Peagu Răzvan, Săraru Roxana, Necula Ana, Moldoveanu Alexandru, Petrişor Ana, Fierbinţeanu-Braticevici Carmen
Gastroenterology Clinic, University Hospital, Bucharest, Romania.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Rom J Intern Med. 2019 Dec 1;57(4):334-340. doi: 10.2478/rjim-2019-0017.
Current guidelines recommend that all patients with cirrhosis undergo upper gastrointestinal endoscopy (UGE) screening for esophageal varices (EV). Unfortunately, UGE has a lot of disadvantages, consequently various non-invasive methods of diagnosing EV have been proposed. We evaluated if spleen stiffness (SS) measured by Acoustic Radiation Force Impulse (ARFI) is a viable technique in diagnosing EV.
We recruited 178 patients with cirrhosis caused by Hepatitis B and C who underwent biochemical tests, abdominal ultrasound, UGE, LS and SS measurements using ARFI elastography. Based on the endoscopic results the patients were divided in 3 groups: without EV, with small EV (<5 mm) and with large EV (>5 mm).
ARFI SS was the only non-invasive parameter associated with the presence of EV (2.7±0.30 vs. 3.4±0.52, p<0.001) and large EV (2.91±0.36 vs. 3.86±0.37, p=0.001) after multivariate logistic regression (p<0.001). ARFI SS for predicting EV showed an AUROC of 0.872 (CI 95%: 0.799-0.944), for a cut-off value of 2.89 m/s: Sensitivity (Se) 91.4% (CI 95%: 81-97%), Specificity (Sp) 67.7% (CI 95%: 51-85%). ARFI SS for diagnosing large EV (>5mm) had better results with an AUROC 0.969 (CI 95%:0.935-0.99), and for a cut-off of 3.30 m/s: Se 96.4% (CI 95%: 82-99.9%), Sp 88.5% (CI 95%: 78-95%).
SS measured using ARFI is a good method of detecting EV and is an excellent method of diagnosing large EV in patients with virus-related cirrhosis.
当前指南建议，所有肝硬化患者均应接受上消化道内镜检查（UGE）以筛查食管静脉曲张（EV）。不幸的是，UGE存在诸多缺点，因此人们提出了各种诊断EV的非侵入性方法。我们评估了通过声辐射力脉冲（ARFI）测量的脾脏硬度（SS）是否是诊断EV的可行技术。
我们招募了178例由乙型和丙型肝炎引起的肝硬化患者，这些患者接受了生化检查、腹部超声、UGE、肝脏硬度（LS）测量以及使用ARFI弹性成像进行的SS测量。根据内镜检查结果，将患者分为3组：无EV组、小EV（<5mm）组和大EV（>5mm）组。
经过多因素逻辑回归分析（p<0.001），ARFI SS是唯一与EV的存在（2.7±0.30对3.4±0.52，p<0.001）和大EV（2.91±0.36对3.86±0.37，p=0.001）相关的非侵入性参数。用于预测EV的ARFI SS的受试者工作特征曲线下面积（AUROC）为0.872（95%置信区间：0.799-0.944），截断值为2.89m/s时：灵敏度（Se）为91.4%（95%置信区间：81-97%），特异性（Sp）为67.7%（95%置信区间：51-85%）。用于诊断大EV（>5mm）时，ARFI SS的结果更好，AUROC为0.969（95%置信区间：0.935-0.99），截断值为3.30m/s时：Se为96.4%（95%置信区间：82-99.9%），Sp为88.5%（95%置信区间：78-95%）。
使用ARFI测量的SS是检测EV的良好方法，也是诊断病毒相关性肝硬化患者大EV的优秀方法。
