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。
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.
作者
王雪梅
张瑶
杨学平
王玥
王米雪
WANG Xuemei;ZHANG Yao;YANG Xueping;WANG Yue;WANG Mixue(Department of Ultrasound, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第5期1081-1084,共4页
Journal of Clinical Hepatology
基金
首都医科大学附属北京地坛医院院内科研基金(DTYM201816)。
关键词
弹性成像技术
食管和胃静脉曲张
肝硬度
脾硬度
Elasticity Imaging Techniques
Esophageal and Gastric Varices
Liver Stiffness Measurement
Spleen Stiffness Measurement
