Zhu Y L, Ding H, Fu T T, Xu Z T, Xue L Y, Chen S Y, Wang W P
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China.
Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2020 Jun 2;100(21):1654-1657. doi: 10.3760/cma.j.cn112137-20191029-02340.
To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis. The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson's correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. The SWE diagnostic performances of Liver (L-SWE), Spleen (S-SWE) were also evaluated. Of all 58 patients, 47 were found HVPG ≥10 mmHg, diagnosed as clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH), which patients are at increased risk of developing complications. Thirty-four patients were found HVPG≥12 mmHg, diagnosed as SPH, which patients were at increased risk of variceal bleeding. Moderate positive correlation was found between L-SWE and HVPG (0.42, 0.01), and S-SWE were significantly correlated with HVPG (0.68, 0.01), while serological models and HVPG were slightly correlated (0.36 and 0.28, all 0.01). The area under the receiver operating characteristic curves of L-SWE, S-SWE and the combination for CSPH were 0.78, 0.88 and 0.89. When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa, patients were at increased risk of developing complications. The area under the receiver operating characteristic curves for SPH were 0.68, 0.81 and 0.77 and the S-SWE had the highest specificity, so when S-SWE was>41.5 kPa, patients were at increased risk of variceal bleeding. L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.
评估二维剪切波弹性成像（2D-SWE）测量的肝脏和脾脏硬度在乙型肝炎相关性肝硬化中的诊断准确性。2017年9月至2018年4月在复旦大学附属中山医院收集了58例乙型肝炎相关性肝硬化患者的临床资料。采用Pearson相关分析评估肝脏/脾脏硬度（L-SWE和S-SWE）与肝静脉压力梯度（HVPG）之间的关系，以及与血清学模型的比较。还评估了肝脏（L-SWE）、脾脏（S-SWE）的SWE诊断性能。58例患者中，47例HVPG≥10 mmHg，诊断为临床显著性门静脉高压（CSPH）和重度门静脉高压（SPH），这些患者发生并发症的风险增加。34例患者HVPG≥12 mmHg，诊断为SPH，这些患者发生静脉曲张出血的风险增加。L-SWE与HVPG呈中度正相关（0.42，P = 0.01），S-SWE与HVPG显著相关（0.68，P = 0.01），而血清学模型与HVPG轻度相关（分别为0.36和0.28，P均= 0.01）。L-SWE、S-SWE及两者联合诊断CSPH的受试者工作特征曲线下面积分别为0.78、0.88和0.89。当L-SWE>12.86 kPa或S-SWE>35.73 kPa时，患者发生并发症的风险增加。SPH的受试者工作特征曲线下面积分别为0.68、0.81和0.77，S-SWE具有最高的特异性，因此当S-SWE>41.5 kPa时，患者发生静脉曲张出血的风险增加。L-SWE和S-SWE是评估CSPH和SPH可靠且有前景的非侵入性参数。
