摘要
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.
作者
朱宇莉
丁红
付甜甜
许智婷
薛立云
陈世耀
王文平
Zhu Yuli;Ding Hong;Fu Tiantian;Xu Zhiting;Xue Liyun;Chen Shiyao;Wang Wenping(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai Institute of Medical Imaging,Shanghai 200032,China;Department of Gastroenterology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第21期1654-1657,共4页
National Medical Journal of China
关键词
肝硬化
弹性成像技术
高血压
门静脉
肝静脉
Liver cirrhosisi
Elasticity imaging techniques
Hypertension,portal
Hepatic veins