二维剪切波弹性成像评价肝脾硬度对乙型肝炎肝硬化食管静脉曲张的预测价值

王雪梅; 张瑶; 杨学平; 王玥; 王米雪

doi:10.3969/j.issn.1001-5256.2021.05.021

二维剪切波弹性成像评价肝脾硬度对乙型肝炎肝硬化食管静脉曲张的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.05.021

首都医科大学附属北京地坛医院超声科，北京 100015

基金项目:

首都医科大学附属北京地坛医院院内科研基金 (DTYM201816)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：王雪梅、杨学平负责课题设计，资料分析，撰写论文；王玥、王米雪参与收集数据；张瑶负责指导撰写文章并最后定稿。

详细信息

作者简介:
王雪梅(1981—)，女，主治医师，主要从事超声诊断与介入治疗工作

通信作者:
张瑶，zgzsy007@163.com

中图分类号: R575.2
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出版历程
- 收稿日期: 2020-10-22
- 录用日期: 2020-12-02
- 出版日期: 2021-05-20

Clinical value of two-dimensional shear wave elastography in predicting esophageal varices in patients with hepatitis B cirrhosis by evaluating liver and spleen stiffness

Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

摘要

摘要: 目的应用二维剪切波弹性成像(2D-SWE)技术测量肝脾硬度(LSM/SSM)，无创性评估乙型肝炎肝硬化患者是否存在食管静脉曲张(EV)。方法前瞻性研究2019年4月—2020年2月首都医科大学附属北京地坛医院临床诊断为乙型肝炎肝硬化的患者172例，根据胃镜结果分为两组：无EV组和EV组，比较两组患者脾脏厚径(SD)、长径(ST)、LSM及SSM值。正态分布的计量资料两组间比较采用独立样本t检验；非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。应用受试者工作特征(ROC)曲线评价LSM、SSM诊断EV的价值，并利用Z检验比较两者的诊断准确性。结果 EV组患者121例，无EV组51例，两组间ST(t=8.143，P＜0.001)、SD(t=7.363，P＜0.001)、LSM(Z=3.024，P=0.002)、SSM(t=15.142，P＜0.001)，有无腹水(χ²=22.101，P＜0.001)差异均有统计学意义。LSM诊断EV的曲线下面积(AUC)为0.646(95%CI: 0.570~0.718)，取最佳截断值13.16时，敏感度(Se)、特异度(Sp)、阳性预测值(PPV)及阴性预测值(NPV)分别为83.47%、47.06%、78.9%、54.5%;SSM诊断EV的AUC为0.951(95%CI: 0.907~0.978)，取最佳截断值38.08时，Se、Sp、PPV、NPV分别为80.99%、96.08%、98.0%、68.1%。SSM诊断准确性优于LSM(Z=6.096，P＜0.001)。结论 LSM、SSM可用于预测乙型肝炎肝硬化患者有无EV，SSM具有更高的准确性，可为临床提供准确的诊断信息。
- 弹性成像技术 /
- 食管和胃静脉曲张 /
- 肝硬度 /
- 脾硬度
Abstract: Objective To investigate the value of two-dimensional shear wave elastography (2D-SWE) in the noninvasive evaluation of the presence or absence of esophageal varices (EV) in patients with hepatitis B cirrhosis by liver stiffness measurement (LSM) and spleen stiffness measurement (SSM). Methods A total of 172 patients who were diagnosed with hepatitis B cirrhosis in Beijing Ditan Hospital, Capital Medical University, from April 2019 to February 2020 were enrolled in a prospective study, and according to the results of gastroscopy, they were divided into non-EV group and EV group. The two groups were compared in terms of spleen thickness (ST), spleen diameter (SD), LSM, and SSM. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data. The receiver operating characteristic (ROC) curve was used to investigate the value of LSM and SSM in the diagnosis of EV, and the Z test was used to compare the diagnostic accuracy of LSM and SSM. Results There were 121 patients in the EV group and 51 patients in the non-EV group. There were significant differences between the two groups in ST (t=8.143, P < 0.001), SD (t=7.363, P < 0.001), LSM (Z=3.024, P=0.002), SSM (t=15.142, P < 0.001), and presence or absence of ascites (χ²=22.101, P < 0.001). LSM had an area under the ROC curve (AUC) of 0.646 (95% confidence interval [CI]: 0.570-0.718) in the diagnosis of EV, with a sensitivity (Se) of 83.47%, a specificity (Sp) of 47.06%, a positive predictive value (PPV) of 78.9%, and a negative predictive value (NPV) of 54.5% at the optimal cut-off value of 13.16. SSM had an AUC of 0.951 (95% CI: 0.907-0.978) in the diagnosis of EV, with an Se of 80.99%, an Sp of 96.08%, a PPV of 98.0%, and an NPV of 68.1% at the optimal cut-off value of 38.08. SSM had a better diagnostic accuracy than LSM (Z=6.096, P < 0.001). Conclusion LSM and SSM can be used to predict the presence or absence of EV in patients with hepatitis B cirrhosis. SSM has a higher accuracy than LSM and can provide accurate diagnostic information for clinical practice.
- Elasticity Imaging Techniques /
- Esophageal and Gastric Varices /
- Liver Stiffness Measurement /
- Spleen Stiffness Measurement

HTML全文

图 1 2D-SWE测量乙型肝炎肝硬化患者LSM

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图 2 2D-SWE测量乙型肝炎肝硬化患者SSM

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图 3 LSM/SSM诊断EV的ROC曲线图

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表 1 EV组与无EV组患者主要临床数据比较

变量	无EV组(n=51)	有EV组(n=121)	统计值	P值
男/女(例)	32/19	90/31	χ²=2.236	0.125
年龄(岁)	52.25±12.21	48.96±10.45	t=1.795	0.074
ST(cm)	41.59±8.84	55.08±10.34	t=8.143	＜0.001
SD(cm)	129.24±27.29	169.29±34.54	t=7.363	＜0.001
LSM(kPa)	14.14(8.54~24.38)	19.94(14.50~26.90)	Z=3.024	0.002
SSM(kPa)	26.57±7.47	48.41±10.92	t=15.142	＜0.001
腹水(有/无，例)	8/43	66/55	χ²=22.101	＜0.001

下载: 导出CSV

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