声脉冲辐射力弹性成像技术对乙型肝炎后肝硬化患者食管静脉曲张的预测价值

Predictive value for esophageal varices using acoustic radiation force impulse elastography in post-hepatitis B cirrhosis patients

目的回顾性分析应用声脉冲辐射力弹性成像技术（ARFI）对乙型肝炎后肝硬化患者食管静脉曲张的预测价值。方法选取2016年8月至2017年8月住院的乙型肝炎后肝硬化患者124例，按照胃镜下食管静脉曲张的形态及出血危险程度将患者分无、轻度、中度、重度4组。在ARFI成像模式下，启动声触诊组织定量（VTQ）功能分别检测肝、脾VTQ值，应用受试者工作特征曲线及曲线下面积（AUC）评估肝、脾VTQ值对食管静脉曲张的诊断价值。组间计量资料数据进行方差分析；计数资料进行X^2检验。结果肝脏VTQ值的组间比较，差异有统计学意义（F=12．623，P〈0．01）。脾脏VTQ值的组间比较，差异有统计学意义（F=9．022，P〈0．01）。肝脏VTQ值预测肝硬化患者轻度食管静脉曲张的AUC值为0．701（0．575～0．827）；中度静脉曲张的AUC值为0．802（0．701～0．902）；重度静脉曲张的AUC值为0．885（0．784～0．986），以2．235为最佳界值，特异度为97．37％，阴性预测值为88．10％，准确率可达90．16％。脾脏VTQ值预测肝硬化患者轻度食管静脉曲张的AUC值为0．688（0．539～0．798）}中度静脉曲张的AUC值为0．762（0．651～0．873）；重度静脉曲张的AUC值为0．800（0．671～0．928），以2．885为最佳界值，特异度为84．21％，阴性预测值为82．05％。结论应用ARFI技术测定肝、脾VTQ值对食管静脉曲张具有一定的预测价值，可用于乙型肝炎后肝硬化患者食管静脉曲张的初级筛查。

Objective Aretrospective analysis of the predictive value of acoustic radiation force impulse （ARFI） elastography for esophageal varices in post-hepatitis B cirrhosis patients. Methods 124 patients with post-hepatitis B cirrhosis who were admitted to Tianjin Second People＇s Hospital from August 2016 to August 2017 were selected. According to the shape of esophageal varices under gastroscopy and the risk of bleeding, patients were divided into 4 groups, none, mild, moderate and severe. In ARFI mode, the VTQ fimction was used to detect the VTQ values of the liver and spleen. The receiver operating characteristic curve and area under the curve （AUC） were used to evaluate the diagnosis of esophageal varices by VTQ values of the liver and spleen. Analysis of variance was performed on the data between the groups, and X^2 test was performed for categorical data. Results The difference in liver VTQ values between groups were statistically significant （F = 12.623, P 〈 0.01）. There was a statistically significant difference in VTQ values between spleens （F = 9.022, P 〈 0.01）. The liver VTQ predicts that the AUC value of mild esophageal varices in patients with cirrhosis was 0.701 （0.575- 0.827）; moderate varices was 0.802 （0.701-0.902）; severe varices was 0.885 （0.784-0.986）. The best cutoffvalue was 2.235, the specificity was 97.37%, the negative predictive value was 88.10%, and the accuracy was 90.16%. The VTQ value of spleen predicts the AUC value of mild esophageal vafices in patients with liver cirrhosis was 0.688 （0.539-0.798）; moderate varices were 0.762 （0.651-0.873）; severe varices were 0.800 （0.671-0.928）. The best cutoff value was 2.885, the specificity was 84.21%, and the negative predictive value was 82.05%. Conclusion The application ofARFI elastography in the determination of VTQ values of liver and spleen has certain predictive value for esophageal varices and it might be useful for primary screening of esophageal varices in post-hepatitis B cirrhosis patients.