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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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    • References(25)
  • [1]
    Chinese Society of Spleen and Portal Hypertension Surgery, Chinese Society of Surgery, Chinese Medical Association. Expert consensus on diagnosis and treatment of esophagogastric variceal bleeding in cirrhotic portal hypertension (2019 edition)[J]. Chin J Surg, 2019, 57(12): 885-892. DOI: 10.3760/cma.j.issn.0529-5815.2019.12.002.

    中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华外科杂志, 2019, 57(12): 885-892. DOI: 10.3760/cma.j.issn.0529-5815.2019.12.002.
    [2]
    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. DOI: 10.1016/j.jhep.2015.05.022.
    [3]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.

    中华医学会肝病学分会, 中华医学会消化病学分会, 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指南[J]. 临床肝胆病杂志, 2016, 32(2): 203-219. DOI: 10.3969/j.issn.1001-5256.2016.02.002.
    [4]
    BUECHTER M, KAHRAMAN A, MANKA P, et al. Spleen and liver stiffness is positively correlated with the risk of esophageal variceal bleeding[J]. Digestion, 2016, 94(3): 138-144. DOI: 10.1159/000450704.
    [5]
    PU K, SHI JH, WANG X, et al. Diagnostic accuracy of transient elastography (FibroScan) in detection of esophageal varices in patients with cirrhosis: A meta-analysis[J]. World J Gastroenterol, 2017, 23(2): 345-356. DOI: 10.3748/wjg.v23.i2.345.
    [6]
    ZHU YL, DING H, FU TT, et al. Portal hypertension in hepatitis B-related cirrhosis: Diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography[J]. Hepatol Res, 2019, 49(5): 540-549. DOI: 10.1111/hepr.13306.
    [7]
    ZHANG XY, TANG SS. Real-time shear wave elastography in quantitative measurement of tissue elasticity on normal spleens[J]. Chin J Med Imaging Technol, 2016, 32(10): 1523-1526. DOI: 10.13929/j.1003-3289.2016.10.013.

    张潇月, 唐少珊. 实时剪切波弹性成像定量评价正常脾脏组织弹性[J]. 中国医学影像技术, 2016, 32(10): 1523-1526. DOI: 10.13929/j.1003-3289.2016.10.013.
    [8]
    Panel of Elastography Assessment of Liver Fibrosis, Study Group of Interventional Ultrasound, Society of Ultrasound in Medicine of Chinese Medical Association. Guidelines for clinical application of two-dimensional shear wave elastography in assessment of liver fibrosis in chronic hepatitis B[J]. J Clin Hepatol, 2018, 34(2): 255-261. DOI: 10.3969/j.issn.1001-5256.2018.02.008.

    中华医学会超声医学分会介入超声学组弹性成像评估肝纤维化专家组. 二维剪切波弹性成像评估慢性乙型肝炎肝纤维化临床应用指南[J]. 临床肝胆病杂志, 2018, 34(2): 255-261. DOI: 10.3969/j.issn.1001-5256.2018.02.008.
    [9]
    FERRAIOLI G, TINELLI C, DAL BELLO B, et al. Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: A pilot study[J]. Hepatology, 2012, 56(6): 2125-2133. DOI: 10.1002/hep.25936.
    [10]
    GIANNINI E, BOTTA F, BORRO P, et al. Platelet count/spleen diameter ratio: Proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis[J]. Gut, 2003, 52(8): 1200-1205. DOI: 10.1136/gut.52.8.1200.
    [11]
    Committee of esophageal varicosity, Society of Digestive Endoscopy of Chinese Medical Association. Tentative guidelines for endoscopic diagnosis and treatment of varicosity and variceal bleeding in digestive tract (2009)[J]. Chin J Dig Endosc, 2010, 27(1): 1-4. DOI: 10.3760/cma.j.issn.1007-5232.2010.01.001.

    中华医学会消化内镜学分会食管胃静脉曲张学组. 消化道静脉曲张及出血的内镜诊断和治疗规范试行方案(2009年)[J]. 中华消化内镜杂志, 2010, 27(1): 1-4. DOI: 10.3760/cma.j.issn.1007-5232.2010.01.001.
    [12]
    Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [13]
    DELONG ER, DELONG DM, CLARKE-PEARSON DL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach[J]. Biometrics, 1988, 44(3): 837-845. https://pubmed.ncbi.nlm.nih.gov/3203132/
    [14]
    WANG J, ZHENG GZ. Factors related to esophageal variceal bleeding in patients with liver cirrhosis[J/CD]. Chin J Liver Dis(Electronic Edition), 2019, 11(1): 42-46. DOI: 10.3969/j.issn.1674-7380.2019.01.008.

    王娟, 郑鸽之. 肝硬化食管静脉曲张破裂出血相关因素分析[J/CD]. 中国肝脏病杂志(电子版), 2019, 11(1): 42-46. DOI: 10.3969/j.issn.1674-7380.2019.01.008.
    [15]
    ZHAO ZZ, LUO BM. The Principle and techniques of ultrasonic elastography[J]. China Med Devices Information, 2008, 14(4): 6-8. DOI: 10.3969/j.issn.1006-6586.2008.04.003.

    赵子卓, 罗葆明. 超声弹性成像基本原理及技术[J]. 中国医疗器械信息, 2008, 14(4): 6-8. DOI: 10.3969/j.issn.1006-6586.2008.04.003.
    [16]
    MERCHANTE N, RIVERO-JUÁREZ A, TÉLLEZ F, et al. Liver stiffness predicts variceal bleeding in HIV/HCV-coinfected patients with compensated cirrhosis[J]. AIDS, 2017, 31(4): 493-500. DOI: 10.1097/QAD.0000000000001358.
    [17]
    COLECCHIA A, MONTRONE L, SCAIOLI E, et al. Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis[J]. Gastroenterology, 2012, 143(3): 646-654. DOI: 10.1053/j.gastro.2012.05.035.
    [18]
    GIBⅡNO G, GARCOVICH M, AINORA ME, et al. Spleen ultrasound elastography: State of the art and future directions-a systematic review[J]. Eur Rev Med Pharmacol Sci, 2019, 23(10): 4368-4381. DOI: 10.26355/eurrev_201905_17944.
    [19]
    TSENG Y, LI F, WANG J, et al. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices[J]. J Clin Ultrasound, 2018, 46(7): 442-449. DOI: 10.1002/jcu.22635.
    [20]
    MANATSATHIT W, SAMANT H, KAPUR S, et al. Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: Systemic review and meta-analysis[J]. J Gastroenterol Hepatol, 2018, 33(10): 1696-1706. DOI: 10.1111/jgh.14271.
    [21]
    CHEN YP, HUANG LW, LIN XY, et al. Alanine aminotransferase influencing performances of routine available tests detecting hepatitis B-related cirrhosis[J]. J Viral Hepat, 2020, 27(8): 826-836. DOI: 10.1111/jvh.13293.
    [22]
    PATEL DM, NAIR S, PATEL PD. Clinical assessment of cases presented with esophageal varices and portal hypertension in a tertiary healthcare institute: An observational study[J]. Int J Contemporary Med Res, 2019, 6(5): e22-e44. DOI: 10.21276/ijcmr.2019.6.5.59.
    [23]
    XU XZ. The value of non-invasive test to predicting risk of esophageal varices in patients with hepatitis B cirrhosis[D]. Changchun: Jilin University China, 2018.

    许馨之. 无创性手段预测乙肝肝硬化食管静脉曲张发生风险的临床价值[D]. 长春: 吉林大学, 2018.
    [24]
    ELALFY H, ELSHERBINY W, ABDEL RAHMAN A, et al. Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients[J]. World J Hepatol, 2016, 8(24): 1028-1037. DOI: 10.4254/wjh.v8.i24.1028.
    [25]
    CHEN XL, CHEN TW, ZHANG XM, et al. Platelet count combined with right liver volume and spleen volume measured by magnetic resonance imaging for identifying cirrhosis and esophageal varices[J]. World J Gastroenterol, 2015, 21(35): 10184-10191. DOI: 10.3748/wjg.v21.i35.10184.
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