摘要
目的探讨佳能二维超声剪切波弹性成像(SWE)及频散成像(SWD)在诊断代偿期肝硬化高风险食管胃静脉曲张中的临床价值。方法选取2020年2月—2021年2月就诊于天津市第三中心医院接受电子胃镜检查的各种病因代偿期肝硬化患者58例,采用佳能Aplio i800彩色超声仪同期检查肝脏SWE及SWD。以胃镜结果将患者分为高风险食管胃静脉曲张(HREGV)组(n=22)及非高风险食管胃静脉曲张(NHREGV)组(n=36)。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非参数检验。计数资料两组间比较采用χ^(2)检验。采用多因素logistic回归分析筛选预测肝硬化高风险食管胃静脉曲张的无创指标。采用受试者工作特征曲线分析肝脏SWD及SWE对高风险食管静脉曲张的临床诊断价值。结果HREGV组与NHREGV组相比,SWD(t=-3.84,P<0.001)、病因(χ^(2)=9.67,P=0.022)、TBil(Z=-2.00,P=0.045)脾脏直径(t=-2.44,P=0.018)、门静脉直径(Z=-1.96,P=0.005)差异均有统计学意义。代偿期肝硬化患者肝脏SWD平均(15.17±2.45)m·s^(-1)·kHz^(-1),其中HREGV组肝脏SWD为(16.59±2.66)m·s^(-1)·kHz^(-1),显著高于NHREGV组的(14.31±1.86)m·s^(-1)·kHz^(-1)(t=-3.84,P<0.001);HREGV组与NHREGV组的SWE差异无统计学意义(Z=-1.21,P=0.223)。SWD为代偿期肝硬化患者发生HREGV的独立危险因素(OR=1.67,95%CI:1.17~2.39,P=0.005)。SWD诊断HREGV的曲线下面积(AUC)为0.786,最佳临界值为15.35 m·s^(-1)·kHz^(-1),特异度80.56%,敏感度81.82%;SWE诊断HREGV的AUC为0.596,特异度52.78%,敏感度68.18%,最佳临界值为9.25 kPa。结论佳能Aplio i800彩色超声测定的SWD有望作为一种新的无创检测方法,在一定程度上预测代偿期肝硬化患者HREGV的存在,SWE则诊断价值有限。
Objective To investigate the clinical value of Canon two-dimensional ultrasound shear wave elastography(SWE)and shear wave dispersion(SWD)in the diagnosis of high-risk esophageal and gastric varices in compensated cirrhosis.Methods A total of 58 patients with compensated cirrhosis of various etiologies who received electronic gastroscopy in Tianjin Third Central Hospital from February 2020 to February 2021,and Canon Aplio i800 color ultrasound instrument was used to perform SWE and SWD of the liver.According to the results of gastroscopy,the patients were divided into high-risk esophageal and gastric varices group(HREGV group)with 22 patients and non-high-risk esophageal and gastric varices group(NHREGV group)with 36 patients.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the non-parametric 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 between two groups.A multivariate logistic regression analysis was used to analyze and screen out the noninvasive indicators for predicting high-risk esophageal and gastric varices,and the receiver operating characteristic(ROC)curve was used to evaluate the clinical value of liver SWD and SWE in the diagnosis of high-risk esophageal and gastric varices.Results There were significant differences between the HREGV group and the NHREGV group in SWD(t=-3.84,P<0.001),etiology(χ^(2)=9.67,P=0.022),total bilirubin(Z=-2.00,P=0.045),spleen diameter(t=-2.44,P=0.018),and portal vein diameter(Z=-1.96,P=0.005).The patients with compensated cirrhosis had a mean liver SWD of 15.17±2.45 m·s^(-1)·kHz^(-1),and the HREGV group had a significantly higher liver SWD than the NHREGV group(16.59±2.66 m·s^(-1)·kHz^(-1) vs 14.31±1.86 m·s^(-1)·kHz^(-1),t=-3.84,P<0.001),while there was no significant difference in SWE between the two groups(Z=-1.21,P=0.223).SWD was an independent risk factor for high-risk es
作者
王佳音
周洪雨
李庭红
赵蕾
徐佰国
尹伟利
王芳
梁静
经翔
向慧玲
WANG Jiayin;ZHOU Hongyu;LI Tinghong;ZHAO Lei;XU Baiguo;YIN Weili;WANG Fang;LIANG Jing;JING Xiang;XIANG Huiling(The Third Central Clinical College of Tianjin Medical University,Tianjin 300170,China;Department of Ultrasound,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Hepatology and Gastroenterology,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2022年第7期1554-1560,共7页
Journal of Clinical Hepatology
基金
天津2019科技重大专项与工程重大疾病防治科技重大专项(19ZXDBSY00030)。
关键词
肝硬化
超声检查
弹性成像技术
食管和胃静脉曲张
Liver Cirrhosis
Ultrasonography
Elasticity Imaging Techniques
Esophageal and Gastric Varices
