剪切波弹性成像技术在不同谷丙转氨酶水平的乙型肝炎患者胆囊疾病及脾脏大小研究中的价值

The value of shear wave elastography in the study of gallbladder disease and spleen size in hepatitis B patients with different alanine amino transferase levels

目的通过剪切波弹性成像(shear wave elastography,SWE)技术研究不同血清谷丙转氨酶(alanine transaminase,ALT)水平的乙型肝炎患者的肝弹性值与胆囊疾病及脾脏大小之间的关系。方法选取2018年12月至2022年12月于深圳市第二人民医院就诊的肝弹性值升高的166例乙型肝炎患者,根据ALT水平将患者分为ALT测值正常组(N组)107例、测值升高但不超过正常值2倍组(Ha组)34例和测值升高且大于正常值2倍组(Hb组)25例,分析各组肝弹性值对胆囊疾病患病率和脾脏大小的影响,并分析肝弹性值与脾厚径的相关性。结果①在N组、Ha组和Hb组中,性别构成比、胆囊疾病患病率与脾脏大小差异无统计学意义(P>0.05),年龄分布差异有统计学意义(P=0.010)。②N组胆囊疾病患者肝弹性值和年龄显著高于无胆囊疾病患者(P<0.001,P=0.005),校正年龄后,肝弹性值是胆囊疾病的危险因素(O R=1.167,P=0.040);N组脾大者肝弹性值显著高于无脾大者(P=0.006),肝弹性值是脾大的危险因素(O R=1.221,P=0.004)。③Hb组脾大者肝弹性值显著高于无脾大者(P=0.021),肝弹性值是脾大的危险因素(O R=1.327,P=0.026),且肝弹性值与脾厚径中等相关(r=0.580,P=0.002)。④以N组肝弹性值和胆囊疾病患病情况绘制ROC曲线,曲线下面积为0.704,最佳干预治疗阈值为7.350,对应敏感度、特异度为68.0%和66.7%。⑤以N组、Hb组肝弹性值和脾大患病情况绘制ROC曲线,曲线下面积分别为0.660、0.773,最佳干预治疗阈值分别为7.450、12.500,对应敏感度分别为61.5%、72.7%,特异度分别为67.6%、92.9%。结论ALT水平正常的乙型肝炎患者,胆囊疾病和脾脏大小与肝弹性值大小相关;ALT水平2倍于正常值的乙型肝炎患者,肝弹性值与脾厚径中度相关;对肝弹性值升高以及ALT水平较高的患者,尽早给予干预。

Objective To study the relationship between the elasticity of hepatitis B patients with different alanine transaminase(ALT),gallbladder disease and spleen size by shear wave elastography(SWE).Method Select hepatitis B patients with elevated liver elasticity who visited Shenzhen Second People's Hospital from December 2018 to December 2022,the patients were divided into normal group(N group)107 cases,high but not more than twice the normal value group(Ha group)34 cases and more than twice the normal value group(Hb group)25 cases according to the ALT level.Analyze the impact of liver elasticity values on the incidence of gallbladder disease and spleen size in each group,and analyze the correlation between liver elasticity values and spleen thickness.Result①There was no statistically significant difference in gender composition ratio,gallbladder disease incidence,and spleen size among the N,Ha,and Hb groups(P>0.05),but there was a statistically significant difference in age distribution(P=0.010).②The liver elasticity value and age of positive patients with gallbladder disease in group N were significantly higher than those of negative patients(P<0.001,P=0.005),and after adjusting for age,liver elasticity value was a risk factor for gallbladder disease(O R=1.167,P=0.040);The elasticity values of liver in group N with splenomegaly were significantly higher than those with the spleen is not swollen(P=0.006)and the elasticity value was a risk factor for splenomegaly(O R=1.221,P=0.004).③The liver elasticity value of Hb group with splenomegaly was significantly higher than that of the spleen is not swollen(P=0.021).The liver elasticity value is a risk factor for splenomegaly(O R=1.327,P=0.026),and the liver elasticity value is moderately correlated with splenic thickness(r=0.580,P=0.002).④A ROC curve was drawn based on the liver elasticity value and gallbladder disease incidence in group N,with an area under the curve of 0.704.The optimal intervention treatment threshold was 7.350,and the corresponding sensitivity and specificity were 68.0%and 66.7%.⑤The ROC curve of the subjects was drawn based on the liver elasticity value and splenomegaly incidence of the N and Hb groups.The area under the curve was 0.660 and 0.773,respectively.The optimal intervention treatment thresholds were 7.450 and 12.500,with corresponding sensitivity of 61.5%and 72.7%,and specificity of 67.6%and 92.9%,respectively.Conclusion In hepatitis B patients with normal ALT level,gallbladder disease and spleen size are related to liver elasticity;In patients with hepatitis B whose ALT level is twice the normal value,the liver elasticity value is moderately related to the thickness and diameter of the spleen.Early treatment of such patients may help reduce the incidence rate of biliary and splenic diseases.