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CN 22-1108/R
Volume 37 Issue 7
Jul.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(7): 1572-1577

Value of spleen stiffness measured by two-dimensional shear wave elastography combined with platelet count/spleen diameter ratio in evaluating moderate-to-severe gastroesophageal varices in patients with hepatitis B cirrhosis

DOI: 10.3969/j.issn.1001-5256.2021.07.019
  • 1a.

    Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110000, China

  • 1b.

    Department of Clinical Epidemiology, The First Affiliated Hospital of China Medical University, Shenyang 110000, China

  • 1c.

    Department of Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang 110000, China

  • 2.

    Department of Infectious Diseases, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China

Research funding:

The National Science and Technology Major Project (2017ZX10103007-005)

  • Received Date: 2020-12-09
  • Accepted Date: 2021-01-05
  • Published Date: 2021-07-20
    Abstract
  •   Objective  To establish a noninvasive diagnostic model for moderate-to-severe gastroesophageal varices (GEV) in patients with hepatitis B cirrhosis.  Methods  The patients with hepatitis B cirrhosis who attended The First Affiliated Hospital of China Medical University from October 2017 to December 2019 were enrolled, and with the results of gastroscopy as the gold standard, the patients were divided into none-to-mild GEV group and moderate-to-severe GEV group. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data. A logistic regression analysis was used to investigate the association of moderate-to-severe GEV with spleen stiffness measured by two-dimensional shear wave elastography (2D-SWE) and platelet count (PLT)/spleen diameter ratio in patients with hepatitis B cirrhosis, and with the backward method for independent variable screening, a regression equation, i.e., a diagnostic model, was established and validated. The receiver operating characteristic (ROC) curve was plotted to investigate the diagnostic value of noninvasive examination indices including liver and spleen stiffness, PLT/spleen diameter ratio, and the above diagnostic model and obtain their cut-off values, the DeLong test was used to compare whether there is a statistical significance between the ROC curves of the above noninvasive indices. Results A total of 168 patients with hepatitis B cirrhosis were enrolled, among whom 67 were diagnosed with moderate-to-severe GEV. There were significant differences in PLT, alanine aminotransferase, albumin, white blood cell count, and international normalized ratio between the none-to-mild GEV group and the moderate-to-severe GEV group (Z=-6.508, -2.132, -2.470, -4.510, and -5.298, all P < 0.05). There were also significant differences in spleen stiffness measured by 2D-SWE, spleen diameter, and PLT/spleen diameter ratio between the two groups (Z=-7.264, -5.924, and -7.028, all P < 0.05). The PLT/spleen diameter ratio had an area under the ROC curve (AUC) of 0.821 (95% confidence interval [CI]: 0.754-0.875) at the cut-off value of ≤6.7, with a sensitivity of 83.58% and a specificity of 74.26%; spleen stiffness had an AUC of 0.831 (95%CI: 0.766-0.885) at the cut-off value of ≥34.2 kPa, with a sensitivity of 85.07% and a specificity of 73.27%; liver stiffness had an AUC of 0.557 (95%CI: 0.479-0.634) at the cut-off value of ≥10.8 kPa, with a specificity of 79.10% and a sensitivity of 40.59%. There was a significant difference in AUC between liver stiffness and spleen stiffness, as well as between liver stiffness and PLT/spleen diameter ratio (Z=4.878 and 5.536, P < 0.001). The model of Y=-0.682+0.068×spleen stiffness-0.225 (PLT/spleen diameter ratio) was established for predicting moderate-to-severe GEV in patients with hepatitis B cirrhosis, which had an AUC of 0.860 (95%CI: 0.799-0.909), a sensitivity of 79.10%, a specificity of 81.19%, and an accuracy of 79.1%.  Conclusion  The noninvasive diagnostic model based on spleen stiffness measured by 2D-SWE and PLT/spleen diameter ratio can be used to assist the judgment of moderate-to-severe GEV in patients with hepatitis B cirrhosis, with a higher accuracy than liver stiffness or spleen stiffness alone.

     

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