| 摘要: |
| 摘要目的探讨剪切波弹性成像（SWE）技术与多参数模型无创诊断HBV相关性肝细胞癌患者食管静脉曲张（EV）的临床价值。方法选取我院经病理确诊的肝细胞癌患者180例，以胃镜检查结果为标准，按有无EV及其轻重水平分为无EV者50例（EV0组）、轻度EV者69例（EV1组）、中度EV者33例（EV2组）、重度EV者28例（EV3组）。应用SWE测量其肝脏硬度、脾脏硬度；实验室检查获取天门冬氨酸氨基转移酶（AST）水平、血小板计数，并计算天门冬氨酸氨基转移酶/血小板比值指数（APRI）和血小板计数/脾脏长径比率（PSR），比较各组上述参数的差异。分析肝脏硬度、脾脏硬度、APRI、PSR与EV的相关性。绘制肝脏硬度、脾脏硬度、APRI及PSR预测不同EV程度发生的受试者工作特征(ROC)曲线，并计算其诊断效能。Spearman相关分析影响脾脏硬度值的相关因素。
结果各组脾脏硬度、APRI和PSR比较，差异均有统计学意义（均P<0.05）。脾脏硬度与EV程度呈显著正相关（r=0.656,P<0.05），肝脏硬度、APRI及PSR与EV程度均呈中等正相关（r=0.524、0.431、0.363，均P<0.05）。脾脏硬度诊断EV≥1（EV1、EV2和EV3），EV≥2（EV2和EV3），EV=3的ROC曲线下面积分别为0.854、0.815、0.821，明显高于肝脏硬度、APRI及PSR的诊断效能。Spearman相关性分析显示：脾脏硬度与总胆红素、年龄及脾脏长径值均呈正相关(r=0.190、0.329、0.464，P= 0.004、0.000、0.004），与PLT呈负相关（r=-0.455，P=0.001）。结论SWE所测脾脏硬度值结合多参数模型APRI及PSR可无创诊断HBV相关性肝细胞癌患者EV程度，具有重要的临床价值。 |
| 关键词: 弹性成像，剪切波 病毒性肝炎，乙型，慢性 肝细胞癌 食管静脉曲张 实验室检查 |
| DOI： |
| 投稿时间：2018-05-21修订日期：2019-03-26 |
| 基金项目:] 上海申康医院发展中心临床辅助科室能力建设项目(SHDC22015004) |
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| Noninvasive diagnosis of esophageal varices in patients with HBV-related hepatocellular carcinoma using shear wave elastography and multiparameter model |
| XU Cheng-chuan,GUO Jia |
| (Department of Ultrasound,Eastern Hepatobiliary Surgery Hospital Affilated to The Naval Military Medical University) |
| Abstract: |
| Objective To investigate the clinical value of shear wave elastography (SWE) and multi-parameter model in the diagnosis of esophageal varices (EV) in patients with HBV-related hepatocellular carcinoma. Methods A total of 180 patients with hepatocellular carcinoma diagnosed by pathology were enrolled. The results of gastroscopy were used as the standard. According to the presence or absence of EV and its severity, 50 patients (EV0 group) and 69 patients with mild EV were included. (EV1 Group), 33 patients with moderate EV (EV2 group) and 28 patients with severe EV (EV3 group). SWE was used to measure liver stiffness and spleen stiffness; laboratory tests were performed to obtain aspartate aminotransferase (AST) levels, platelet counts, and aspartate aminotransferase/platelet ratio index (APRI) and platelet count/ The spleen long diameter were calculated. ratio (PSR) compares the differences of the above parameters in each group. The correlation between liver stiffness, spleen stiffness, APRI, PSR and EV was analyzed. Liver stiffness, spleen stiffness, APRI and PSR were used to predict the receiver operating characteristic (ROC) curve at different EV levels, and the diagnostic efficacy was calculated. Spearman correlation analysis of factors affecting spleen stiffness values.
Results The spleen stiffness, APRI and PSR were statistically significant (P<0.05). There was a significant positive correlation between spleen stiffness and EV (r=0.656, P<0.05). There was a moderate positive correlation between liver stiffness, APRI and PSR and EV (r=0.524, 0.431, 0.363, P<0.05). Spleen stiffness diagnosis EV ≥ 1 (EV1, EV2 and EV3), EV ≥ 2 (EV2 and EV3), the area under the ROC curve of EV = 3 was 0.854, 0.815, 0.821, respectively, which was significantly higher than the diagnosis of liver stiffness, APRI and PSR. efficacy. Spearman correlation analysis showed that spleen stiffness was positively correlated with total bilirubin, age and spleen long diameter values (r=0.190, 0.329, 0.464, P= 0.004, 0.000, 0.004), and negatively correlated with PLT (r=- 0.455, P = 0.001). Conclusion The spleen stiffness value measured by SWE combined with multi-parameter model APRI and PSR can non-invasively diagnose the EV degree of HBV-related hepatocellular carcinoma patients, and has important clinical value. |
| Key words: elastography, shear wave viral hepatitis, type B, chronic hepatocellular carcinoma esophageal varices laboratory examination |
