超声联合剪切波弹性成像技术在病毒性肝炎后肝硬化门静脉高压中的应用研究

Applied research of conventional ultrasound combining shear-wave elastography in posthepatitic cirrhosis patients with portal hypertension

目的评估超声联合剪切波弹性成像(SWE)技术在肝硬化门静脉高压中的临床应用价值。方法选取病毒性肝炎后肝硬化门静脉高压患者64例,门静脉压力(PVP)测定前超声测量门静脉和脾静脉血流参数;采用SWE技术检测获得肝脏和脾脏硬度指标组织剪切波传播速度(SWV);分析门静脉和脾静脉血流参数、肝功能、肝脏和脾脏SWV与PVP的相关性。结果肝功能Child-Pugh A级14例,B级43例,C级7例,平均肝脏SWV:C级(2.10±0.30)m/s>B级(1.87±0.25)m/s>A级(1.71±0.14)m/s。Spearman相关分析显示,门静脉内径、门静脉充血指数及脾脏SWV与PVP相关。多元回归分析显示,脾脏SWV为PVP的独立相关因素(t=7.493,P<0.001);而门静脉和脾静脉血流参数、肝功能、肝脏SWV与PVP无明显相关性。结论脾脏SWV与PVP存在较好的相关性,SWE技术测定脾脏SWV将可能成为无创性评估肝硬化门静脉高压的重要方法。

Objective This paper intends to determine the feasibility of using conventional ultrasound combined with shear-wave elastography(SWE)in the evaluation of portal hypertension in patients with cirrhosis. Methods Clinical data of 64 posthepatitic cirrhosis patients with portal hypertension were collected.The portal venous(PV)velocity,the diameter of PV,the splenic veous(SPV)velocity,and the diameter of SPV were measured with ultrasound.The liver and spleen shearwave velocity(SWV)were measured using SWE,and the liver function was measured.On the same day,the portal venous pressure(PVP)measurement was calculated.Spearman rank correlation and the multiple factor linear regressioin method were adopted to analyze the correlation between these indexes and PVP.Results Fourteen patients were found to be Child-Pugh A cirrhosis,forty-three B cirrhosis,and 7 C cirrhosis.In the study group,the liver SWV values were found to be(1.71±0.14)m/s in Child-Pugh A,(1.87±0.25)m/s in B and(2.10±0.30)m/s in C.Spearman correlation analysis showed that PVP was significantly correlated with the diameter of PV,the congestion index of PV,and the spleen SWV.The multiple factor analysis indicated that there was a certain relevance between spleenSWV and PVP(t=7.493,P<0.001),and there were no relevance between the other indexes and PVP.Conclusions Significant positive correlations were observed between spleen SWV and PVP.The measurement of spleen SWV can be used for noninvasive assessment of portal hypertension in patients with cirrhosis.