64名健康体检者(对照组),根据CKD分期进一步将CKD组分为CKD1~5共5个亚组;比较CKD各亚组及对照组间肝脏及肾脏SWE参数,包括杨氏模量均值(EQImean)、最大值(EQImax)及中位值(EQImed);以Spearman相关分析观察肝脏及肾脏SWE参数与CKD分期、肝脏SWE参数与生化指标的相关性;采用多因素logistic回归分析筛选CKD肝损伤的独立预测因素,绘制受试者工作特征曲线,计算曲线下面积(AUC),观察单一各独立预测因素及其联合评估CKD肝损伤的效能。结果 CKD各亚组及对照组间肝脏及肾脏SWE参数总体差异有统计学意义(P均≤0.001)。两两比较,CKD5亚组肝脏SWE参数及CKD4亚组肝脏EQImax均高于对照组(P均＜0.003);CKD3亚组肾脏SWE参数均高于对照组、CKD4亚组肾脏SWE参数均高于对照组及CKD1~3亚组(P均＜0.003),CKD5亚组肾脏EQImean及EQImed均高于对照组及CKD1~4亚组、肾脏EQImax均高于对照组及CKD1~3亚组(P均＜0.003)。肝脏及肾脏SWE参数均与CKD分期呈低-中度正相关(r=0.364~0.665,P均＜0.001)。CKD患者肝脏SWE参数均与碱性磷酸酶(ALP)呈弱正相关(r=0.229~0.248,P均＜0.01)。γ-谷氨酰转移酶、ALP及肝脏EQImax均为CKD肝损伤的独立预测因素(P均＜0.01),以之单一评估CKD肝损伤的AUC分别为0.645、0.756及0.741,均低于三者联合(0.851,P均＜0.01)。结论 实时SWE联合肝功能指标可反映不同CKD分期肝损伤程度。 |
| 英文摘要: |
| Objective To observe the value of real-time shear wave elastography (SWE) combined with biochemical indicators for evaluating liver injury in patients with chronic kidney disease (CKD). Methods Totally 210 patients with CKD (CKD group) and 64 healthy subjects (control group) were retrospectively enrolled. Patients in CKD group were further divided into CKD1—5 subgroups according to CKD stages. SWE parameters of liver and kidney, including mean value, the maximum value and the median value of Young's modulus (EQImean, EQImax and EQImed) were compared between CKD subgroups and control group. Spearman correlation analysis were performed to explore the correlations of liver and kidney SWE parameters with CKD stage, as well as of liver SWE parameters with biochemical indicators. Multivariate logistic regression analysis was used to screen independent predictors of liver injury in CKD patients. Receiver operating characteristic curves were drawn, the area under the curves (AUC) were calculated to evaluate the efficacy of the independent predictors alone and their combination for assessing liver injury in CKD patients. Results Significant differences of liver and kidney SWE parameters were found among CKD subgroups and control group (all P≤0.001). Pairwise comparison showed that liver SWE parameters in CKD5 subgroup and liver EQImax in CKD4 subgroup were all higher than those in control group (all P＜0.003). Kidney SWE parameters in CKD3 subgroup were all higher than those in control group, while in CKD4 subgroup were all higher than those in control group and CKD1—3 subgroup (all P＜0.003). Kidney EQImean and EQImed in CKD5 subgroup were all higher than those in control group and CKD1—4 subgroup, while kidney EQImax in CKD5 subgroup were higher than those in control group and CKD1—3 subgroup (all P＜0.003). Liver and kidney SWE parameters were lowly-moderately and positively correlated with CKD stages (r=0.364—0.665, all P＜0.001). Liver SWE parameters of CKD were weakly and positively correlated with alkaline phosphatase (ALP) (r=0.229—0.248, all P＜0.01). The γ-glutamyl transferase, ALP and liver EQImax were all independent predictors of liver injury in CKD patients (all P＜0.01), with AUC for evaluating liver injury in CKD patients alone of 0.645, 0.756 and 0.741, respectively, lower than that of their combination (0.851, all P＜0.01). Conclusion Real-time SWE combined with liver function indicators could reflect degree of liver injury in patients with different CKD stages. |
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