Danish Muhammad, Ismail Hina, Tulsi Rani, Mehmood Nasir, Laeeq Syed Muddasir, Hassan Luck Nasir
Department of Gastroenterology and Hepatology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Cureus. 2021 Oct 8;13(10):e18593. doi: 10.7759/cureus.18593. eCollection 2021 Oct.
Introduction Liver cirrhosis is an advanced consequence of a long-standing liver disease that can lead to portal hypertension which subsequently can manifest as life-threatening variceal bleeding. The present study aimed to determine liver stiffness by shear wave elastography (SWE) to predict esophageal varices (EV) in patients with chronic liver diseases. Methodology A prospective observational study was performed at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi between November 2020 and July 2021. Individuals aged between 18 and 50 years, irrespective of gender, with diagnosed chronic liver disease >6 months were eligible to partake in the study. Patients with concomitant renal failure, severe ascites, severe life-threatening co-morbidities including congestive heart failure NYHA-III and IV, acute asthmatic attack, and recent myocardial infarction (MI) were excluded from the study. SWE was determined in all patients to measure liver stiffness. Esophagogastroduodenoscopy (EGD) was performed to visualize the esophageal varices. All findings were recorded. A 2 × 2 table was applied to determine the sensitivity, specificity, positive, and diagnostic accuracy for SWE by taking endoscopy as the definitive test. Results A total of 204 patients were included in the study. Mean age of 40.37 ± 15.20 years was observed. The mean liver size of patients was 12.38 ± 2.06 cm and the mean liver stiffness of patients was 19.97 ± 8.6. The sensitivity and specificity of liver elastography were 44.90% and 51.90%, respectively. Furthermore, the positive and negative predictive values were 53.00% and 99.39%, respectively. The diagnostic accuracy of the test was 51.86%. Conclusion Even though the diagnostic gold standard for the detection of varices is EGD, liver elastography provides a less invasive procedure to assess for varices in patients with cirrhotic liver disease. The present study concluded that liver elastography is a non-invasive and indirect valuable tool to predict the presence of esophageal varices with sensitivity and specificity of 44.90% and 51.90%, respectively.
引言 肝硬化是长期肝病的晚期后果，可导致门静脉高压，进而可能表现为危及生命的静脉曲张出血。本研究旨在通过剪切波弹性成像（SWE）测定肝脏硬度，以预测慢性肝病患者的食管静脉曲张（EV）。
方法 在2020年11月至2021年7月期间，于卡拉奇信德泌尿与移植研究所肝病胃肠病科进行了一项前瞻性观察研究。年龄在18至50岁之间、无论性别、确诊慢性肝病超过6个月的个体有资格参与本研究。伴有肾衰竭、严重腹水、包括纽约心脏协会III级和IV级充血性心力衰竭、急性哮喘发作和近期心肌梗死（MI）等严重危及生命的合并症的患者被排除在研究之外。对所有患者进行SWE测定以测量肝脏硬度。进行食管胃十二指肠镜检查（EGD）以观察食管静脉曲张。记录所有结果。以内镜检查作为确诊试验，应用2×2列联表来确定SWE的敏感性、特异性、阳性和诊断准确性。
结果 本研究共纳入204例患者。观察到平均年龄为40.37±15.20岁。患者的平均肝脏大小为12.38±2.06 cm，平均肝脏硬度为19.97±8.6。肝脏弹性成像的敏感性和特异性分别为44.90%和51.90%。此外，阳性和阴性预测值分别为53.00%和99.39%。该试验的诊断准确性为51.86%。
结论 尽管检测静脉曲张的诊断金标准是EGD，但肝脏弹性成像为评估肝硬化肝病患者的静脉曲张提供了一种侵入性较小的方法。本研究得出结论，肝脏弹性成像是一种无创且间接的有价值工具，用于预测食管静脉曲张的存在其敏感性和特异性分别为44.90%和51.90%。
