实时组织弹性成像评估慢性乙型肝炎患者食管静脉曲张的研究  

Evaluation of esophageal varices in patients with chronic hepatitis B by real-time tissue elastography

作　　者：刘韵 徐云 韩亮 钱艺 谭碧波 LIU Yun;XU Yun;HAN Liang;QIAN Yi;TAN Bi-bo(Department of Ultrasound,Wujiaochang Community Health Service Center,Yangpu District,Shanghai 200433,China;Department of Hepatobiliary Surgery,Jiangxi Provincial People′s Hospital,Nanchang 330006,China;Department of Ultrasound,Third Affiliated Hospital of Second Military Medical University,Shanghai 200438,China)

机构地区：[1]杨浦区五角场社区卫生服务中心超声科,上海200433 [2]江西省人民医院肝胆外科,330006 [3]解放军海军军医大学第三附属医院超声科,200438

出　　处：《肝脏》2024年第4期423-428,共6页Chinese Hepatology

摘　　要：目的评估实时弹性组织成像(RTE)诊断慢性乙型肝炎患者出现食管静脉曲张(EVs)的性能。方法回顾性分析回顾性分析2014年1月—2015年12月东方肝胆外科医院收治的127例慢性乙型肝炎患者的临床,腹部超声,RTE和上消化道内镜(EDG)等病例资料。分析LF index与不同程度EVs之间的关系。AUROC比较不同非侵入指标诊断患者出现EVs,高危EVs的性能。结果127例患者中,EDG发现55例(43.3%)有EVs,其中轻度33例(26.0%),中度11例(8.7%),重度11例(8.7%)。食管静脉曲张组患者PLT更低,γ球蛋白、APRI、FIB-4及LF index更高(P<0.001)。LF index与EVs分级呈强正相关(P<0.001,r=0.802)。PLT、γ球蛋白、APRI、FIB-4及LF index诊断EVs的AUROC值分别为0.296、0.770、0.797、0.801和0.891。LF index最佳截断值为2.71,其相应的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及诊断准确性分别为92.7%、70.8%、76.4%、90.7%、3.2、0.1及81.8%。诊断高危食管静脉曲张时,PLT、γ球蛋白、APRI、FIB-4及LF index的AUROC值分别为0.262、0.858、0.862、0.897及0.935。LF index最佳截断值为3.28,其相应的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及诊断准确性分别为86.6%、90.5%、90.3%、87.1%、9.1、0.1、88.6%。结论肝脏实时组织弹性成像所测得的LF index,对诊断慢性乙型肝炎患者静脉曲张具有很高的价值。Objective To evaluate the effectiveness of real-time elastography(RTE)in the diagnosis of esophageal varices(EVs)in patients with chronic hepatitis B.Methods We conducted a retrospective analysis of the clinical data,abdominal ultrasound,RTE and upper gastrointestinal endoscopy(EDG)results of 127 patients with chronic hepatitis B.The relationship between LF index and different grades of EVs was investigated.The AUROC was used to compare the diagnostic performance of various non-invasive markers for identifying patients with EVs and those at high-risk EVs.Results Among the 127 patients,EDG revealed EVs in 55(43.3%).Mild EVs were observed in 33(26.0%),moderate EVs in 11(8.7%),and severe EVs in 11(8.7%).Patients with EVs had lower PLT counts and higher levels ofγglobulin,APRI,FIB-4,and LF index(P<0.001).A significant positive correlation was found between the LF index and the grade of EVs(P<0.001,r=0.802).The AUROC values for PLT,γglobulin,APRI,FIB-4,and LF index in diagnosing EVs were 0.296,0.770,0.797,0.801 and 0.891,respectively.The optimal cut-off value for LF index was determined as 2.71,with corresponding sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,and diagnostic accuracy of 92.7%,70.8%,76.4%,90.7%,3.2,0.1 and 81.8%,respectively.For the diagnosis of high-risk EVs,the AUROC values of PLT,gamma globulin,APRI,FIB-4,and LF index were 0.262,0.858,0.862,0.897 and 0.935,respectively.The optimal cut-off value of LF index was 3.28,with corresponding sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and diagnostic accuracy of 86.6%,90.5%,90.3%,87.1%,9.1,0.1,and 88.6%,respectively.Conclusion Real-time liver tissue elastography’s LF index displays strong diagnostic efficacy in detecting EVs in patients with chronic hepatitis B.

关 键 词：实时组织弹性成像 肝纤维化指数 慢性乙型肝炎 食管静脉曲张 

分 类 号：R445.1[医药卫生—影像医学与核医学] R512.62[医药卫生—诊断学] R575.2[医药卫生—临床医学]