应用ARFI测量脾脏硬度在预测乙型和丙型肝炎病毒相关性肝硬化患者食管静脉曲张中的作用。

The role of spleen stiffness using ARFI in predicting esophageal varices in patients with Hepatitis B and C virus-related cirrhosis.

作者信息

Peagu Răzvan, Săraru Roxana, Necula Ana, Moldoveanu Alexandru, Petrişor Ana, Fierbinţeanu-Braticevici Carmen

机构信息

Gastroenterology Clinic, University Hospital, Bucharest, Romania.

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

出版信息

Rom J Intern Med. 2019 Dec 1;57(4):334-340. doi: 10.2478/rjim-2019-0017.

DOI:10.2478/rjim-2019-0017

PMID:31301679

Abstract

INTRODUCTION

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.

METHODS

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).

RESULTS

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%).

CONCLUSIONS

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.

摘要

引言

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。

方法

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。

结果

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%）。