超声剪切波弹性成像与门静脉血流动力学参数对慢性肝炎肝纤维化的诊断价值

Diagnostic value of ultrasound shear wave elastography and portal vein hemodynamic parameters in chronic hepatitis liver fibrosis

目的探讨超声剪切波弹性成像与门静脉血流动力学参数对慢性肝炎肝纤维化的诊断价值。方法收集2019年5月至2020年7月阜阳市第二人民医院诊断为慢性肝炎住院患者的临床资料进行回顾性分析,共48例。患者自愿接受门静脉血流动力学、超声剪切波弹性成像检查,48例患者根据Scheuer法进行肝纤维化分期,共5期,S0期10例,S1期13例,S2期10例,S3期10例,S4期5例,比较各期患者门静脉平均流速、门静脉流速峰值(peak portal vein velocity,PVVmax)、门静脉主干内径(portal vein diameter,PVD)、肝脏硬度值(liver stiffness measurement,LSM)、肝杨氏模量,且以肝穿刺活检为金标准,分析各项检测方式灵敏度、特异性。呈正态分布的计量资料以xˉ±s表示,多组间的比较采用单因素方差分析,两两比较采用LSD-t检验。采用Spearman法分析肝纤维化分期与各参数之间相关性;用ROC曲线分析超声剪切波弹性成像、门静脉血流动力学及联合检测预测慢性肝炎肝纤维化的诊断价值。结果肝纤维化分期中,S0期组患者LSM为(5.29±0.19)kPa、肝杨氏模量为(21.65±2.35)kPa,S1期组患者LSM(6.38±1.25)kPa、肝杨氏模量(22.89±3.19)kPa,S2期组患者LSM(9.76±1.33)kPa、肝杨氏模量(23.77±3.52)kPa,S3期组患者LSM(15.44±2.44)kPa、肝杨氏模量(25.14±2.29)kPa,S4期患者LSM(18.08±1.22)kPa、肝杨氏模量(27.94±2.58)kPa,组间比较差异均有统计学意义(F值分别为115.47、4.84,P值分别为<0.001、0.003),两两比较差异均有统计学意义(均P<0.05)。S0期患者门静脉平均流速(20.56±4.21)cm/s、PVVmax(22.19±4.33)cm/s,S1期门静脉平均流速(18.39±3.79)cm/s、PVVmax(20.69±3.12)cm/s,S2期门静脉平均流速(13.46±2.21)cm/s、PVVmax(16.65±2.54)cm/s,S3期门静脉平均流速(10.56±2.85)cm/s、PVVmax(13.42±2.46)cm/s,S4期门静脉平均流速(8.15±1.65)cm/s、PVVmax(11.89±2.89)cm/s,组间比较差异均有统计学意义(F值分别为21.35、16.96,均P<0.001),两两比较差异均有统计学意义(均P<0.05)。经Spearman法相关性分析显示,肝纤维化分期与门静脉平均流速、PVVmax均呈负相关性(r值分别为-0.75、-0.88;均P<0.001),与肝杨氏模量、LSM均呈正相关性(r值分别为0.54、0.86;均P<0.001)。经ROC曲线分析,超声剪切波弹性成像预测慢性肝炎肝纤维化AUC为0.75,门静脉血流动力学预测AUC为0.68,联合检测预测AUC为0.94。结论门静脉血流动力学联合超声剪切波弹性成像对评估慢性肝炎肝纤维化具有一定诊断效能,存在较高特异性和灵敏度。

Objective To explore the diagnostic value of ultrasound shear wave elastography and portal vein hemodynamic parameters for chronic hepatitis and liver fibrosis.Methods The clinical data of 48 hospitalized patients with chronic hepatitis diagnosed in Fuyang Second People's Hospital from May 2019 to July 2020 were collected and analyzed retrospectively.The patients voluntarily received portal vein hemodynamics and ultrasonic shear wave elastography.According to Scheuer's method,48 patients were classified into 5 stages of liver fibrosis,including 10 patients in S0 stage,13 patients in S1 stage,10 patients in S2 stage,10 patients in S3 stage and 5 patients in S4 stage.The average velocity of portal vein,peak portal vein velocity(PVVmax),portal vein diameter(PVD),liver stiffness measurement(LSM)and Young's modulus of liver were compared.Pathological and liver biopsy was the gold standard to analyze the sensitivity and specificity of various detection methods.The normally distributed measurement data were expressed as x¯±s,the comparison between multiple groups was performed by one-way ANOVA,and the pairwise comparison was performed by LSD-t test.Spearman method was used to analyze the correlation between liver function classification and various parameters.ROC curve was used to analyze the diagnostic value of ultrasonic shear wave elastography,portal vein hemodynamics and combined detection in predicting liver fibrosis in chronic hepatitis.Results In the staging of liver fibrosis,the LSM of the patients in the S0 stage was(5.29±0.19)kPa,and the Young's modulus of the liver was(21.65±2.35)kPa;the LSM of the patients in the S1 stage was(6.38±1.25)kPa,and the Young's modulus of the liver(22.89±3.19)kPa,LSM(9.76±1.33)kPa and hepatic Young's modulus(23.77±3.52)kPa in S2 group,LSM(15.44±2.44)kPa,hepatic Young's modulus(25.14±2.29)in S3 group,LSM(18.08±1.22)kPa and hepatic Young's modulus(27.94±2.58)kPa in patients with S4 stage,the differences between groups were statistically significant(F values​​were 115.47,4.84,P values​were<0.001,0.003),and the difference was statistically significant(all P<0.05).The average flow velocity of patients in S0 stage was(20.56±4.21)cm/s,PVVmax(22.19±4.33)cm/s,the average flow velocity of S1 stage was(18.39±3.79)cm/s,PVVmax(20.69±3.12)cm/s,and the average of S2 stage Flow velocity(13.46±2.21)cm/s,PVVmax(16.65±2.54)cm/s,average flow velocity in S3 stage(10.56±2.85)cm/s,PVVmax(13.42±2.46)cm/s,average flow velocity in S4 stage(8.15±1.65)cm/s,PVVmax(11.89±2.89)cm/s,the difference between the groups was statistically significant(F values were 21.35,16.96,all P<0.001),and the difference between the two groups was statistically significant(all P<0.05).Correlation analysis by Spearman method showed that liver function grades were negatively correlated with average flow velocity and PVVmax(r values​were-0.75 and-0.88,respectively;all P<0.001),and were positively correlated with liver Young's modulus and LSM.(r values​​were 0.54 and 0.86,respectively;all P<0.001).According to the ROC curve analysis,the AUC predicted by ultrasonic shear wave elastography was 0.75,AUC predicted by portal vein hemodynamics predicts was 0.68,and AUC predicted by combined detection predicts was 0.94.Conclusion The combination of portal vein hemodynamics and ultrasonic shear wave elastography has a certain diagnostic power for the assessment of chronic hepatitis and liver fibrosis,with high specificity and sensitivity.