超声联合剪切波弹性成像技术在土三七致肝窦阻塞综合征中的应用

Application of ultrasound combined with shear-wave elastography in hepatic sinusoidal obstruction syndrome caused by Gynura segetum

目的探讨超声联合剪切波弹性成像(shear-wave elastography,SWE)技术在土三七致肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)治疗中的临床应用价值。方法以2015年1月至2017年5月在南京大学医学院附属鼓楼医院确诊的土三七致肝窦阻塞综合征(PA-HSOS)患者81例为研究对象,根据治疗方法将患者分为药物治疗组(51例)和药物+经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystem shunt,TIPS)治疗组(30例)。另选取健康志愿者30例为正常对照组。通过超声测量门静脉(portal vein,PV)和脾静脉(splenic vein,SPV)血流参数,采用剪切波弹性成像(shear-wave elastography,SWE)技术检测肝脏和脾脏剪切波速度(shear-wave velocity,SWV)值,比较各组患者上述指标的差异并评估其预测治疗方法的价值。结果与对照组相比,PAHSOS患者的PV和SPV流速显著降低,肝脏和脾脏SWV值显著升高,差异有统计学意义(P均<0.05),PV和SPV内径差异无统计学意义(P均>0.05)。治疗后药物治疗组和药物+TIPS治疗组患者病情均好转,PV流速和SPV流速较治疗前增加,肝脏SWV值和脾脏SWV值较治疗前下降。治疗后,药物治疗组患者的PV流速和SPV流速显著高于药物+TIPS治疗组,肝脏SWV值显著低于药物+TIPS治疗组,差异均有统计学意义(P均<0.05)。PV流速、SPV流速和肝脏SWV值联合预测治疗方法的AUC为0.910。结论通过SWE技术测定肝脏SWV值,联合PV和SPV流速将可能成为PA-HSOS患者评估治疗效果和预测预后的重要方法。

Objective To investigate the value of ultrasound combined with shear-wave elastography in hepatic sinusoidal obstruction syndrome caused by Gynura segetum(PA-HSOS).Methods Total of 81 patients with PA-HSOS in Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2015 to May 2017 were selected and divided into pharmacotherapy group(51 cases)and pharmacotherapy+transjugular intrahepatic portosystem shunt(TIPS)group(30 cases)according to therapeutic method.Another 30 healthy volunteers were selected as control group.The differences of the above indexes and the predictive value on treatment methods in each group were compared.Results Compared with the control group,the PV and SPV velocities of patients with PA-HSOS decreased significantly,and the SWV values of liver and spleen increased significantly(P<0.05).There were no significant differences in the inner diameter of PV and SPV(P>0.05).After treatment,patients in pharmacotherapy group and pharmacotherapy+TIPS group all improved.The PV velocity and SPV velocity increased,while the SWV value of the liver and spleen decreased.After treatment,the PV velocity and SPV velocity of patients in pharmacotherapy group were significantly higher than those in pharmacotherapy+TIPS group,and the SWV value in liver was significantly lower than that in pharmacotherapy+TIPS group.The differences were statistically significant(P<0.05).The AUC of combined prediction of PV velocity,SPV velocity and SWV value of liver was 0.910.Conclusions SWV of liver combined with the velocity of PV and SPV can be used to provide a better method to evaluate the curative effect and predict the prognosis of PA-HSOS.