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二维剪切波弹性成像测量脾硬度联合血小板/脾直径对乙型肝炎肝硬化患者中重度食管胃静脉曲张的评估价值

余敏睿 杨杰 王进勇 周波 姜镔 邓宝成

余敏睿, 杨杰, 王进勇, 等. 二维剪切波弹性成像测量脾硬度联合血小板/脾直径对乙型肝炎肝硬化患者中重度食管胃静脉曲张的评估价值[J]. 临床肝胆病杂志, 2021, 37(7): 1572-1577. DOI: 10.3969/j.issn.1001-5256.2021.07.019
引用本文: 余敏睿, 杨杰, 王进勇, 等. 二维剪切波弹性成像测量脾硬度联合血小板/脾直径对乙型肝炎肝硬化患者中重度食管胃静脉曲张的评估价值[J]. 临床肝胆病杂志, 2021, 37(7): 1572-1577. DOI: 10.3969/j.issn.1001-5256.2021.07.019
YU MR, YANG J, WANG JY, et al. Value of spleen stiffness measured by two-dimensional shear wave elastography combined with platelet count/spleen diameter ratio in evaluating moderate-to-severe gastroesophageal varices in patients with hepatitis B cirrhosis[J]. J Clin Hepatol, 2021, 37(7): 1572-1577 DOI: 10.3969/j.issn.1001-5256.2021.07.019
Citation: YU MR, YANG J, WANG JY, et al. Value of spleen stiffness measured by two-dimensional shear wave elastography combined with platelet count/spleen diameter ratio in evaluating moderate-to-severe gastroesophageal varices in patients with hepatitis B cirrhosis[J]. J Clin Hepatol, 2021, 37(7): 1572-1577 DOI: 10.3969/j.issn.1001-5256.2021.07.019

二维剪切波弹性成像测量脾硬度联合血小板/脾直径对乙型肝炎肝硬化患者中重度食管胃静脉曲张的评估价值

DOI: 10.3969/j.issn.1001-5256.2021.07.019
基金项目: 

国家“十三五”科技重大专项 2017ZX10103007-005

详细信息
    通讯作者:

    姜镔,jiangbincmu@163.com

    邓宝成,sydengbc@163.com

  • 中图分类号: R575.2

Value of spleen stiffness measured by two-dimensional shear wave elastography combined with platelet count/spleen diameter ratio in evaluating moderate-to-severe gastroesophageal varices in patients with hepatitis B cirrhosis

Funds: 

The National Science and Technology Major Project 2017ZX10103007-005

  • 摘要:   目的  建立乙型肝炎肝硬化患者中重度食管胃静脉曲张(GEV)的无创性诊断模型。  方法  选取2017年10月—2019年12月于中国医科大学附属第一医院就诊的乙型肝炎肝硬化患者。以胃镜检查结果为金标准,分为无/轻度GEV组和中重度GEV组。不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验。采用logistic回归分析乙型肝炎肝硬化患者中重度食管胃静脉发生与二维剪切波弹性成像(2D-SWE)测量脾硬度、PLT/脾直径之间的关系,以后退法作为自变量筛选方法,建立回归方程即诊断模型并进行检验。绘制受试者工作特征曲线(ROC曲线)判断肝和脾硬度、PLT/脾直径以及诊断模型等无创性检查指标的诊断价值,得出最佳截断值,DeLong检验比较几种无创性检查指标的ROC曲线之间是否具有统计学意义。  结果  共纳入168例乙型肝炎肝硬化患者,其中有67例诊断为中重度GEV。肝硬化无/轻度和中重度GEV组PLT、ALT、Alb、WBC以及INR比较差异均有统计学意义(Z值分别为-6.508、-2.132、-2.470、-4.510、-5.298,P值均<0.05)。2D-SWE测量的脾硬度、脾脏直径以及PLT/脾脏直径在两组间差异均有统计学意义(Z值分别为-7.264、-5.924、-7.028,P值均<0.05)。PLT/脾直径ROC曲线下面积(AUC)为0.821(95%CI:0.754~0.875),截断值为≤6.7,敏感度为83.58%,特异度为74.26%。脾硬度AUC为0.831(95%CI:0.766~0.885),脾硬度截断值≥34.2 kPa,敏感度为85.07%,特异度为73.27%。肝硬度AUC为0.557(95%CI:0.479~0.634),肝硬度的截断值≥10.8 kPa,特异度为79.10%,敏感度为40.59%。肝硬度与脾硬度、PLT/脾直径对GEV诊断价值的AUC比较,差异均有统计学意义(Z值分别为4.878、5.536,P值均<0.001)。建立判断乙型肝炎肝硬化患者中重度GEV模型:Y=-0.682+0.068×脾硬度-0.225(PLT/脾直径)。诊断模型AUC为0.860(95%CI:0.799~0.909),敏感度为79.10%,特异度为81.19%,准确度为79.1%。  结论  据2D-SWE测量的脾硬度联合PLT/脾直径建立的无创性诊断模型可用于辅助判断乙型肝炎肝硬化患者中重度GEV,准确度较单独使用肝硬度或脾硬度判断中重度GEV高。

     

  • 图  1  肝硬度、脾硬度及PLT/脾直径对GEV诊断价值的ROC曲线

    注:a,PLT/脾直径的ROC曲线;b,脾硬度值的ROC曲线;c,肝硬度的ROC曲线;d,PLT/脾直径、脾硬度、肝硬度三者的ROC曲线。

    图  2  诊断模型预测概率的ROC曲线

    表  1  患者基本特征

    项目 结果
    男/女(例) 118/50
    年龄(岁) 53.42(46.17~61.06)
    实验室检查
      WBC(×109/L) 3.99(2.56~5.46)
      AST(U/L) 37.43(25.33~60.50)
      ALT(U/L) 30.71(20.14~58.50)
      Alb(g/L) 32.40(28.16~39.00)
      TBil(μmol/L) 21.65(13.00~39.95)
      DBil(μmol/L) 7.90(4.66~18.55)
      PLT(×109/L) 87.00(60.00~134.50)
      INR 1.19(1.05~1.41)
      肌酐(μmol/L) 61.00(48.00~72.14)
    GEV(例)
      无/轻 101
      中重 67
    弹性成像结果
      门静脉直径(cm) 1.47(1.29~1.65)
      肝硬度(kPa) 15.20(9.05~20.35)
      脾硬度(kPa) 34.35(22.80~40.20)
      脾直径(cm) 12.86(10.79~14.94)
    下载: 导出CSV

    表  2  无/轻度GEV与中重度GEV肝硬化患者临床特征比较

    项目 无/轻度GEV(n=101) 中重度GEV(n=67) 统计值 P
    男/女(例) 72/29 46/21 χ2=0.133 0.716
    年龄(岁) 53.00(44.50~61.00) 54.00(47.00~61.00) Z=-0.905 0.365
    实验室指标
      WBC(×109/L) 4.82(3.11~6.02) 3.19(2.02~4.04) Z=-4.510 <0.001
      AST(U/L) 38.00(25.00~77.50) 33.00(25.00~55.00) Z=-1.115 0.265
      ALT(U/L) 37.00(21.00~81.00) 29.00(18.00~42.00) Z=-2.132 0.033
      Alb(g/L) 34.90(28.75~40.50) 30.30(27.60~35.40) Z=-2.470 0.014
      TBil(μmol/L) 19.70(11.20~45.20) 23.00(15.20~35.10) Z=-1.095 0.274
      DBil(μmol/L) 7.60(3.70~20.30) 8.70(5.70~18.20) Z=-1.545 0.122
      PLT(109/L) 116.00(79.00~169.00) 64.00(51.00~83.00) Z=-6.508 <0.001
      INR 1.07(1.00~1.29) 1.30(1.17~1.61) Z=-5.298 <0.001
      肌酐(μmol/L) 61.00(49.00~74.00) 61.00(44.00~69.00) Z=-0.987 0.324
    门静脉主干(cm) 1.45(1.20~1.62) 1.50(1.39~1.66) Z=-1.367 0.172
    肝硬度(kPa) 14.00(8.45~20.20) 16.9(11.60~21.00) Z=-1.261 0.207
    脾硬度(kPa) 26.60(20.55~35.70) 39.90(35.70~43.30) Z=-7.264 <0.001
    脾直径(cm) 11.60(10.00~13.94) 14.45(12.80~16.30) Z=-5.942 <0.001
    PLT/脾直径 10.15(6.54~16.98) 4.78(2.99~6.19) Z=-7.028 <0.001
    下载: 导出CSV

    表  3  肝硬度、脾硬度及PLT/脾直径对GEV诊断价值的ROC曲线比较

    组别 AUC差异值 95%CI Z P
    PLT/脾直径vs脾硬度 0.011 -0.066~0.088 0.274 0.784
    PLT/脾直径vs肝硬度 0.263 0.157~0.369 4.878 <0.001
    脾硬度vs肝硬度 0.274 0.177~0.371 5.536 <0.001
    下载: 导出CSV

    表  4  乙型肝炎肝硬化患者中重度GEV的诊断模型

    变量 B SE Wald P OR 95%CI
    脾硬度 0.068 0.023 8.578 0.003 1.070 1.023~1.119
    PLT/脾直径 -0.225 0.061 17.282 0.000 0.775 0.687~0.874
    常量 -0.682 1.008 0.458 0.499 0.506
    下载: 导出CSV

    表  5  诊断乙型肝炎肝硬化患者中重度GEV不同参数的正确百分比

    参数 实测GEV 例数 预测GEV(例) 正确率(%)
    无/轻度 中重度
    PLT/脾直径
    无/轻度 101 80 21 79.2
    中重度 67 17 50 74.6
    脾硬度
    无/轻度 101 84 17 83.2
    中重度 67 22 45 67.2
    诊断模型
    无/轻度 101 701) 21 76.9
    中重度 67 12 55 82.1
    注:PLT/脾直径、脾硬度和诊断模型的总体正确率分别为77.4%、76.8%和79.1%。1)10例患者因数据缺失,未使用诊断模型。
    下载: 导出CSV
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  • 收稿日期:  2020-12-09
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