乙型肝炎肝硬化患者三维显微定量超声和二维剪切波弹性成像与Child-Pugh评分的相关性

Correlation between Child-Pugh scores and three-dimensional microscopic quantitative ultrasound, two-deminsional shear wave elastography of patients with hepatitis B cirrhosis

目的探讨乙型肝炎肝硬化患者三维显微定量超声(three-dimensional microscopic quantitative ultrasound,3D-MQU)和二维剪切波弹性成像(two-deminsional shear wave elastography,2D-SWE)与Child-Pugh评分的相关性。方法以2016年1月至2017年12月于青海省第四人民医院住院并诊断为乙型肝炎肝硬化的患者为研究对象,收集患者肝功能、血常规、腹部超声、3D-MQU及2D-SWE等指标。计算患者天门冬氨酸氨基转移酶和血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)与Child-Pugh评分。根据Child-Pugh评分将患者分为Child-Pugh A级组、Child-Pugh B级组与Child-Pugh C级组。比较各组患者3D-MQU评分、2D-SWE测量值及APRI的差异。采用Spearman相关分析3D-MQU评分、2D-SWE测量值及APRI与Child-Pugh分级的相关性。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价3D-MQU、2D-SWE及APRI对乙型肝炎肝硬化患者肝功能失代偿的预测价值。结果共入组乙型肝炎肝硬化患者165例,其中Child-Pugh A级56例,B级74例,C级35例。3组3D-MQU评分分别为(14.61±1.62)分、(15.76±1.77)分、(18.37±2.48)分,2D-SWE测量值分别为(14.36±3.38)kPa、(19.29±6.36)kPa、(26.66±8.27)kPa,差异均有统计学意义(P均<0.001)。3D-MQU评分及2D-SWE测量值与Child-Pugh评分均呈正相关(r值分别为0.512、0.575,P均<0.001)。3D-MQU、2D-SWE及APRI预测乙型肝炎肝硬化失代偿的ROC曲线下面积分别为0.818(95%CI:0.738~0.897)、0.821(95%CI:0.747~0.89)、0.608(95%CI:0.490~0.711)。结论乙型肝炎肝硬化患者3D-MQU和2D-SWE与Child-Pugh评分具有相关性,3D-MQU可考虑作为乙型肝炎肝硬化患者肝功能失代偿简易、无创的辅助评价工具。

Objective To investigate the correlation between Child-Pugh scores and three-dimensional microscopic quantitative ultrasound(3 D-MQU) and two-dimensional shear wave elastography(2 D-SWE) of patients with hepatitis B cirrhosis. Methods Patients with hepatitis B cirrhosis in the Fourth People’s Hospital of Qinghai Province from January 2016 to December 2017 were enrolled. The liver function indexes, whole blood cell count, abdominal ultrasound, 3 D-MQU and 2 D-SWE were collected, the aspartate aminotransferase-to-platelet ratio index(APRI) and Child-Pugh scores were calculated. Patients were divided into Child-Pugh A group, Child-Pugh B group and Child-Pugh C group, 3 D-MQU scores, 2 D-SWE tests and APRI were compared among the groups. Correlation between Child-Pugh scores and 3 D-MQU, 2 D-SWE and APRI were analyzed by Spearman correlation analysis. Values of 3 D-MQU, 2 D-SWE, and APRI for predicting liver decompensation of patients with hepatitis B cirrhosis were furtherly analyzed by ROC curve. Results Total of 165 patients with hepatitis B cirrhosis were enrolled, including 56 cases of ChildPugh A grade,74 cases of in Child-Pugh B grade and 35 cases of Child-Pugh C grade. 3 D-MQU scores of the three groups were(14.61 ± 1.62) points,(15.76 ± 1.77) points and(18.37 ± 2.48) points respectively, and the measured values of 2 D-SWE were(14.36 ± 3.38) kPa,(19.29 ± 6.36) kPa and(26.66 ± 8.27) kPa, respectively, the differences were statistically significant(all P < 0.001). The AUROC of 3 D-MQU, 2 D-SWE and APRI in prediction of decompensation of hepatitis B cirrhosis were 0.818(95% CI: 0.738~0.897), 0.821(95% CI: 0.747~0.89) and 0.608(95% CI: 0.490~0.711), respectively. Conclusion 3 D-MQU and 2 D-SWE were correlated with Child-Pugh scores. 3 D-MQU may be used as a simple, non-invasive tool for predicting liver decompensation of patients with hepatitis B cirrhosis.