Portal hypertension in hepatitis B-related cirrhosis: Diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography
Portal hypertension in hepatitis B-related cirrhosis: Diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography
复制标题
乙型肝炎相关性肝硬化门脉高压：二维剪切波弹性成像对肝脏和脾脏硬度的诊断准确性
DOI：
10.1111/hepr.13306
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发表时间：
2019
影响因子：
4.2
通讯作者：
Wang Wen ping
中科院分区：
文献类型：
--
作者：
Zhu Yu li;Ding Hong;Fu Tian tian;Peng Shi yun;Chen Shi yao;Luo Jian jun;Wang Wen ping
目的评价2维横波弹性成像（SWE）测量肝脏和脾脏刚度在评估临床显著性和重度门静脉高压（分别为CSPH和SPH）中的诊断准确性。方法收集155例乙型肝炎相关肝硬化患者的临床资料及肝、脾僵硬度（分别为L‐SWE和S‐SWE）。评价L‐SWE、S‐SWE、肝刚度-脾脏直径血小板比评分（LSPS）和门静脉高压症危险评分的诊断价值。结果104例患者符合分析条件。临床显著性和重度PH分别为84例和74例。总体组、CSPH组、SPH组肝、脾僵硬度与肝静脉压梯度显著相关（rL分别为0.607、0.554、0.412，rS分别为0.665、0.566、0.467，均p < 0.05）。L‐SWE、S‐SWE、LSPS和PH风险评分的受试者工作特征曲线下面积CSPH为0.72（95%可信区间[CI]， 0.49-0.95）、0.81 （95% CI, 0.55-0.97）、0.76 （95% CI, 0.51-0.96）和0.73 (95% CI, 0.55-0.88)， SPH为0.77 （95% CI, 0.51-0.93）、0.85 （95% CI, 0.59-0.96）、0.80 （95% CI, 0.58-0.98）和0.80 （95% CI, 0.59-0.93）。L - SWE测定CSPH和SPH的最佳截断值分别为16.1 kPa（灵敏度78%，特异性72%）和23.5 kPa（灵敏度81%，特异性79%）。对于S‐SWE，最佳临界值分别为25.3 kPa（敏感性85%，特异性79%）和33.4 kPa（敏感性74%，特异性70%）。L - SWE <13.2 kPa或S - SWE <23.2 kPa可排除CSPH，而L - SWE >24.9 kPa或S - SWE >34.2 kPa可排除CSPH。结论二维SWE测量银和脾脏刚度是评估CSPH和SPH的可靠和有前途的无创参数。
AimTo assess the diagnostic accuracy of liver and spleen stiffness measured by 2‐D shear‐wave elastography (SWE) in evaluation of clinically significant and severe portal hypertension (CSPH and SPH, respectively).MethodsClinical data of 155 hepatitis B‐related cirrhosis patients and their liver and spleen stiffness (L‐SWE and S‐SWE, respectively) were collected. The diagnostic performances of L‐SWE, S‐SWE, the liver stiffness–spleen diameter to platelet ratio score (LSPS) and portal hypertension risk score were evaluated.ResultsOne hundred and four patients were eligible for analysis. Clinically significant and severe PH were detected in 84 and 74 patients, respectively. Liver and spleen stiffness were significantly correlated with hepatic venous pressure gradient in overall, CSPH, and SPH groups (rL= 0.607, 0.554, and 0.412;rS= 0.665, 0.566, and 0.467, respectively; allP< 0.05). The area under the receiver operating characteristic curves of L‐SWE, S‐SWE, LSPS, and PH risk score were 0.72 (95% confidence interval [CI], 0.49–0.95), 0.81 (95% CI, 0.55–0.97), 0.76 (95% CI, 0.51–0.96), and 0.73 (95% CI, 0.55–0.88) for CSPH, and 0.77 (95% CI, 0.51–0.93), 0.85 (95% CI, 0.59–0.96), 0.80 (95% CI, 0.58–0.98), and 0.80 (95% CI, 0.59–0.93) for SPH. The best cut‐off of L‐SWE for determining CSPH and SPH were 16.1 kPa (sensitivity, 78%; specificity, 72%) and 23.5 kPa (sensitivity, 81%; specificity, 79%). For S‐SWE, the best cut‐offs were 25.3 kPa (sensitivity, 85%; specificity, 79%) and 33.4 kPa (sensitivity, 74%; specificity, 70%). A cut‐off of L‐SWE <13.2 kPa or S‐SWE <23.2 kPa was able to rule out CSPH, whereas a cut‐off of L‐SWE >24.9 kPa or S‐SWE >34.2 kPa was able to rule in CSPH.ConclusionsLiver and spleen stiffness measured by 2‐D SWE are reliable and promising non‐invasive parameters to assess CSPH and SPH.