声脉冲辐射力成像测量的肝脏和脾脏硬度与肝静脉压力梯度的相关性分析  

Correlation analysis between liver and spleen stiffness measured by acoustic radiation force impulse and hepatic venous pressure gradient

作　　者：缪成成 诸葛宇征[2] 张明[2] 张峰[2] 杨建[3] 韩浩[3] Miao Chengcheng Zhuge Yuzheng Zhang Ming Zhang Feng Yung Jian Han Hao(Medical College of Southeast University, Nanjing 210008, China)

机构地区：[1]东南大学医学院,南京210008 [2]南京大学医学院附属鼓楼医院消化科,南京210008 [3]南京大学医学院附属鼓楼医院超声诊断科,南京210008

出　　处：《中华消化杂志》2017年第1期30-34,共5页Chinese Journal of Digestion

基　　金：南京市医学科技发展重点项目（ZKX14017）

摘　　要：目的 探讨通过声脉冲辐射力成像（ARFI）测定的肝脏和脾脏硬度与肝静脉压力梯度（HVPG）的相关性，以及其诊断门静脉高压的效能。方法 纳入2014年4月至2016年3月因肝硬化而行HVPG测定的20例患者。在HVPG测定前运用ARFI测量其肝脏和脾脏硬度。分析所有患者的年龄、ALT、AST、TBil、血清白蛋白、PLT、PT、天冬氨酸转氨酶与血小板比率指数（APRI）评分、Child-Pugh评分、终末期肝病模型（MELD）评分、肝脏硬度、脾脏硬度与HVPG的相关性。统计学分析采用Pearson和Spearman相关性分析。结果 20例肝硬化患者均成功测定了肝脏和脾脏硬度，以及HVPG，肝脏硬度为（1.78±0.29） m/s，脾脏硬度为（3.37±0.44） m/s，HVPG为（16.10±5.14） mmHg（1 mmHg＝0.133 kPa）。年龄、ALT、AST、TBil、血清白蛋白、PLT、PT、APRI评分、Child-Pugh评分、MELD评分与HVPG之间均无相关性（P均〉0.05），肝脏硬度和脾脏硬度均与HVPG呈正相关（r＝0.449，P＝0.047；r＝0.487，P＝0.030）。在诊断HVPG≥12 mmHg时，肝脏硬度的AUC值为0.875，最佳临界值为1.77 m/s，其敏感度为68.6%，特异度为100.0%；脾脏硬度的AUC值为0.711，最佳临界值为3.18 m/s，其敏感度为68.8%，特异度为75.0%。在诊断HVPG≥20 mmHg时，肝脏硬度的AUC值为0.798，最佳临界值为1.85 m/s，其敏感度为100.0%，特异度为68.8%；脾脏硬度的AUC值为0.820，最佳临界值为3.23 m/s，其敏感度为100.0%，特异度为56.3%。结论 对于肝硬化患者，ARFI测定的肝脏和脾脏硬度与HVPG呈正相关，在门静脉高压的无创诊断中具有一定应用价值。Objective To investigate the correlation between liver and spleen stiffness measured by acoustic radiation force impulse （ARFI） and hepatic venous pressure gradient （HVPG）, and to evaluate its efficiency in the diagnosis of portal hypertension.Methods From April 2014 to March 2016, 20 cases underwent HVPG measurement because of liver cirrhosis were enrolled. Before HVPG measurement, liver and spleen stiffness were assessed with ARFI. The correlation between HVPG and age, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, total bilirubin, serum albumin, platelet count, prothrombin time, aspartate aminotransferase to platelet ratio index （APRI） score, Child-Pugh score, model for end-stage liver disease （MELD） score, liver stiffness and spleen stiffness were analyzed. Pearson correlation and Spearman rank correlation were performed for statistical analysis.Results HVPG, liver and spleen stiffness were successfully measured in all 20 patients. The mean liver stiffness was （1.78±0.29） m/s, the mean spleen stiffness was （3.37±0.44） m/s and HVPG was （16.10±5.14） mmHg （1 mmHg=0.133 kPa）. Age, ALT, AST, total bilirubin, serum albumin, platelet count, prothrombin time, APRI score, Child-Pugh score and MELD score were all not correlated with HVPG （all P〉0.05）. But HVPG was positively correlated with liver and spleen stiffness （r=0.449, P=0.047; r=0.487, P=0.030）. In the diagnosis of HVPG≥12 mmHg, the area under curve （AUC） of liver stiffness was 0.875, the optimal cut-off value was 1.77 m/s, the sensitivity was 68.6% and the specificity was 100.0%. In the diagnosis of HPVG≥20 mmHg, the AUC of liver stiffness was 0.798, the optimal cut off value was 1.85 m/s, the sensitivity was 100.0% and the specificity was 68.8%. The AUC of spleen stiffness was 0.820, the optimal cut-off value was 3.23 m/s, the sensitivity was 100.0 % and the specificity was 56.3%.Conclusion In patients with liver cirrhosis, liver stiffness and spleen stiffness assessed by ARFI ar

关 键 词：肝硬化 声脉冲辐射力成像 肝静脉压力梯度 无创诊断 

分 类 号：R575.2[医药卫生—消化系统]