实时二维剪切波弹性成像评估慢加急性肝衰竭患者的预后

Two-dimensional Shear Wave Elastography in Predicting Prognosis of Patients with Acute-on-chronic Liver Failure

【目的】探讨实时二维剪切波弹性成像(2D SWE)评估慢加急性乙型肝炎肝衰竭(ACLF-HBV)患者预后的临床应用价值。【方法】入组对象为2013年10月1日至2015年12月31日我院感染科确诊的312例慢加急性乙型肝炎肝衰竭患者。观察终点为90 d,根据临床结局分为好转组192例和恶化组120例。入组后3 d内,应用2D SWE进行肝脏硬度测量,收集患者血常规、凝血、生化等血清学指标,观察患者肝实质回声均匀度、肝包膜光滑度、右肝厚度、胆囊壁厚度、脾脏指数、腹水指数、门静脉主干内径、附脐静脉是否重开,计算终末期肝病评分(MELD)、CTP评分(CTP)、皇家医学院医院评分(KCH),入组后每2-4周动态检测2D SWE,直至患者出院或死亡\肝移植。【结果】恶化组的2D SWE高于好转组[(44.0±7.5)k Pa vs(36.8±10.3)k Pa,t=-6.5,P=0.000],39.2 k Pa可作为预后不良的阈值。2D SWE评估ACLF-HBV患者预后的受试者操作特征曲线下面积(AUROC)为0.73,预后效能高于KCH(AUROC:0.65,z=2.1,P=0.033)。动态检测2D SWE,好转组维持在40 k Pa以下,恶化组则一直高于40 k Pa,并有升高趋势。【结论】2D SWE评估ACLF-HBV患者预后的准确性较高,测值高于39.2 k Pa的患者预后较差,反之预后较好;动态检测2D SWE的变化对于ACLF-HBV患者的预后评估也有潜在价值。

【Objective】To evaluate the two-dimensional shear wave elastography（2D SWE）in predicting the prognosis of the patients with acute-on-chronic hepatitis B liver failure（ACLF-HBV）.【Methods】312 patients diagnosed with ACLF-HBV at the Department of Infectious Diseases in the Third Affiliated Hospital of Sun Yat-sen University from October 1st 2013 to December 31th2015 were recruited. The baseline data of all patients,including 2D SWE,laboratory data,ultrasonographic data,Model for Endstage Liver Disease score（MELD）,Child-Turcotte-Pugh score（CTP）,and King′s College Hospital score（KCH）,were collected when enrolled. All patients were followed up for at least 90 days and their clinical outcomes（recovering or worsening）were recorded.2D SWE values of all patients were dynamically collected every 2 ~ 4 weeks during the follow-up until death,liver transplantation,or discharging from hospital.【Results】The worsening patients showed higher 2D SWE values than the recovering ones[（44.0 ± 7.5）kPa vs（36.8 ± 10.3）kPa,t =-6.5,P = 0.000],2D SWE value less than 39.2 kPa could be a prediction of the patient′s recovery in90 days.The predictive value of 2D SWE（AUROC = 0.73）was higher than that of KCH（AUROC：0.65,z = 2.1,P = 0.033）. Among all the dynamically measured patients,2D SWE rose from（42.1 ± 8.0）k Pa to（47.5 ± 9.3）k Pa in the worsening group during the 90-day follow-up,while nearly stable in the recovery group.【Conclusion】Noninvasive liver stiffness measurement by 2D SWE is a useful method in evaluating the prognosis of ACLF-HBV patients. Taking a cutoff of 39.2 k Pa,patients with higher 2D SWE values could have worse clinical outcomes,otherwise better. It seems that dynamically measuring 2D SWE values could also be helpful,but more research in the future should be needed.