超声剪切波频散成像对代偿期肝硬化高风险食管胃静脉曲张的诊断价值

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

doi:10.3969/j.issn.1001-5256.2022.07.018

超声剪切波频散成像对代偿期肝硬化高风险食管胃静脉曲张的诊断价值

DOI: 10.3969/j.issn.1001-5256.2022.07.018

王佳音¹,
周洪雨^2a,
李庭红^2b,
赵蕾^2a,
徐佰国^2b,
尹伟利^2b,
王芳^2b,
梁静^2b,
经翔^2a,
向慧玲^2b, , ,

1.
天津医科大学三中心临床学院, 天津 300170
2a.
天津市第三中心医院，天津市重症疾病体外生命支持重点实验室，天津市人工细胞工程技术研究中心，天津市肝胆疾病研究所超声科，天津 300170
2b.
天津市第三中心医院，天津市重症疾病体外生命支持重点实验室，天津市人工细胞工程技术研究中心，天津市肝胆疾病研究所消化(肝病)科，天津 300170

基金项目:

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)

伦理学声明：本研究于2019年12月27日经由天津市第三中心医院伦理委员会审批，批号为IRB2019-022-02，所有患者都签订了知情同意书。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：王佳音负责数据收集，统计分析及论文写作；周洪雨、赵蕾负责对文章内容进行批判性审阅；徐佰国参与文章统计分析；李庭红、尹伟利、王芳、梁静负责数据收集，对文章内容进行批判性审阅；经翔负责本研究设计及实施研究；向慧玲负责本研究设计及论文审核。

详细信息

通信作者:
向慧玲，huilingxiang@163.com

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出版历程
- 收稿日期: 2021-10-30
- 录用日期: 2021-12-17
- 出版日期: 2022-07-20

Value of ultrasonic shear-wave dispersion imaging in diagnosis of high-risk esophageal and gastric varices in compensated cirrhosis

1.
The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China
2a.
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
2b.
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

Research funding:

Tianjin Science and Technology Major Project and Critical Disease Prevention and Control Project 2019 (19ZXDBSY00030)

More Information

Corresponding author: XIANG Huiling, huilingxiang@163.com(ORCID: 0000-0003-3678-4225)

摘要

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χ²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(χ²=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。
- 肝硬化 /
- 超声检查 /
- 弹性成像技术 /
- 食管和胃静脉曲张
Abstract: 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 (χ²=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 esophageal and gastric varices in patients with compensated liver cirrhosis (odds ratio=1.67, 95% confidence interval: 1.17-2.39, P=0.005). In the diagnosis of high-risk esophageal and gastric varices, SWD had an area under the ROC curve (AUC) of 0.786, with a specificity of 80.56% and a sensitivity of 81.82% at the optimal cut-off value of 15.35 m·s^-1·kHz^-1; SWE had an AUC of 0.596, with a specificity of 52.78% and a sensitivity of 68.18% at the optimal cut-off value of 9.25 kPa. Conclusion Liver SWD measured by Canon Aplio i800 color ultrasound is excepted to become a new noninvasive method to predict the presence of high-risk esophageal and gastric varices in patients with compensated cirrhosis, while SWE has a limited diagnostic value.
- Liver Cirrhosis /
- Ultrasonography /
- Elasticity Imaging Techniques /
- Esophageal and Gastric Varices

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图 1 四视图模型

注：包括剪切波速度图、剪切波到达时间轮廓(传播图)、超声图像、剪切波频散斜率图。

Figure 1. Quad-view mode

下载: 全尺寸图片幻灯片

图 2 肝脏SWE/SWD诊断代偿期肝硬化患者HREGV的ROC曲线

Figure 2. ROC curve of liver SWE/SWD diagnoses HREGV in patients with compensated cirrhosis

下载: 全尺寸图片幻灯片

表 1 NHREGV组与HREGV组一般资料比较

Table 1. General information of patients in NHREGV group and HREGV group

指标	总人群(n=58)	NHREGV组(n=36)	HREGV组(n=22)	统计值	P值
年龄(岁)	53.48±10.91	54.67±10.15	51.55±12.05	t=1.06	0.295
性别[例(%)]				χ²=0.91	0.340
男	35(60.34)	20(55.56)	15(68.18)
女	23(39.66)	16(44.44)	7(31.82)
病因[例(%)]				χ²=9.67	0.022
乙型肝炎	39(67.24)	29(80.56)	10(45.45)
丙型肝炎	7(12.07)	4(11.11)	3(13.64)
ALD	5(8.62)	1(2.78)	4(18.18)
其他	7(12.07)	2(5.56)	5(22.73)
CTP分级[例(%)]				χ²=1.11	0.292
A	55(94.83)	35(97.22)	20(90.91)
B	3(5.17)	1(2.78)	2(9.09)
ALT(U/L)	28.00(11.00~101.70)	30.00(11.00~89.00)	24.00(15.00~101.70)	Z=-0.34	0.728
AST(U/L)	24.0(14.0~184.2)	26.0(14.0~15.0)	29.0(15.0~184.2)	Z=-1.33	0.184
TBil(μmol/L)	18.95(7.60~80.80)	16.10(7.60~80.80)	19.80(12.00~66.60)	Z=-2.00	0.045
SWD(m·s^-1·kHz^-1)	15.17±2.45	14.31±1.86	16.59±2.66	t=-3.84	＜0.001
SWE(kPa)	9.45(4.70~34.20)	9.20(4.70~34.20)	10.45(5.80~19.00)	Z=-1.21	0.223
脾脏直径(mm)	122.62±23.53	116.82±20.68	131.85±25.27	t =-2.44	0.018
门静脉直径(mm)	12.4(8.4~23.8)	12.0(8.4~16.0)	13.0(10.0~23.8)	Z=-1.96	0.005
注：ALD，酒精性肝病。

下载: 导出CSV

表 2 代偿期肝硬化患者HREGV无创指标的logistic分析

Table 2. Logistic analysis of HREGV non-invasive indicators in patients with compensated cirrhosis

指标	单因素分析		多因素分析
指标	OR(95%CI)	P值	OR(95%CI)	P值
年龄(岁)	0.97(0.927~1.023)	0.292
性别
男	1.00
女	0.58(0.19~1.77)	0.342
病因
乙型肝炎	1.00
丙型肝炎	2.18(0.41~11.45)	0.359	0.34(0.03~3.55)	0.366
ALD	11.60(1.16~116.42)	0.037	5.65(0.41~77.50)	0.200
其他	7.25(1.21~43.44)	0.030	4.11(0.39~42.88)	0.240
CTP分级
A	1.00
B	3.50(0.30~41.07)	0.319
ALT(U/L)	1.01(0.98~1.03)	0.701
AST(U/L)	1.01(0.99~1.03)	0.229
TBil(μmol/L)	1.03(0.99~1.08)	0.174
SWE(kPa)	1.02(0.91~1.13)	0.789
SWD(m·s^-1·kHz^-1)	1.64(1.19~2.26)	0.003	1.67(1.17~2.39)	0.005
脾脏直径(mm)	1.03(1.00~1.06)	0.025	1.03(0.99~1.07)	0.101
门静脉直径(mm)	1.34(0.99~1.80)	0.057	1.18(0.82~1.71)	0.376

下载: 导出CSV

表 3 肝脏SWD/SWE诊断代偿期肝硬化患者HREGV的ROC分析

Table 3. ROC analysis of liver SWD/SWE diagnoses HREGV in patients with compensated cirrhosis

指标	AUC	95%CI	阈值	特异度(%)	敏感度(%)	阳性预测值(%)	阴性预测值(%)
SWE(kPa)	0.596	0.447~0.745	9.25	52.78	68.18	59.10	62.41
SWD(m·s^-1·kHz^-1)	0.786	0.655~0.917	15.35	80.56	81.82	80.83	81.58

下载: 导出CSV

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