肝豆状核变性患者肝脏剪切波速度的变化

doi:10.3969/j.issn.1672-5069.2021.02.005

摘要/Abstract

摘要： 目的采用超声声辐射力脉冲成像(ARFI)技术检测肝豆状核变性(HLD)患者肝脏剪切波速度(SWV)的变化。方法 2017年6月～2019年6月我院收治的38例HLD患者、49例非HLD的慢性肝脏疾病患者和56例健康体检者,采用超声观察肝脏表现,并应用ARFI技术测量肝脏SWV。采用原子吸收光谱法测定血清铜离子(Cu^2＋)水平,采用免疫透射比浊法测定血清铜蓝蛋白(CP)水平,采用手工法测定血清铜氧化酶(sCO)水平。采用放射免疫法检测血清Ⅲ型前胶原(PC-Ⅲ)、层黏蛋白(LN)、Ⅳ型胶原(Ⅳ-C)和透明质酸(HA)水平。结果 HLD患者血清Cu^2＋和CP水平分别为(6.7±1.5)μmol/L和(88.0±13.2)mg/L,显著低于非HLD组【分别为(13.2±1.6)μmol/L和(216.6±43.5)mg/L,P＜0.05】或健康人【分别为(17.2±6.2)μmol/L和(400.0±150.0)mg/L,P＜0.05】,HLD患者sCO水平为(0.02±0.01)U/L,显著低于健康人【(0.4±0.1)U/L,P＜0.05】;HLD患者血清PC-Ⅲ、Ⅳ-C、LN和HA水平分别为(11.1±0.3)ng/mL、(95.9±12.4)ng/mL、(43.6±11.4)ng/mL和(88.9±15.8)ng/mL,显著低于非HLD组【分别为(48.5±24.2)ng/mL、(140.6±15.3)ng/mL、(847.6±38.5)ng/mL和(261.2±22.8)ng/mL,P＜0.05】;HLD患者肝脏超声声像图呈脂肪肝型、星光型、树枝状、岩层状和结节状;HLD患者SWV值为(1.9±0.2)m/s,显著低于非HLD组【( 2.2±0.3 )m/s,P＜0.05】,但显著高于健康人【(1.1±0.2)m/s,P＜0.05】。结论 HLD患者肝脏超声有独特的声像图改变,应用ARFI技术检测SWV水平低有助于与其他慢性肝病鉴别。

关键词: 肝豆状核变性, 声辐射力脉冲成像, 剪切波速度

Abstract: Objective The purpose of this study was to observe the shear wave velocity (SWV) by acoustic radiation force impulse (ARFI) in patients with hepatolenticular degeneration (HLD).Methods 38 patients with HLD, 49 with other chronic liver disease (CLD) and 56 healthy persons were recruited in thisstudy between June 2017and June 2019. The ARFI technology was used to measure hepatic SWV. Serum copper ion (Cu²⁺) level was determined by atomic absorption spectrometry, serum ceruloplasmin (CP) level was determined by immunoturbidimetric method, and serum copper oxidase (sCO) were determined by manual method.Serum type III procollagen (PC-III), laminin (LN), type IV collagen (IV-C), and hyaluronic acid (HA) wereassayed by radioimmunoassay.Results Serum Cu^2＋and CP levels in patients with HLD were (6.7±1.5)μmol/L and (88.0±13.2)mg/L, significantly lower than 【(13.2±1.6)μmol/L and (216.6±43.5)mg/L, respectively, P＜0.05】 in patients with CLD, or 【(17.2±6.2)μmol/L and (400.0±150.0)mg/L, respectively, P＜0.05】 in healthy persons, and sCO activity in patients with HLD was (0.02±0.01)U/L, much lower than 【(0.4±0.1)U/L, P＜0.05】 in healthy persons; serum PC-Ⅲ, Ⅳ-C, LN and HA levels in patients with HLD were (11.1±0.3)ng/mL, (95.9±12.4)ng/mL, (43.6±11.4)ng/mL and (88.9±15.8)ng/mL, all significantly lower than 【(48.5±24.2)ng/mL, (140.6±15.3)ng/mL, (847.6±38.5)ng/mL and (261.2±22.8)ng/mL, P＜0.05】 in patients with CLD; the sonogram showed that the liver were fatty liver-like, starlight, dendritic, terraneous or nodular in patients with HLD, and the SWV in patients with HLD was (1.9±0.2)m/s, significantly lower than 【( 2.2±0.3 )m/s,P＜0.05】 in patients with CLD, but much higher than 【(1.1±0.2)m/s, P＜0.05】 in healthy persons.Conclusion The sonogram shows characteristic hepatic changes in patients with HLD, and the SWV might help discriminate with other CLD to some extent.

Key words: Hepatolenticular degeneration, Acoustic radiation force impulse, Shear wave velocity

齐端, 唐绘卓, 阳静, 欧阳飞. 肝豆状核变性患者肝脏剪切波速度的变化[J]. 实用肝脏病杂志, 2021, 24(2): 168-171.

Qi Duan, Tang Huizhuo, Yang Jing, et. Shear wave velocity by acoustic radiation force impulse in patients with hepatolenticular degeneration[J]. Journal of Practical Hepatology, 2021, 24(2): 168-171.

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