声触诊组织量化技术在预测乙型肝炎后肝硬化食管静脉曲张发生风险中的价值

Value of virtual touch tissue quantification technique in predicting risk of esophageal varices in patients with hepatic cirrhosis

目的探讨常规超声与声触诊组织量化(VTQ)技术在肝硬化食管静脉曲张(EV)发生风险中的诊断效能及临床价值。方法选取2015年12月至2016年12月在吉林大学中日联谊医院就诊的154例肝硬化患者,其中经胃镜检查结果证实:无静脉曲张组(NEV)52例,EV组102例。采用常规超声检测右肝斜径、脾脏厚径、脾脏长径、肝门静脉和脾静脉的内径及血流速度,并应用VTQ技术检测肝脏和脾脏的剪切波速度(SWV)值。采用Logistic回归分析筛选影响EV发生的独立危险因素;进而采用ROC曲线判断相关独立危险因素预测肝硬化EV发生的诊断效能。结果 EV组的肝功能Child Pugh分级明显高于NEV组,差异有统计学意义(χ2=50.74,P <0.05);EV组的肝门静脉和脾静脉内径以及肝脏和脾脏的SWV值均明显大于NEV组,但肝门静脉及脾静脉的血流速度均明显低于NEV组,差异均有统计学意义(t=1.62、0.03、3.66、3.92、-0.18、-0.10,P均<0.05)。Logistic回归分析结果显示肝门静脉内径、肝脏及脾脏SWV值为预测EV发生的独立危险因素,其OR值分别为2.396、1.007、1.005(P均<0.05)。肝门静脉内径、肝脏及脾脏SWV值的AUC分别为0.88(95%CI:0.824～0.936)、0.911(95%CI:0.866～0.957)及0.908(95%CI:0.863～0.953);最佳临界值分别为14.05 mm、2.013 m/s及2.937 m/s;其敏感度分别为73.6%、82.4%、79.6%;特异度分别为87.1%、90.3%、87.6%;准确性分别为82.5%、87.7%、85.1%。结论肝门静脉内径、肝脏和脾脏SWV值为预测EV发生的独立危险因素,三者在评估肝硬化EV发生风险中有较好的诊断效能,尤其是肝脏SWV值。

Obiective This study discusses the diagnosis efficiency and clinical value of application of two kinds of ultrasonic technology in the risk of EV in hepatic cirrhosis.Methods This research selected154cases of patients(NEV,n=52and EV,n=102).The conventional ultrasound examination and VTQ are performed in every patients been checked hepatic portal vein diameter and blood flow velocity,spleen vein diameter and blood flow velocity and the value of SWV of liver and spleen in patients with hepatic sclerosis.Result The comparison of clinical datas and liver function classification Child-Pugh grades of liver function of patients in group of EV,The inner diameter of hepatic portal vein and splenic vein and the SWV value of liver and spleen in group of EV were obviously higher than those in group of NEV,with statistical difference(P<0.05);The blood flow velocity of hepatic portal vein and splenic vein in group of EV were lower than that in group of NEV,with statistical difference(P<0.05).The value of SWV of liver and spleen are the independent risk factors in predicted EV,and values of OR were2.396,1.007and2.396,respectively(P<0.05).The area under the curves(AUC)were0.88(95%CI:0.8240.936),0.911(95%CI:0.866-0.957)and0.866(95%CI:0.863-0.953);The best cut-off values respectively were14.05mm,2.013m/s and2.937m/s;Sensitivity were respectively73.6%,82.4%and79.6%.Specificity were87.1%,90.3%and87.6%respectively.The accuracy rate were82.5%,87.7%and85.1%respectively.Conclusion Diameter of hepatic portal vein,SWV values of liver and spleen were independent risk factors of EV.The ROC curves analysis showed that diameter of hepatic portal vein,SWV values of liver and spleen have good diagnostic performance in assessing the risk of EV.Liver SWV value has a unique advantage.