二维剪切波弹性成像技术检测肝脾硬度早期识别乙肝肝硬化的临床研究

Clinical study on early recognition of hepatitis B cirrhosis by two-dimensional shear wave elastography

目的评估基于二维剪切波弹性成像技术(2D-SWE)的肝脏及脾脏弹性硬度(L/S-SWE)在肝硬化患者中应用的可行性及确定早期识别肝硬化的排除界值及确诊界值。方法共纳入574例慢性乙型肝炎(简称乙肝)患者,收集入组患者的临床特征及L-SWE和S-SWE,分析其在肝硬化组(n=311)和非肝硬化组(n=263)中的差异。评估两组中肝脾弹性操作的成功率及稳定性。采用受试者工作特征(ROC)曲线分析L-SWE、S-SWE、天冬氨酸转氨酶与血小板比值指数(APRI)单独及其联合诊断肝硬化的效能。通过分析ROC曲线,确定排除和确诊肝硬化的双重界值。结果肝硬化组和非肝硬化组血小板及APRI差异有统计学意义(均P<0.05)。2D-SWE技术可行性评估中,肝脾弹性操作成功率和稳定性均较高(成功率:97.2%vs 81.3%;稳定性:0.92 vs 0.84),且L-SWE的操作成功率及稳定性均略优于S-SWE。肝硬化组S-SWE的操作成功率高于非肝硬化组(P<0.05)。相关性分析结果显示,L-SWE、S-SWE、APRI与肝组织病理分级均呈正相关(r=0.677、0.528、0.149,均P<0.05)。L-SWE、S-SWE、APRI识别肝硬化的ROC曲线下面积分别为0.959,0.896和0.706。当L-SWE和S-SWE联合时,ROC曲线下面积为0.987,灵敏度为92.6%,特异度为96.0%。Delong检验显示L-SWE和S-SWE联合诊断与单独使用L-SWE诊断肝硬化效能等同(P>0.05)。进一步分析ROC曲线,L-SWE<9.4 kPa时肝硬化可能性小,>12.0 kPa时肝硬化可能性极大,介于9.4~12.0 kPa者可进一步行S-SWE检测;若S-SWE介于17.5~29.3 kPa者则归类为由2D-SWE难以界定是否有肝硬化,需进一步行肝穿刺等检查。结论2D-SWE技术在肝硬化的诊断中有较高的操作可行性,同时结合S-SWE,有助于提高早期无创识别肝硬化的诊断效能,使更多的患者避免不必要的肝穿刺检查。

Objective To evaluate the feasibility of using two-dimensional shear wave elastography(2D-SWE)based liver and spleen elastic hardness(L/S-SWE)in patients with liver cirrhosis,and to determine the exclusion and diagnostic thresholds for early identification of liver cirrhosis.Methods A total of 574 patients with chronic hepatitis B(hepatitis B for short)were included in this study.The clinical characteristics,L-SWE and S-SWE of the patients were collected,and the differences between cirrhosis group(n=311)and non cirrhosis group(n=263)were analyzed.The success rate and stability of liver and spleen elastic surgery were evaluated in two groups.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of L-SWE,S-SWE,aspartate aminotransferase to platelet ratio index(APRI)alone and in combination in diagnosing liver cirrhosis.By analyzing the ROC curve,the double threshold for excluding and diagnosing liver cirrhosis was determined.Results There was a statistically significant difference in platelet count and APRI between the cirrhosis group and the non cirrhosis group(all P<0.05).In the feasibility assessment of 2D-SWE technology,the success rate and stability of liver and spleen elastic operation were relatively high(success rate:97.2%vs 81.3%;stability:0.92 vs 0.84),and the success rate and stability of L-SWE operation were slightly better than S-SWE.The success rate of S-SWE operation in the cirrhosis group was higher than that in the non cirrhosis group(P<0.05).The correlation analysis results showed that L-SWE,S-SWE,APRI were positively correlated with liver tissue pathological grading(r=0.677,0.528,0.149,all P<0.05).The areas under the ROC curve for identifying liver cirrhosis using L-SWE,S-SWE,and APRI were 0.959,0.896,and 0.706,respectively.When L-SWE and S-SWE were combined,the area under the ROC curve was 0.987,the sensitivity was 92.6%,and the specificity was 96.0%.The Delong test showed that the combined diagnosis of L-SWE and S-SWE had the same diagnostic efficacy as using L-SWE alone for liver cirrhosis(P>0.05).Further analysis of the ROC curve showed that the likelihood of liver cirrhosis was low when L-SWE was less than 9.4 kPa,and high when L-SWE was greater than 12.0 kPa.Patients between 9.4 and 12.0 kPa can undergo further S-SWE testing;If the S-SWE was between 17.5 and 29.3 kPa,it was classified as 2D-SWE,which was difficult to determine whether there was liver cirrhosis,and further liver puncture and other examinations were needed.Conclusions 2D-SWE technology has high operational feasibility in the diagnosis of liver cirrhosis,and combined with S-SWE,it helps to improve the diagnostic efficiency of early non-invasive identification of liver cirrhosis,enabling more patients to avoid unnecessary liver puncture examinations.