基于梳状剪切波弹性成像的列线图对慢性乙型肝炎患者食管胃静脉曲张的预测价值

Predictive value of nomogram based on comb-push ultrasound shear wave elastography for gastroesophageal varices in patients with chronic hepatitis B

目的探讨梳状剪切波弹性成像(CUSE)对慢性乙型肝炎(CHB)患者食管胃静脉曲张(GOV)的预测价值,建立基于CUSE的列线图,为预测CHB患者GOV风险提供参考。方法选取2019年6月~2021年12月行CUSE检查的CHB患者138例,以食管胃十二指肠镜(EGD)结果为金标准,对临床资料进行单因素和多因素分析,筛选有意义的指标建立列线图并进行评价与比较。结果CUSE测量肝脏硬度(LS)的成功率为97.8%(135/138),根据有无GOV进行分组,门静脉主干内径、门静脉主干最大流速、脾脏长径(SBD)、LS和血小板计数(PLT)的组间差异均有统计学意义(P<0.05),其中SBD、LS和PLT是GOV的独立影响因素(P<0.05),OR(95%CI)依次为1.379(1.088,1.747)、1.307(1.025,1.668)和0.968(0.953,0.984)。包含以上3项指标的列线图预测GOV的敏感度、特异性、阳性预测值、阴性预测值和符合率分别为77.1%、87.0%、67.5%、91.6%和84.4%,ROC曲线下面积为0.907(95%CI:0.845,0.950),高于单独使用LS的0.787(95%CI:0.709,0.853),差异有统计学意义(P<0.05),校正曲线显示模型的符合度良好,一致性指数为0.907(95%CI:0.853,0.961)。结论CUSE测量LS成功率高,LS对CHB患者GOV有一定预测价值,联合其他非侵入性指标建立列线图有助于提高其预测效能,可对患者GOV情况进行初步筛查,使一部分患者避免不必要的EGD检查。

Objective To explore the value of comb-push ultrasound shear wave elastography(CUSE)in the diagnosis of gastroesophageal varices(GOV)in patients with chronic hepatitis B(CHB)and construct a CUSE-based nomogram.Methods 138 CHB patients who underwent CUSE examination from Jun 2019 to Dec 2021 were selected.The esophagogastroduodenoscopy(EGD)results were used as the gold standard,and the clinical data were analyzed using univariate and multivariate analysis to screen meaningful indicators.A nomogram was constructed,evaluated and compared.Results The success rate of measuring liver stiffness(LS)using CUSE was 97.8%(135/138).Subjects were grouped according to the GOV situation.There were statistically significant differences in portal vein diameter,maximum portal vein velocity,spleen bipolar diameter(SBD),LS and the platelet count(PLT)(P<0.05),of which SBD,LS and PLT was independent influencing factor of GOV(P<0.05),and OR(95%CI)was 1.379(1.088,1.747),1.307(1.025,1.668)and 0.968(0.953,0.984).The area under the ROC curve of the nomogram including the above three indicators was 0.907(95%CI:0.845,0.950)for GOV diagnosis,which was higher than 0.787(95%CI:0.709,0.853)of LS alone(P<0.05),and the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate was 77.1%,87.0%,67.5%,91.6%and 84.4%,respectively.The calibration curve was well-fitted,and the C-index was 0.907(95%CI:0.853,0.961).Conclusion CUSE has a high success rate in measuring LS.LS has a certain diagnostic value for GOV in CHB patients.The construction of a nomogram combined with other noninvasive indicators can help improve its diagnostic efficiency and can be used to screen patients for GOV,so that some patients may avoid unnecessary EGD examinations.