剪切波弹性成像、瞬时弹性成像联合APRI检测评估肝硬化食管胃底静脉曲张程度的价值

摘要/Abstract

摘要： 目的探讨剪切波弹性成像(SWE)、瞬时弹性成像(TE)技术联合天冬氨酸氨基转移酶与血小板比值指数(APRI)在评估肝硬化食管胃底静脉曲张(EGV)严重程度中的应用价值。方法选取2022年1月至2024年12月濮阳市安阳地区医院确诊为肝硬化并接受胃镜检查,证实存在EGV的患者128例,按内镜下EGV程度分为轻度组(n=61)与中重度组(n=67)。所有患者于内镜检查前1周内接受SWE、TE检查及血清学检测,记录肝脏弹性指标及APRI指数,分析其与EGV程度的相关性,并绘制ROC曲线评价三者联合应用对患者肝硬化中重度EGV的诊断效能。结果中重度组患者肝脏平均弹性值(肝脏Emean)[(28.03±10.15)kPa]、肝脏峰值弹性值(肝脏Emax)[(49.78±11.65)kPa]、脾脏Emean[(55.15±8.77)kPa]、脾脏Emax[(80.45±10.54)kPa]、肝脏纤维化指数(LF Index)[(3.02±0.23)]、脾脏LF Index[(3.32±0.71)]、脾脏硬度[(16.55±3.21)kPa]、APRI指数[(3.51±0.56)]水平均显著高于轻度组[分别为(20.66±5.68)kPa、(37.15±8.77)kPa、(33.46±9.41)kPa、(49.78±12.69)kPa、(2.92±0.24)、(2.91±0.88)、(11.12±2.65)kPa、(2.02±0.55),P<0.05]。Spearman相关性分析显示,上述指标与患者的肝硬化EGV程度呈正相关。ROC诊断效能分析显示,将SWE、TE指标及APRI指数中AUC值大于0.750的指标(即肝脏Emax、脾脏Emean、脾脏Emax、脾脏硬度和APRI指数)纳入联合诊断模型后,其AUC为0.930。结论超声SWE、TE技术及APRI联合应用构建的诊断模型可有效评估肝硬化患者EGV严重程度,具有较高的诊断效能,可为内镜前无创分级提供参考。

关键词: 肝硬化, 食管胃静脉曲张, 剪切波弹性成像, 瞬时弹性成像, 天冬氨酸氨基转移酶与血小板比值指数

Abstract: Objective To investigate the clinical value of shear wave elastography (SWE), transient elastography (TE), and the aspartate aminotransferase-to-platelet ratio index (APRI) in assessing the severity of esophagogastric varices (EGV) in patients with liver cirrhosis. Methods A total of 128 patients diagnosed with liver cirrhosis and confirmed to have EGV by endoscopy in Anyang District Hospital of Puyang City between January 2022 and December 2024 were enrolled in this study. Based on the finding of endoscopic examination, the patients were divided into a mild group (n=61) and a moderate-to-severe group (n=67). All patients underwent SWE, TE, and serological tests within one week prior to endoscopic examination. Liver and spleen elasticity parameters and APRI values were recorded. The correlations of them with EGV severity were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the combined model. Results The liver mean values of elasticity (liver Emean) [(28.03±10.15) kPa], liver maximum values of elasticity (liver Emax) [(49.78±11.65) kPa], spleen Emean [(55.15±8.77) kPa], spleen Emax [(80.45±10.54) kPa], liver fibrosis index (LF) Index[(3.02±0.23)], spleen LF index [(3.32±0.71)], spleen stiffness [(16.55±3.21) kPa], and APRI index [(3.51±0.56)] levels in the moderate-to-severe group were significantly higher than those of (20.66±5.68) kPa, (37.15±8.77) kPa, (33.46±9.41) kPa, (49.78±12.69) kPa, (2.92±0.24), (2.91±0.88), (11.12±2.65) kPa, (2.02±0.55),in the mild group [P<0.05]. Spearman correlation analysis showed that these indicators were positively correlated with EGV severity. ROC analysis demonstrated that a combined diagnostic model incorporating indicators with AUC>0.750 (including liver Emax, spleen Emean, spleen Emax, spleen stiffness, and APRI) yielded an AUC of 0.930. Conclusion The diagnostic model constructed using SWE, TE, and APRI can effectively assess the severity of EGV in patients with liver cirrhosis with high diagnostic performances, which may provide a noninvasive reference for pre-endoscopic stratification.

Key words: Liver cirrhosis, Esophagogastric varices, Shear wave elastography, Transient elastography, Aspartate aminotransferase-to-platelet ratio index

李文周, 郭俊贤, 鲍启德. 剪切波弹性成像、瞬时弹性成像联合APRI检测评估肝硬化食管胃底静脉曲张程度的价值[J]. 肝脏, 2026, 31(2): 195-199.

LI Wen-zhou, GUO Jun-xian, BAO Qi-de. The application of ultrasound SWE and TE techniques combined with APRI in assessing the severity of esophagogastric varices in liver cirrhosis[J]. Chinese Hepatolgy, 2026, 31(2): 195-199.

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