声脉冲辐射力成像技术测量的肝脏硬度对肝硬化门静脉高压的诊断价值

王曦旋; 丁量子; 程洋; 韩浩; 杨建; 肖江强; 王轶; 张明; 张峰; 诸葛宇征

doi:10.3969/j.issn.1001-5256.2022.11.010

声脉冲辐射力成像技术测量的肝脏硬度对肝硬化门静脉高压的诊断价值

DOI: 10.3969/j.issn.1001-5256.2022.11.010

王曦旋¹,
丁量子^2a,
程洋^2a,
韩浩^2b,
杨建^2b,
肖江强^2a,
王轶^2a,
张明^2a,
张峰^2a, , ,,
诸葛宇征^1, , ,

1.
东南大学医学院，南京 210000
2a.
南京大学医学院附属鼓楼医院消化内科，南京 210000
2b.
南京大学医学院附属鼓楼医院超声诊断科，南京 210000

基金项目:

国家自然科学基金 (81900552)

伦理学声明：本研究方案于2019年12月25日经由南京大学医学院附属鼓楼医院伦理委员会审批，批号：2019-265-01，所纳入患者均签署知情同意书。

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：王曦旋、程洋、丁量子负责数据收集；张峰、张明、肖江强、王轶、韩浩、杨建提供相关技术支持；王曦旋进行数据整理、统计学分析并撰写论文；诸葛宇征、张峰负责文章的构思与设计，指导撰写文章并最后定稿。

详细信息

通信作者:
张峰，fzdndx@126.com

诸葛宇征，yuzheng9111963@aliyun.com

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出版历程
- 收稿日期: 2022-04-07
- 录用日期: 2022-05-16
- 出版日期: 2022-11-20

Value of liver stiffness measured by acoustic radiation force impulse in diagnosis of cirrhotic portal hypertension

Xixuan WANG¹,
Liangzi DING^2a,
Yang CHENG^2a,
Hao HAN^2b,
Jian YANG^2b,
Jiangqiang XIAO^2a,
Yi WANG^2a,
Ming ZHANG^2a,
Feng ZHANG^{2a
, ,
,},
Yuzheng ZHUGE^{1
, ,
,}

1.
Medical College of Southeast University, Nanjing 210000, China
2a.
Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210000, China
2b.
Department of Ultrasonic Diagnosis, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210000, China

Research funding:

National Natural Science Foundation of China (81900552)

More Information

Corresponding author: ZHANG Feng, fzdndx@126.com(ORCID: 0000-0002-3653-5977); ZHUGE Yuzheng, yuzheng9111963@aliyun.com (ORCID: 0000-0002-3829-5831)

摘要

摘要: 目的评估肝脏硬度(LS)无创预测失代偿期肝硬化患者肝静脉压力梯度(HVPG)的准确性，探讨LS对失代偿期肝硬化的诊断价值。方法回顾性分析2013年4月—2021年6月于南京鼓楼医院消化内科同时接受HVPG测定及声脉冲辐射力成像技术(ARFI)测定LS的88例病毒性肝炎肝硬化失代偿期或酒精性肝硬化失代偿期患者的临床资料，根据HVPG值将患者分为严重门静脉高压(SPH)组(HVPG≥20 mmHg，n=24)和非SPH组(HVPG＜20 mmHg，n=64)，比较两组间LS、脾脏硬度、门静脉流速及相关生化指标差异。计量资料两组间比较采用t检验或Mann-Whitney U秩和检验；计数资料两组间比较采用χ²检验。不同无创指标与HVPG的相关性采用Pearson相关分析。采用Logistic回归分析不同无创检测指标与SPH发生风险之间的关系。绘制不同无创指标预测HVPG≥20 mmHg发生的受试者工作特征曲线并计算曲线下面积(AUC)、敏感度、特异度、最大约登指数及对应的临界值，以评估各指标对SPH的预测价值。结果 88例患者中病毒性肝炎相关肝硬化失代偿期76例，酒精性肝硬化失代偿期12例。SPH组与非SPH组患者的年龄、性别、白细胞计数、血红蛋白、血小板计数、凝血酶原时间、谷丙转氨酶、谷草转氨酶、白蛋白、血钠、肌酐、Child-Pugh肝功能分级、脾脏硬度等比较，差异均无统计学意义(P值均＞0.05)；两组间LS比较差异有统计学意义(t=-3.970，P＜0.01)。相关分析结果显示HVPG与LS呈正相关(r=0.458，P＜0.001)。Logistic回归分析结果显示，LS为SPH发生的危险因素(OR=3.941，95%CI：1.245~12.476，P=0.020)。受试者工作特征曲线结果显示，LS预测SPH发生的AUC为0.751，最佳临界值为2.295 m/s，敏感度为54.17%，特异度为90.63%。结论在失代偿期肝硬化患者中，ARFI测得的LS与HVPG相关，对肝硬化失代偿期HVPG≥20 mmHg的无创诊断具有一定价值。
- 肝硬化 /
- 高血压, 门静脉 /
- 肝脏硬度 /
- 诊断
Abstract: Objective To investigate the accuracy of liver stiffness (LS) as a noninvasive index in predicting hepatic venous pressure gradient (HVPG) in patients with decompensated liver cirrhosis and the value of LS in the diagnosis of decompensated liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 88 patients with decompensated cirrhosis due to viral hepatitis or decompensated alcoholic cirrhosis who received both HVPG measurement and LS measurement by acoustic radiation force impulse (ARFI) in Department of Gastroenterology, Nanjing Drum Tower Hospital, from April 2013 to June 2021, and according to HVPG, the patients were divided into serious portal hypertension (SPH) (HVPG≥20 mmHg) group with 24 patients and non-SPH (HVPG < 20 mmHg) group with 64 patients. The two groups were compared in terms of LS, spleen stiffness, portal vein velocity, and related biochemical parameters. The t-test or the Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of different noninvasive indices with HVPG, and a Logistic regression analysis was used to investigate the association of different noninvasive indices with the risk of SPH. Receiver operating characteristic (ROC) curves were plotted for different noninvasive indices in predicting HVPG≥20 mmHg, and the area under the ROC curve (AUC), sensitivity, specificity, maximum Youden index, and corresponding cut-off value were calculated to investigate the value of each index in predicting SPH. Results Among the 88 patients, 76 had decompensated cirrhosis due to viral hepatitis and 12 had decompensated alcoholic cirrhosis. There were no significant differences between the SPH group and the non-SPH group in age, sex, white blood cell count, hemoglobin, platelet count, prothrombin time, alanine aminotransferase, aspartate aminotransferase, albumin, serum sodium, creatinine, Child-Pugh class, and spleen stiffness, while there was a significant difference in LS between the two groups (t=-3.970, P < 0.01). The correlation analysis showed that HVPG was positively correlated with LS (r=0.458, P < 0.001). The Logistic regression analysis showed that LS was a risk factor for SPH (odds ratio=3.941, 95% confidence interval: 1.245-12.476, P=0.020). The ROC curve analysis showed that LS had an AUC of 0.751 in predicting the onset of SPH, with a sensitivity of 54.17% and a specificity of 90.63% at the optimal cut-off value of 2.295 m/s. Conclusion In patients with decompensated cirrhosis, LS measured by ARFI is correlated with HVPG and has a certain value in the non-invasive diagnosis of decompensated cirrhosis with HVPG≥20 mmHg.
- Liver Cirrhosis /
- Hypertension, Portal /
- Liver Stiffness /
- Diagnosis

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图 1 不同无创指标预测SPH发生风险的ROC曲线

Figure 1. ROC curve of different non-invasive index to predict the risk of SPH

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表 1 受试者基线资料

Table 1. Baseline of the patients included

指标	所有患者(n=88)	非SPH组(n=64)	SPH组(n=24)	统计值	P值
男/女(例)	65/23	48/16	17/7	χ²=0.157	0.79
年龄(岁)	53.93±11.39	54.35±12.08	53.54±9.68	t=0.132	0.90
病因(病毒性/酒精性，例)	76/12	56/8	20/4	χ²=0.257	0.73
肝右叶斜径(cm)	12.20±1.48	12.56±1.28	12.57±1.66	t=-1.245	0.22
内镜下静脉曲张程度(轻/中/重，例)	4/19/65	3/14/47	1/5/18	χ²=0.025	0.99
白细胞计数(×10⁹/L)	2.25(1.70~3.30)	1.90(1.55~3.30)	2.50(2.05~3.20)	Z=-1.918	0.06
血红蛋白(g/L)	86.64±26.66	82.35±25.97	86.64±26.66	t=0.124	0.90
血小板计数(×10⁹/L)	59.49±33.65	60.10±28.95	57.35±30.83	t=0.367	0.72
凝血酶原时间(s)	14.89±2.74	14.35±1.64	15.90±3.10	t=-1.772	0.08
国际标准化比值	1.31±0.20	1.25±0.15	1.39±0.26	t=-1.525	0.07
谷丙转氨酶(U/L)	22.75(16.40~29.40)	24.75(15.90~29.00)	18.75(15.85~29.40)	Z=-0.932	0.35
谷草转氨酶(U/L)	26.75(21.25~35.55)	26.80(22.35~36.25)	23.15(20.10~31.50)	Z=-1.466	0.14
总胆红素(μmol/L)	16.90(11.00~22.35)	15.85(10.10~20.10)	18.70(13.10~31.70)	Z=-1.743	0.08
白蛋白(g/L)	35.43±4.77	36.43±4.45	33.96±5.31	t=1.155	0.25
血肌酐(μmol/L)	67.14±19.23	64.15±14.74	64.29±21.46	t=0.787	0.43
血钠(mmol/L)	141.20±2.60	141.16±3.13	141.23±2.84	t=-0.137	0.89
腹水(有/无，例)	30/58	25/39	5/19	χ²=2.581	0.13
Child-Pugh评分	6.85±1.32	6.40±1.05	7.25±1.29	t=-1.982	0.05
Child-Pugh分级(A/B/C，例)	37/48/3	31/32/1	6/16/2	χ²=5.517	0.06

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表 2 SPH组和非SPH组不同无创测定指标的比较

Table 2. The comparison of different noninvasive indexes between SPH group and non-SPH group

指标	所有患者(n=88)	非SPH组(n=64)	SPH组(n=24)	t值	P值
LS(m/s)	2.00±0.43	1.88±0.34	2.33±0.50	-3.970	＜0.01
SS(m/s)	3.48±0.53	3.46±0.56	3.54±0.46	-0.612	0.54
PVF(m/s)	27.56±9.53	27.65±9.59	27.33±9.58	0.139	0.89
SVD(cm)	1.19±0.30	1.18±0.30	1.22±0.30	-0.430	0.67

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表 3 SPH发生风险的Logistic回归分析

Table 3. Logistic regression analysis of SPH risk

无创指标	OR	95%CI	P值
LS	3.941	1.245~12.476	0.020
SS	0.840	0.281~2.507	0.754
PVF	0.542	0.192~1.527	0.246
SVD	1.452	0.497~4.241	0.496
Child-Pugh分级
B级	0.184	0.011~3.192	0.245
C级	0.402	0.027~5.948	0.507
注：LS≤1.925 m/s赋值为0，LS＞1.925 m/s赋值为1；SS≤3.50 m/s赋值为0，SS＞3.50 m/s赋值为1；PVF≤25.85 m/s赋值为0，PVF＞25.85 m/s赋值为1；SVD≤1.12 cm赋值为0，SVD＞1.12 cm赋值为1；Child-Pugh分级以Child-Pugh A级为参考。

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