剪切波弹性成像检测肝脾硬度值预测肝硬化患者食管静脉曲张的价值

Value of Liver and Spleen Stiffness Measurement Using Shear Wave Elastography in Predicting Esophageal Varices in Patients with Liver Cirrhosis

目的探讨剪切波弹性成像(SWE)技术检测肝脾硬度值预测肝硬化患者食管静脉曲张(EV)的价值。方法选择南昌市第九医院肝硬化患者85例。所有患者先行胃镜检查,根据胃镜结果是否并发EV,分为无EV组(n=32)和EV组(n=53)。2组患者均行瞬时弹性成像检测肝脏硬度值(TE-LSM),比较TE-LSM;采用SWE声触诊弹性成像(STE)和声触诊弹性测量(STQ)检测STE-LSM、脾脏硬度值(SSM),比较STE-LSM、STE-SSM、STQ-SSM。采用二元Logistic回归分析肝硬化患者EV的影响因素。以胃镜检查结果为金标准绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC),分析不同弹性成像中肝脾硬度值单独及联合应用预测EV的价值。结果EV组的TE-LSM、STE-LSM、STE-SSM、STQ-SSM均高于无EV组(均P<0.001);STQ-SSM为肝硬化患者出现EV的独立危险因素(P<0.05)。TE-LSM、STE-LSM、STE-SSM、STQ-SSM的AUC分别为0.789、0.809、0.871、0.895;STE-LSM+STE-SSM、STE-LSM+STQ-SSM的AUC分别为0.902、0.932。结论应用SWE测量肝脾硬度值可有效预测肝硬化患者EV的存在,且肝硬度联合脾硬度可以提高预测肝硬化患者EV的诊断效能。

Objective To investigate the value of liver and spleen stiffness measurement using shear wave elastography(SWE)in predicting esophageal varices(EV)in patients with liver cirrhosis.Methods A total of 85 patients with liver cirrhosis were selected from the Ninth Hospital of Nanchang and underwent gastroscopy.According the presence of EV,these patients were divided into non-EV group(n=32)and EV group(n=53).Liver stiffness measurement(LSM)was performed using transient elastography(TE).Sound touch elastography(STE)and sound touch quantification(STQ)were carried out for LSM and spleen stiffness measurement(SSM),respectively.The results of TE-LSM,STE-LSM,STE-SSM and STQ-SSM were compared between the two groups.The factors influencing EV in cirrhotic patients were analyzed by binary Logistic regression.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was calculated using gastroscopy as the gold standard.The diagnostic values of liver and spleen stiffness measured by different elastic imaging techniques were analyzed.Results The values of TE-LSM,STE-LSM,STE-SSM and STQ-SSM in EV group were higher than those in non-EV group(P<0.001).STQ-SSM was an independent risk factor for EV in patients with cirrhosis(P<0.05).The AUCs of TE-LSM,STE-LSM,STE-SSM and STQ-SSM were 0.789,0.809,0.871 and 0.895,respectively.The AUCs of STE-LSM+STE-SSM and STE-LSM+STQ-SSM were 0.902 and 0.932,respectively.Conclusion Liver and spleen stiffness measurement using SWE can effectively predict the presence of EV,and the combination of LSM and SSM can improve the diagnostic efficiency in patients with liver cirrhosis.