Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, 95 Yongan Rd, 100050 Beijing China.
J Ultrasound Med. 2014 Jan;33(1):73-81. doi: 10.7863/ultra.33.1.73.
To evaluate quantitative measurement of spleen stiffness for indirect assessment of liver fibrosis in patients with chronic hepatitis B and to correlate spleen stiffness with liver stiffness using pathologic examination as a reference standard.
Sixty patients with clinically confirmed chronic hepatitis B (n = 54) and liver cirrhosis (n = 6) were enrolled. Quantitative stiffness measurements (kilopascals) were obtained from spleen and liver parenchyma with the FibroScan system (Echosens, Paris, France). Correlation analyses were performed between spleen and liver stiffness and between spleen stiffness and liver fibrosis stages. The diagnostic performance of spleen stiffness for indirect prediction of liver fibrosis was estimated by receiver operating characteristic curves.
Both spleen and liver stiffness increased as liver fibrosis progressed. Spleen stiffness values had a positive correlation with liver stiffness values in all patients (Pearson r = 0.810; P < .001). The correlation between spleen stiffness and fibrosis stages was statistically significant (Spearman r = 0.833; P < .001). The areas under the receiver operating characteristic curves for spleen stiffness were 0.902 (95% confidence interval [CI], 0.825-0.978) for stage S1 (fibrous portal expansion and limited perisinusoidal or lobular fibrosis) or higher, 0.927 (95% CI, 0.852-1.0) for S2 (periportal fibrosis and few fibrous septa but intact architecture) or higher, 0.962 (95% CI, 0.918-1.0) for S3 (numerous fibrous septa with architectural distortion but no obvious cirrhosis) or higher, and 0.983 (95% CI, 0.957-1.0) for S4 (cirrhosis) (all P < .001). The differences between the areas under the curves for spleen and liver stiffness in liver fibrosis staging were not statistically significant (P = .115-.756).
Quantitative measurement of spleen stiffness is a feasible and promising technique for estimating liver fibrosis. The overall diagnostic performance of spleen stiffness for liver fibrosis staging is comparable with that of liver stiffness.
评估慢性乙型肝炎患者脾脏硬度的定量测量，以间接评估肝纤维化，并将脾脏硬度与肝硬度相关联，以病理检查作为参考标准。
共纳入 60 例临床确诊的慢性乙型肝炎患者（n = 54）和肝硬化患者（n = 6）。使用 FibroScan 系统（Echosens，法国巴黎）获取脾脏和肝实质的定量硬度值（千帕）。对脾脏和肝脏硬度之间以及脾脏硬度与肝纤维化分期之间进行相关性分析。通过受试者工作特征曲线估计脾脏硬度对间接预测肝纤维化的诊断性能。
随着肝纤维化的进展，脾脏和肝脏的硬度均增加。所有患者的脾脏硬度值与肝脏硬度值呈正相关（Pearson r = 0.810；P <.001）。脾脏硬度与纤维化分期之间的相关性具有统计学意义（Spearman r = 0.833；P <.001）。脾脏硬度的受试者工作特征曲线下面积为 S1 期（纤维性门脉扩张和有限的窦周或小叶纤维化）或更高（0.902 [95%置信区间，0.825-0.978]），S2 期（门周纤维化和少量纤维间隔但结构完整）或更高（0.927 [95%置信区间，0.852-1.0]），S3 期（大量纤维间隔伴结构扭曲但无明显肝硬化）或更高（0.962 [95%置信区间，0.918-1.0]），S4 期（肝硬化）或更高（0.983 [95%置信区间，0.957-1.0]）（均 P <.001）。脾脏和肝脏硬度在肝纤维化分期中的曲线下面积之间的差异无统计学意义（P =.115-.756）。
脾脏硬度的定量测量是一种可行且有前途的技术，可用于估计肝纤维化。脾脏硬度用于肝纤维化分期的总体诊断性能与肝脏硬度相当。
