Objective To investigate the clinical value of acoustic radiation force impulse ( ARFI) in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group ( EV0, 16 patients) , mild varices group ( EV1, 39 patients) , moderate varices group ( EV2, 26 patients) , and severe varices group ( EV3, 35 patients) . The receiver operating characteristic ( ROC) curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2. 54 ± 0. 34 m/s for EV0 patients, 3. 05 ± 0. 34 m/s for EV1 patients, 3. 48 ± 0. 50 m/s for EV2 patients, and 3. 69 ± 0. 33 m/s for EV3 patients ( χ2= 60. 121, P < 0. 001) . The ARFI value of the spleen was positively correlated with the grade of esophageal varices ( r =0. 713, P < 0. 001) . The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0. 93, 0. 88, and 0. 83, respectively. There was no significant difference in the ARFI value of the liver between groups ( P =0. 085) , and the ARFI value of the liver was not correlated with the degree of esophageal varices ( P = 0. 245) . Conclusion The ARFI value of the spleen helps to achieve accurate quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension and holds promise for clinical application.
[1]de FRANCHIS R, BAVENO VI Faculty.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.
|
[2]CHEN YP, ZHANG Q, DAI L, et al.Is transient elastography valuable for high-risk esophageal varices prediction in patients with hepatitis-B-related cirrhosis?[J].J Gastroenterol Hepatol, 2012, 27 (3) :533-539.
|
[3]LI Q, WANG LW, GONG ZJ.Analysis of risk factors of gastrointestinal bleeding in cirrhotic patients related hepatitis B[J].Chin J Integr Tradit West Med Liver Dis, 2010, 20 (6) :338-340, 384. (in Chinese) 李卿, 王鲁文, 龚作炯.乙型肝炎肝硬化消化道出血的危险因素分析[J].中西医结合肝病杂志, 2010, 20 (6) :338-340, 384.
|
[4]NIGHTINGALE K, SOO MS, NIGHTINGALE R, et al.Acoustic radiation force impulse imaging:in vivo demonstration of clinical feasibility[J].Ultrasound Med Biol, 2002, 28 (2) :227-235.
|
[5]FAHEY BJ, HSU SJ, WOLF PD, et al.Liver ablation guidance with acoustic radiation force impulse imaging:challenges and opportunities[J].Phys Med Biol, 2006, 51 (15) :3785-3808.
|
[6] Chinese digestive disease association, Chinese liver disease Association, Chinese endoscopicology association.Consensus for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].Chin J Dig, 2008, 28 (8) :551-558. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治共识 (2008, 杭州) [J].中华消化杂志, 2008, 28 (8) :551-558.
|
[7]YANG LY.Dilemma and opportunity of surgery for portal hypertension in China[J].Chin J Dig Surg, 2016, 15 (7) :658-660. (in Chinese) 杨连粤.我国门静脉高压症外科的困境与机遇[J].中华消化外科杂志, 2016, 15 (7) :658-660.
|
[8]SHI KQ, FAN YC, PAN ZZ, et al.Transient elastography:a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease[J].Liver Int, 2013, 33 (1) :62-71.
|
[9]SPOREA I, RA爩IU I, SIRLI R, et al.Value of transient elastography for the prediction of variceal bleeding[J].World J Gastroenterol, 2011, 17 (17) :2206-2210.
|
[10]STEFANESCU H, GRIGORESCU M, LUPSOR M, et al.Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients[J].J Gastroenterol Hepatol, 2011, 26 (1) :164-170.
|
[11]ZHANG DK, CHEN M, LIU Y, et al.Comparative study of acoustic radiation force impulse imaging and transient elastography on diagnosing liver fibrosis in patients with chronic hepatitis B[J].J Clin Ultrasound in Med, 2016, 18 (1) :21-24. (in Chinese) 张大鹍, 陈敏, 刘阳, 等.声脉冲辐射力成像与瞬时弹性成像诊断慢性乙型肝炎肝纤维化的对比研究[J].临床超声医学杂志, 2016, 18 (1) :21-24.
|
[12]FRIEDRICH-RUST M, NIERHOFF J, LUPSOR M, et al.Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis:a pooled meta-analysis[J].J Viral Hepat, 2012, 19 (2) :e212-e219.
|
[13]SALZL P, REIBERGER T, FERLITSCH M, et al.Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J].Ultraschall Med, 2014, 35 (6) :528-533.
|
[14]BOTA S, SPOREA I, SIRLI R, et al.Spleen assessment by Acoustic Radiation Force Impulse Elastography (ARFI) for prediction of liver cirrhosis and portal hypertension[J].Med Ultrason, 2010, 12 (3) :213-217.
|
[15]HONG W, HAN EH, LYU ZH, et al.Feasibility study of predicting esophageal varices in cirrhosis patients with spleen shear wave[J].J Clin Ultrasound in Med, 2013, 15 (12) :827-830. (in Chinese) 洪玮, 韩鄂辉, 吕志红, 等.脾脏剪切波速预测肝硬化患者食管静脉曲张的可行性研究[J].临床超声医学杂志, 2013, 15 (12) :827-830.
|
[16]BAO MW, LI HY, DONG CF, et al.Value of shear wave velocity of spleen in predicting esophageal varices of cirrhosis[J].J Clin Ultrasound in Med, 2015, 17 (3) :181-184. (in Chinese) 包明稳, 李汉英, 董常峰, 等.脾脏剪切波速预测肝硬化合并食管胃底静脉曲张的价值[J].临床超声医学杂志, 2015, 17 (3) :181-184.
|
1. | 温芳芳,张龙,王娟. 预后营养指数、血清白蛋白对肝切除术病人术后感染风险的预测价值及护理指导意义. 全科护理. 2025(02): 236-239 . ![]() | |
2. | 魏红艳,王远珍,常丽仙,木唤,刘春云,刘立. 原发性肝癌合并腹水患者发生SBP的风险预测分析. 昆明医科大学学报. 2024(03): 133-140 . ![]() | |
3. | 魏红艳,王远珍,常丽仙,木唤,刘春云,刘立. 原发性肝癌患者并发自发性腹膜炎临床诊断模型的构建和应用. 现代肿瘤医学. 2024(19): 3718-3725 . ![]() | |
4. | 朱明强,杨大帅,熊祥云,裴俊鹏,彭阳,丁佑铭. 肝癌肝切除术后感染风险预测模型的建立与评价. 临床肝胆病杂志. 2023(01): 110-117 . ![]() | |
5. | 罗清兰,邓宇伟,曾涛. 原发性肝癌术前中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值和甲胎蛋白对预后的评估分析. 当代医学. 2022(19): 18-21 . ![]() | |
6. | 付先锋,晏燕. 肝动脉介入栓塞治疗的肝癌患者预后与血清胆碱酯酶、钠水平的关系分析. 检验医学与临床. 2022(24): 3417-3420 . ![]() | |
7. | 曾桥. 腹腔镜手术治疗肝癌的分析. 当代医学. 2021(04): 96-98 . ![]() | |
8. | 黄旦华. 多项肿瘤标志物联合检测在肝癌中的诊断效能. 医疗装备. 2021(11): 52-53 . ![]() | |
9. | 袁维,孙克伟,陈斌,朱文芳,银思涵. 56例中晚期原发性肝癌死亡患者的临床分析. 中西医结合肝病杂志. 2021(08): 707-711 . ![]() | |
10. | 马冰,白黎,赵艳,海丹丹,李花花. 原发性肝癌TACE术后发生感染性并发症的影响因素研究. 实用癌症杂志. 2021(12): 2033-2035 . ![]() | |
11. | 王益卓,刘唯佳,卢兵,黄其密,唐德奉. 原发性肝癌合并肺部感染58例临床特征分析. 中华肺部疾病杂志(电子版). 2020(01): 83-84 . ![]() | |
12. | 刘娟. 以坚强概念为基础的心理干预对原发性肝癌合并抑郁病人症状改善、心理状态及生命质量的影响. 全科护理. 2020(28): 3834-3837 . ![]() | |
13. | 叶颖剑,刘波,陈伟,李琼霞. 血清AFP阴性的肝细胞癌患者预后及分期系统分析. 临床肝胆病杂志. 2019(03): 535-541 . ![]() |