剪切波弹性成像联合多参数模型无创诊断HBV相关性肝细胞癌食管静脉曲张的研究

Noninvasive diagnosis of esophageal varices in patients with HBV-related hepatocellular carcinoma by shear wave elastography and multiparameter model

目的探讨剪切波弹性成像(SWE)技术联合多参数模型无创评估慢性乙型肝炎病毒(HBV)相关性肝细胞癌患者食管静脉曲张(EV)的临床价值。方法选取我院经病理确诊的HBV相关性肝细胞癌患者180例,以胃镜检查结果为金标准,分为无EV者50例(EV0组)、轻度EV者69例(EV1组)、中度EV者33例(EV2组)、重度EV者28例(EV3组)。应用SWE测量其肝脏和脾脏硬度;实验室检查获取天门冬氨酸氨基转移酶水平、血小板计数,并计算天门冬氨酸氨基转移酶与血小板计数比值指数(APRI)和血小板计数与脾脏长径比率(PSR),比较各组上述参数的差异。分析肝脏硬度、脾脏硬度、APRI、PSR与EV的相关性。绘制肝脏硬度、脾脏硬度、APRI及PSR预测EV程度的受试者工作特征(ROC)曲线,并计算其诊断效能。Spearman相关分析法分析影响脾脏硬度的相关因素。结果各组脾脏硬度、APRI和PSR比较,差异均有统计学意义(均P<0.05)。脾脏硬度与EV程度呈显著正相关(r=0.656,P<0.05),肝脏硬度、APRI及PSR与EV程度均呈中等正相关(r=0.524、0.431、0.363,均P<0.05)。脾脏硬度诊断EV≥1、EV≥2、EV3级的ROC曲线下面积分别为0.854、0.815、0.821,明显高于肝脏硬度、APRI及PSR(均P<0.05)。Spearman相关性分析显示:脾脏硬度与白蛋白、总胆红素、脾脏长径和肝脏硬度均呈正相关(r=0.190、0.135、0.429、0.464,P=0.004、0.008、0.000、0.004),与血小板计数呈负相关(r=-0.545,P=0.001)。结论 SWE所测脾脏硬度结合多参数模型APRI和PSR可无创评估HBV相关性肝细胞癌患者的EV程度,具有重要的临床价值。

Objective To investigate the clinical value of shear wave elastography(SWE)and multi-parameter model in the diagnosis of esophageal varices(EV)in patients with HBV-related hepatocellular carcinoma.Methods A total of 180 patients with hepatocellular carcinoma diagnosed by pathology were enrolled. The results of gastroscopy were used as the standard,50 patients without EV(EV0 group)and 69 patients with mild EV(EV1 group),33 patients with moderate EV(EV2 group)and 28 patients with severe EV(EV3 group)were included.SWE was used to measure the liver stiffness and spleen stiffness,laboratory tests were performed to obtain aspartate aminotransferase(AST)levels,platelet counts,the ratio of aspartate aminotransferase and platelet index(APRI),and the ratio of platelet count and spleen long diameter(PSR)were calculated.The differences of the above parameters were compared among the groups.The correlation between liver stiffness,spleen stiffness,APRI,PSR and EV were analyzed.Liver stiffness,spleen stiffness,APRI and PSR were used to predict the receiver operating characteristic(ROC)curve at different EV levels,and the diagnostic efficacy was calculated.Spearman correlation analysis of factors affecting spleen stiffness values was performed.Results The spleen stiffness,APRI and PSR awcong different group were statistically significant(all P<0.05).There was a significant positive correlation between spleen stiffness and EV(r=0.656,P<0.05).There was a moderate positive correlation between liver stiffness,APRI,PSR and EV(r=0.524,0.431,0.363,all P<0.05).The area under the ROC curve of spleen stiffness for diagnosis of EV ≥1,EV ≥2,EV 3 were 0.854,0.815,0.821,respectively,which were significantly higher than that of the liver stiffness,APRI and PSR.Spearman correlation analysis showed that spleen stiffness was positively correlated with total bilirubin,age and spleen long diameter values(r=0.190,0.329,0.464,P=0.004,0.000,0.004),and negatively correlated with platelet(r=-0.455,P=0.001).Conclusion The spleen stiffness value measured by SWE combined with multi-parameter model APRI and PSR can non-invasively diagnose the EV degree in patients with HBV-related hepatocellular carcinoma,and has important clinical value.