中国血吸虫病防治杂志 ›› 2020, Vol. 32 ›› Issue (4): 405-.

• 临床研究 • 上一篇    下一篇

肝脾实时剪切波弹性成像预测晚期血吸虫病患者食管胃底静脉曲张及出血风险的价值

丁炎,李绍雷,周锋盛*,吴鹏西,朱巧英   

  1. 南京医科大学附属无锡人民医院超声医学科(无锡214023)
  • 出版日期:2020-08-28 发布日期:2020-08-28
  • 作者简介:丁炎,男,博士,副主任医师。研究方向:超声诊断及介入治疗
  • 基金资助:
    江苏省血地寄防科研课题(X201818);江苏省无锡市卫计委科教强卫工程青年人才(QNRC069)

Value of shear-wave elastography of the liver and spleen for predicting the risk of esophageal-gastric varices and bleeding in patients with advanced schistosomiasis

DING Yan, LI Shao-Lei, ZHOU Feng-Sheng*, WU Peng-Xi, ZHU Qiao-Ying   

  1. Department of Medical Ultrasound, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
  • Online:2020-08-28 Published:2020-08-28

摘要: 目的 探讨实时剪切波弹性成像(SWE)用于预测晚期血吸虫病患者食管胃底静脉曲张(EGV)及食管胃底静脉曲张破裂出血(EGVB)风险的价值。方法 回顾性分析2017年1月至2020年1月在南京医科大学附属无锡人民医院临床确诊的90例晚期血吸虫病患者临床资料。以胃镜检查结果为金标准,对90例晚期血吸虫病患者进行EGV分级,根据分级结果,将患者分成无EGV组和EGV组,以及EGVB低风险和EGVB高风险组。测定并比较各组患者肝脏实时剪切波模量(L?SWE)值、脾脏实时剪切波模量(S?SWE)值,绘制ROC曲线,计算曲线下面积(AUC),评估L?SWE和S?SWE截断值对预测EGV和EGVB高风险的诊断效能。结果 90例晚期血吸虫病患者中,男性61例,女性29例;年龄62~83岁,平均(74.3 ± 8.6)岁。以胃镜为金标准,EGV 0级32例(35.5%)、1级17例(18.9%)、2级15例(16.7%)、3级26例(28.9%)。无EGV组32例(35.6%, 32/90),EGV组58例(64.4%, 58/90);EGVB高风险、低风险组分别为41例(41/90,45.6%)和49例(49/90,54.4%)。EGV组L?SWE值和S?SWE值均高于无EGV组,差异均有统计学意义(t = 5.73、7.26,P均<0.05)。L?SWE、S?SWE预测EGV的AUC分别为0.70、0.75,最佳截断值分别为16.1 kPa和22.6 kPa,敏感性为80.6%和83.9%,特异性为71.4%和78.6%。EGVB高风险组患者L?SWE值和S?SWE值高于EGVB低风险组,差异有统计学意义(t = 7.35、9.61, P均<0.05)。L?SWE、S?SWE预测EGVB高风险的AUC分别为0.68、0.71,最佳截取点分别为22.7 kPa和33.8 kPa,敏感性分别为70.4% 和73.6%,特异性分别为89.3%和93.1%。结论 SWE可用于预测晚期血吸虫病患者EGV以及EGVB风险。

关键词: 晚期血吸虫病, 实时剪切波弹性成像, 食管胃底静脉曲张, 食管胃底静脉曲张破裂出血

Abstract: Objective To assess the value of shear?wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal?gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. Methods The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non?EGV and EGV groups, and the low? and high?risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. Results The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non?EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high?risk EGV group (45.6%) and 49 cases in the low?risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non?EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut?off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high?risk EGVB groups than in the low?risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut?off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high?risk EGV, respectively. Conclusion SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.

Key words: Advanced schistosomiasis, Real?time shear?wave elastography, E sophageal?gastric varices, Bleeding esophageal and gastric varices

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