肝肿瘤患者背景肝脏剪切波弹性模量值的多因素回归分析

Influenced factors of shear wave elastography on liver background in patients with liver tumors: a multivariate regression analysis

目的分析肝肿瘤患者的背景肝脏实时剪切波弹性成像(SWE)模量值的相关因素及其独立预测因子。方法收集2015年7月至2016年3月在中山大学肿瘤防治中心就诊的肝肿瘤患者132例,对所有病例均行常规超声检查及背景肝脏SWE检测,同时记录临床及实验室相关指标,变量包括性别、年龄、乙型肝炎表面抗原(HBs Ag)、甲胎蛋白(AFP)、糖类蛋白19-9(CA19-9)、癌胚抗原(CEA)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、谷胺酰转肽酶(GGT)、白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、凝血酶原时间(PT)、Child-Pugh评分、肿瘤直径及位置、肝脾测量径线、门静脉及脾静脉内径。所有病例均行肝肿瘤切除术,术后获得肿瘤病理及瘤旁肝组织脂肪变性情况及肝纤维化S分期。上述变量分别与SWE背景肝脏弹性模量值作Spearman两两相关分析,筛选出显著性相关的变量进行多重线性回归分析,得出回归方程并进行方差分析,评估方程的独立预测因子。结果 HBs Ag、AFP、CA19-9、ALT、AST、ALP、GGT、ALB、肝左叶前后径、脾长径(LS)、脾厚径、肝肿瘤病理类型(pathology)、肝纤维化S分期等变量与背景肝脏SWE弹性模量值均显著性相关(r=0.406、0.317、0.288、0.317、0.391、0.265、0.340、-0.269、0.230、0.414、0.365、0.416、0.597,P值均<0.01)。拟合的回归模型:SWE=0.958+0.126 S4+0.000371 GGT+0.002 LS-0.009 ALB+0.085 pathology,调整决定系数R2=0.422(F=19.996,P<0.01)。结论肝纤维化S分期与肝肿瘤患者背景肝脏SWE模量值有较高的相关性;肝硬化(S4)是SWE测值主要的独立预测因子。

Objective To explore the influenced factors on the elastic modulus of shear wave elastography（SWE） and independently predicted factors on liver background in patients with liver tumors. Methods From July 2015 to March 2016, a total of 132 patients with liver tumors underwent blood test, baseline ultrasonography and SWE of liver background before surgery at Sun Yat-sen University Cancer Center. All variables, including sex, age, hepatitis B surface antigen（HBs Ag）, α-fetoprotein（AFP）, carbohydrate atigen 19-9（CA19-9）, carcinoembryonic antigen（CEA）, glutamic-oxal acetic transaminase（AST）, glutamate pyruvate transaminase（ALT）, alkaline phosphatase（ALP）, glutamyl transpeptidase（GGT）, albumin（ALB）, total bilirubin（TBIL）, direct bilirubin（DBIL）, prothrombin time（PT）, Child-Pugh Score, size and location of tumors, size of spleen and liver, inner diameter of portal and spleen vein, histological analysis and fibrosis S stage of paratumor liver, were characterized and their relationship with SWE elastic modulus using the Spearmen correlation coefficients and those related to SWE values were explored by stepwise regression in multiple linear regression analysis and the regression equation was established. Results Variables including fibrosis S stage, HBs Ag, AFP, CA19-9, AST, ALT, GGT, ALP, ALB, size of spleen and left lobe of liver, pathology, showed a significant correlation coefficients（r=0.406, 0.317, 0.288, 0.317, 0.391, 0.265, 0.340,-0.269, 0.230, 0.414, 0.365, 0.416, 0.597, all P〈 0.01）. The predict model can be expressed as follows： SWE=0.958 ＋ 0.126 S4＋ 0.000371 GGT ＋ 0.002 LS-0.009 ALB ＋0.085 pathology（adjusted R2=0.422, P〈 0.01）. Conclusions SWE elastic modulus on paratumor liver was affected by various factors, especially fibrosis S stage. Cirrhosis（S4） can be considered as the most important independently predicted factor of SWE elastic modulus.