实时剪切波弹性成像技术检测肝脾弹性硬度对乙型病毒性肝炎肝硬化门脉高压的预测价值

Diagnostic accuracy of liver and spleen stiffness by two dimensional shear wave elastography for portal hypertension in hepatitis B-related cirrhosis

目的探讨实时剪切波弹性成像技术(2D-SWE)获得的肝脾弹性对乙型病毒性肝炎(简称乙肝)肝硬化门脉高压严重程度的预测价值。方法选择2017年9月至2018年4月就诊于复旦大学附属中山医院的乙肝肝硬化门脉高压患者58例,其中男37例、女21例,年龄(55±12)岁,回顾性分析2D-SWE技术获得的肝(L-SWE)脾(S-SWE)弹性值与肝静脉压力梯度(HVPG)的相关性,并与常见血清学模型进行比较,分析其对门脉高压的诊断价值。结果根据HVPG测值,58例患者中HVPG≥10 mmHg(1 mmHg=0.133 kPa)者47例,为临床显著门脉高压(CSPH),食管胃底静脉曲张的风险增高;HVPG≥12 mmHg者34例,为严重门脉高压(SPH),曲张静脉破裂出血的概率增加。相关分析显示L-SWE与HVPG值呈中等程度正相关(r=0.42,P<0.01),S-SWE为高度正相关(r=0.68,P<0.01)。血清学模型为低度正相关(r=0.36及r=0.28,均P<0.01)。L-SWE、S-SWE及二者联合预测CSPH的曲线下面积分别为0.78、0.88、0.89,当L-SWE>12.86 kPa或S-SWE>35.73 kPa时,食管胃底静脉曲张的风险性增高。L-SWE、S-SWE及二者联合预测SPH的曲线下面积分别为0.68、0.81、0.77,且S-SWE特异度最高,当S-SWE>41.5 kPa时,曲张静脉出血风险大。结论2D-SWE技术获得的L-SWE及S-SWE可协助诊断CSPH及SPH,进行危险分级评估。

Objective To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography(2D-SWE)in hepatitis B-related cirrhosis.Methods The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital,Fudan University from September 2017 to April 2018.Pearson′s correlation analyses were used to assess the relationship between liver/spleen stiffness(L-SWE and S-SWE)and hepatic venous pressure gradient(HVPG),as well as the comparison with serological model.The SWE diagnostic performances of Liver(L-SWE),Spleen(S-SWE)were also evaluated.Results Of all 58 patients,47 were found HVPG≥10 mmHg,diagnosed as clinically significant portal hypertension(CSPH)and severe portal hypertension(SPH),which patients are at increased risk of developing complications.Thirty-four patients were found HVPG≥12 mmHg,diagnosed as SPH,which patients were at increased risk of variceal bleeding.Moderate positive correlation was found between L-SWE and HVPG(r=0.42,P<0.01),and S-SWE were significantly correlated with HVPG(r=0.68,P<0.01),while serological models and HVPG were slightly correlated(r=0.36 and 0.28,all P<0.01).The area under the receiver operating characteristic curves of L-SWE,S-SWE and the combination for CSPH were 0.78,0.88 and 0.89.When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa,patients were at increased risk of developing complications.The area under the receiver operating characteristic curves for SPH were 0.68,0.81 and 0.77 and the S-SWE had the highest specificity,so when S-SWE was>41.5 kPa,patients were at increased risk of variceal bleeding.Conclusion L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.