声辐射力脉冲弹性成像技术预测肝硬化食管静脉曲张破裂出血的临床价值

Clinical value of acoustic radiation force impulse elastography in predicting esophageal variceal bleeding in liver cirrhosis

目的探讨声辐射力脉冲弹性成像(ARFI)技术在预测肝硬化食管静脉曲张破裂出血中的临床价值。方法回顾分析2014年10月-2017年5月于解放军总医院第五医学中心就诊的271例肝硬化患者资料,所有患者均应用ARFI技术对肝脏和脾脏的超声弹性进行检测,并根据有无食管静脉曲张破裂出血将患者分为出血组(n=56)和无出血组(n=215),比较两组间相关指标的差异并结合受试者工作特征曲线(ROC曲线)评估分析ARFI弹性测值对肝硬化食管静脉曲张破裂出血的诊断价值。正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验。结果肝硬化食管静脉曲张出血组及无出血组脾脏ARFI弹性测值分别为3.89(3.49~4.11)m/s和3.46(2.93~3.80)m/s,出血组显著高于无出血组(Z=-4.941,P<0.001);出血组及无出血组肝脏ARFI弹性值分别为2.08(1.57~2.74)m/s和1.98(1.49~2.70)m/s,两组间差异无统计学意义(Z=-1.025,P=0.305)。脾脏和肝脏ARFI弹性测值预测肝硬化食管静脉曲张破裂出血的ROC曲线下面积分别为0.714和0.544(P=0.0025),以3.71 m/s作为脾脏ARFI弹性测值预测食管静脉曲张出血发生的诊断界值,其敏感度为0.68,特异度0.69。结论脾脏ARFI弹性测值较肝脏弹性测值可更有效预测肝硬化食管静脉曲张破裂出血的风险,具有良好的临床应用前景。

Objective To investigate the clinical value of acoustic radiation force impulse(ARFI)elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of 271 patients with liver cirrhosis who attended the Fifth Medical Center of Chinese PLA General Hospital from October 2014 to May 2017,and ARFI elastography was performed for all patients to measure the elasticity of the liver and the spleen.According to the presence or absence of esophageal variceal bleeding,the patients were divided into bleeding group and non-bleeding group,and related indices were compared between the two groups.The receiver operating characteristic(ROC)curve was used to evaluate the value of ARFI elasticity in the diagnosis of esophageal variceal bleeding in liver cirrhosis.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Results The bleeding group had a significantly higher ARFI elasticity of the spleen than the non-bleeding group[3.89(3.49-4.11)m/s vs 3.46(2.93-3.80)m/s,Z=-4.941,P<0.001],and there was no significant difference in the ARFI elasticity of the liver between the bleeding group and the non-bleeding group[2.08(1.57-2.74)m/s vs 1.98(1.49-2.70)m/s,Z=-1.025,P=0.305].The areas under the ROC curve for ARFI elasticity values of the spleen and the liver were 0.714 and 0.544,respectively,in predicting esophageal variceal bleeding in patients with liver cirrhosis(P=0.0025).At the cut-off value of 3.71 m/s,the ARFI elasticity of the spleen had a sensitivity of 0.68 and a specificity of 0.69 in predicting esophageal variceal bleeding.Conclusion The ARFI elasticity value of the spleen has a better value than that of the liver in predicting the risk of esophageal variceal bleeding and thus holds promise for clinical application.