剪切波弹性成像在肝移植受者移植物纤维化评估中优于血清学评分
本研究回顾111例肝移植受者（63成人、48儿童），对比剪切波弹性成像（SWE）与APRI、FIB-4、GPR对显著移植物纤维化（≥S2）的诊断效能。SWE与纤维化分期相关性最强（ρ=0.76），AUC达0.927，最优阈值成人10.14 kPa、儿童10.92 kPa，且在不同移植物年龄中表现稳定。SWE可作为长期无创监测移植物纤维化的一线工具。
要点
- SWE诊断显著移植物纤维化（≥S2）的AUC为0.927，显著优于APRI、FIB-4和GPR。
- SWE最优阈值成人10.14 kPa、儿童10.92 kPa，成人及儿童受者均保持高诊断准确性。
- FIB-4与纤维化分期无显著相关（ρ=-0.02，p=0.818），移植后早期血清学指标变异性大。
核心结论
- SWE对肝移植受者移植物显著纤维化（≥S2）的诊断效能显著优于APRI、FIB-4和GPR，且在成人和儿童受者及不同移植物年龄中表现稳定。
研究设计与样本
- 回顾性分析111例肝移植受者（63例成人、48例儿童），均接受肝活检及同期SWE和生化检测，纤维化采用Scheuer分类分期，以ROC曲线评估诊断准确性。
诊断标准与关键数值
- SWE诊断显著纤维化（≥S2）的AUC为0.927（95%CI：0.879-0.975），优于GPR（0.759）、APRI（0.691）和FIB-4（0.594）。
- SWE最优cut-off值成人10.14 kPa、儿童10.92 kPa。
- SWE与组织学纤维化分期的相关系数ρ=0.76（p<0.001），FIB-4无显著相关（ρ=-0.02，p=0.818）。
临床应用与阅片要点
- SWE可作为肝移植受者长期无创移植物监测的一线工具，尤其凭借其高阴性预测值。
- 移植后早期血清学评分变异性大，不宜单独依赖APRI、FIB-4或GPR评估纤维化。
局限性
- 回顾性研究设计，样本量111例，可能存在选择偏倚。
- 原文未报告SWE的敏感度、特异度及阴性预测值具体数值。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Graft fibrosis is a critical pathological endpoint of chronic injury after liver transplantation (LT). While serum-based scores are validated in native liver diseases, their efficacy in LT recipients remains controversial. This study compared the diagnostic performance of shear wave elastography (SWE) with common serological indices (APRI, FIB-4, GPR) for detecting significant graft fibrosis (≥S2) in adult and pediatric recipients.
METHODS: We retrospectively analyzed 111 LT recipients (63 adults, 48 children) who underwent liver biopsy and concurrent SWE/biochemical testing. Fibrosis was staged by the Scheuer classification. Diagnostic accuracy was evaluated using Spearman correlation and receiver operating characteristic (ROC) curves, stratified by recipient and graft age.
RESULTS: SWE demonstrated the strongest correlation with histological fibrosis stage (ρ = 0.76, p < 0.001), significantly outperforming all serological indices. For the detection of significant fibrosis, SWE achieved an AUC of 0.927 (95% CI: 0.879-0.975), superior to GPR (0.759), APRI (0.691), and FIB-4 (0.594). Notably, FIB-4 showed no significant correlation with fibrosis (ρ = -0.02, p = 0.818). SWE maintained high diagnostic accuracy across adult and pediatric recipients, with optimal cut-off values of 10.14 kPa and 10.92 kPa. Moreover, SWE exhibited stable performance across different graft ages, whereas serological indices showed marked variability in the early post-transplant period.
CONCLUSION: SWE provides a superior and more stable assessment of graft fibrosis compared to conventional serological models in both adult and pediatric LT recipients. Given its high NPV, SWE serves as a robust first-line tool for long-term non-invasive graft surveillance.
引用
- Wang SR, Wang SC, Yi ZX, et al. Limited Utility of Serum Scores vs. Shear Wave Elastography for Graft Fibrosis in Adult and Pediatric Liver Transplant Recipients. Ultrasound Med Biol. 2026. PMID: 42128721. doi:10.1016/j.ultrasmedbio.2026.04.015
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。