剪切波弹性成像技术联合多参数评估肝硬化患者食管静脉曲张价值研究

Diagnostic efficacy of shear wave elastography by ultrasonography in predicting esophageal varices in patients with hepatitis B cirrhosis

目的探讨应用剪切波弹性成像(SWE)技术联合多参数评估肝硬化患者并发食管静脉曲张(EV)的价值。方法2018年3月~2021年3月我院收治的肝硬化患者89例,接受胃镜检查,了解EV发生情况,采用SWE技术检测脾脏杨氏模量最大值(Emax)和杨氏模量平均值(Emean),使用彩色多普勒超声检测肝脏门静脉直径(PVD)、脾脏厚径(ST)、脾脏长径(SD)和脾静脉直径(SVD),应用受试者工作特征曲线下面积(AUC)分析各参数诊断肝硬化患者并发EV的效能。结果经胃镜检查发现,本组89例肝硬化患者并发EV者53例;EV组在Child-Pugh分级、白蛋白、凝血酶原时间国际标准化比值、血小板计数和有腹水的比率等方面与非EV组比,均存在显著性差异(P<0.05);EV组Emax和Emean分别为(55.9±10.5)kPa和(38.9±9.2)kPa,显著大于非EV组【分别为(45.2±7.3)kPa和(29.3±6.7)kPa,P<0.05】,PVD、ST、SD和SVD分别为(13.6±2.1)mm、(48.0±9.4)mm、(149.1±27.1)mm和(10.1±1.9)mm,均显著大于非EV组【分别为(11.5±1.8)mm、(36.9±8.7)mm、(119.8±24.9)mm和(7.8±1.7)mm,P<0.05】;分别以Emax、Emean、PVD、ST、SD和SVD为53.2 kPa、33.6 kPa、11.9 mm、43.8 mm、136.5 mm和8.9 mm为截断点,其诊断肝硬化并发EV的AUC分别为0.84、0.83、0.73、0.80、0.67和0.82,诊断的敏感度和特异度分别为66.0%和88.9%、75.5%和77.8%、79.3%和61.1%、77.4%和72.2%、58.5%和69.4%、77.4%和80.6%。结论应用SWE技术测量脾脏Emax和Emean可用于肝硬化患者并发EV的诊断,对帮助判断病情,及时予以预防处理。

Objective The aim of this study was to explore the diagnostic efficacy of shear wave elastography(SWE)by ultrasonography in predicting esophageal varices(EV)in patients with hepatitis B cirrhosis.Methods 89 patients with hepatitis B-induced liver cirrhosis were enrolled in our hospital between March 2018 and March 2021,and all patients underwent gastroscopy to find the occurrence of EV.SWE by ultrasonography was applied to detect the spleen maximum Young’s modulus(Emax)and mean Young’s modulus(Emean).The portal vein diameter(PVD),spleen thickness diameter(ST),spleen long diameter(SD)and spleen vein diameter(SVD)were obtained by Color Doppler ultrasound.The diagnostic efficacy was evaluated by the area under receiver operating characteristic curve(AUC).Results The gastroscopy found 53 cases with EV among the 89 cirrhotics in our series;there were significant differences respect to Child-Pugh class,serum albumin,prothrombin time international normalized rati,platelet counts and ascites between patients with and without EV(P<0.05);the Emax and Emean in patients with EV were(55.9±10.5)kPa and(38.9±9.2)kPa,significantly higher than[(45.2±7.3)kPa and(29.3±6.7)kPa,respectively,P<0.05],the PVD,ST,SD and SVD were 13.6±2.1)mm,(48.0±9.4)mm,(149.1±27.1)mm and(10.1±1.9)mm,significantly higher than[(11.5±1.8)mm,(36.9±8.7)mm,(119.8±24.9)mm and(7.8±1.7)mm,respectively,P<0.05]in patients without EV;the AUCs were 0.84 and 0.83 in predicting EV in patients with liver cirrhosis as the Emax and Emean equal to 53.2 kPa and 33.6 kPa were set as the cut-off-value,with the sensitivities and specificities of 66.0%and 88.9%,and 75.5%and 77.8%.Conclusion The spleen Emax and Emean measured by SWE could be used to diagnose the EV in patients with liver cirrhosis,which needs further clinical investigations.