【摘要】 目的应用剪切波弹性成像(SWE)检测乳腺癌患者化疗前后肝脏组织硬度的变化,探讨其在诊断乳腺癌新辅助化疗肝脂肪变中的临床应用价值。方法 121例乳腺癌患者分别在化疗前、化疗4周期、8周期后检测肝功能指标,包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)及谷氨酰转肽酶(GGT);行肝脏常规超声和SWE检查,测量肝脏杨氏模量最大值(Emax)、最小值(Emin)及平均值(Emean),比较不同化疗周期肝脏杨氏模量值间的差异,分析其与肝功能检查指标间的相关性。结果 121例患者化疗前Emax、Emin、Emean分别为(5.74±0.39)kPa、(4.16±0.28)kPa、(4.91±0.18)kPa;化疗4周期后Emax、Emin、Emean分别为(5.43±0.25)kPa、(3.85±0.17)kPa、(4.50±0.27)kPa;化疗8周期后Emax、Emin、Emean分别为(5.24±0.36)kPa、(3.47±0.26)kPa、(4.28±0.16)kPa;化疗4周期和8周期后各杨氏模量值均较化疗前减低,差异均有统计学意义(均P<0.05)。化疗后4周期和8周期后ALT、ALP、GGT均较化疗前升高(均P<0.05),而AST化疗前后比较差异无统计学意义。化疗8周期后Emean与AST和GGT均呈负相关(r=-0.71、-0.67,P=0.042、0.035),与ALT和ALP均无相关。结论 SWE可无创、定量评估乳腺癌患者化疗前后肝脏硬度的变化,以评价乳腺癌新辅助化疗前后肝脂肪变的情况,具有较好的临床应用价值。更多还原

【Abstract】 Objective To investigate the application value of shear wave elastography(SWE) in detecting the changes of liver tissue stiffness before and after chemotherapy in patients with breast cancer. Methods SWE was performed before chemotherapy,4 cycles after chemotherapy,8 cycles after chemotherapy in all the patients. The maximum,minimum,and mean of Young’s modulus(Emax,Emin,Emean)of liver were measured,and the serum test including AST,ALT,ALP,GGT were measured,then their differences were compared. The correlation between Young’s modulus and serum indexes were analyzed.Results The Emax,Emin and Emean were(5.74±0.39)kPa,(4.16±0.28)kPa,(4.91±0.18)kPa respectively before chemotherapy,(5.43±0.25)kPa,(3.85±0.17)kPa,(4.50±0.27)kPa respectively after 4 cycles of chemotherapy,(5.24±0.36)kPa,(3.47±0.26)kPa,(4.28±0.16)kPa respectively after 8 cycles of chemotherapy. The Young’s modulus of liver after chemotherapy were significantly lower than that before chemotherapy(both P<0.05).The serum indexes after chemotherapy including ALT,ALP,GGT were increased,and there were statistical differences(all P<0.05),while AST had no statistical difference.After8 cycle of chemotherapy,Emean was negatively correlated with AST and GGT(r=-0.71,-0.67,P=0.042,0.035),while not correlated with ALT and ALP.Conclusion SWE is expected to be a new,noninvasive and quantitative method to evaluate the changes of liver stiffness before and after breast cancer chemotherapy.更多还原