2D-SWE技术联合FIB-4和血清VEGF水平评估乙型肝炎肝硬化患者食管静脉曲张价值研究

Assessment of esophageal varices by 2D-SWE technology,FIB-4 and serum VEGF level in patients with hepatitis B-induced liver cirrhosis

目的探讨超声二维剪切波弹性成像(2D-SWE)技术联合肝纤维化-4因子指数(FIB-4)和血清血管内皮生长因子(VEGF)水平评估乙型肝炎肝硬化患者食管静脉曲张(EV)的价值。方法2020年6月~2023年6月我院收治的乙型肝炎肝硬化患者117例,常规行胃镜检查了解EV发生情况,采用超声2D-SWE技术检测肝硬度(LSM)和脾硬度(SSM)。根据临床检测结果计算FIB-4,采用ELISA法检测血清VEGF水平。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估各指标预测肝硬化患者EV发生的效能。结果经胃镜检查发现,本组117例乙型肝炎肝硬化患者中非EV者42例(35.9%)和发生EV者75例(64.1%);EV组LSM、SSM、FIB-4和血清VEGF水平分别为(19.4±5.4)kPa、(42.5±9.5)kPa、(4.7±1.6)和(168.6±50.4)pg/mL,显著高于非EV组【分别为(14.2±4.7)kPa、(30.9±8.6)kPa、(2.6±0.9)和(130.9±39.3)pg/mL,P<0.05】;经ROC曲线分析,LSM、SSM、FIB-4和血清VEGF水平联合评估乙型肝炎肝硬化患者EV发生(其截断点分别为16.0 kPa、38.8 kPa、3.7和142.9 pg/mL)的AUC为0.954,其灵敏度和特异度分别为92.0%和85.7%,显著优于各指标单独预测(P<0.05)。结论应用2D-SWE技术检测LSM和SSM联合FIB-4和血清VEGF水平能够帮助初步判断乙型肝炎肝硬化患者EV的发生,值得临床进一步验证。

Objective The aim of this study was to evaluate the existence of esophageal varices(EV)by two-dimensional shear wave elastography(2D-SWE)technology,fibrosis-4 factor index(FIB-4)and serum vascular endothelial growth factor(VEGF)levels in patients with hepatitis B-induced liver cirrhosis(LC).Methods 117 patients with hepatitis Binduced LC were enrolled in our hospital between June 2020 and June 2023,and they all underwent routine gastroscopy to determine the occurrence of EV.The liver stiffness measurement(LSM)and spleen stiffness measurement(SSM)were detected by 2D SWE technology.The FIB-4 was calculated based on blood biochemical results and demographic data.Serum VEGF level was assayed by ELISA.The receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)were calculated to evaluate the diagnostic efficacy of each parameter on EV happening in patients with hepatitis B-induced LC.Results The gastroscopy found EV in 42 cases(35.9%)and no EV in 75 cases(64.1%)in our 117 patients with LC;the LSM,SSM,FIB-4 score and serum VEGF level in patients with EV were(19.4±5.4)kPa,(42.5±9.5)kPa,(4.7±1.6)and(168.6±50.4)pg/mL,all significantly higher than[(14.2±4.7)kPa,(30.9±8.6)kPa,(2.6±0.9)and(130.9±39.3)pg/mL,respectively,P<0.05]in patients without EV;the ROC analysis showed that the AUC was 0.954,with the sensitivity and specificity of 92.0%and 85.7%,respectively,when the LSM,SSM,FIB-4 and serum VEGF level were combined to predict the occurrence of EV(the cut-off-value were 16.0 kPa,38.8 kPa,3.7 and 142.9 pg/mL,respectively),much superior to any parameter alone(P<0.05).Conclusion The application of 2D-SWE technology to detect LSM and SSM and their combination of FIB-4 score and serum VEGF level could predict the occurrence of EV in patients with hepatitis B-induced LC,which needs further clinical verification.