二维剪切波弹性成像对原发性胆汁性胆管炎食管静脉曲张的预测

摘要/Abstract

摘要： 目的探讨二维剪切波弹性成像(2D-SWE)对原发性胆汁性胆管炎(PBC)患者食管静脉曲张(EV)的预测价值。方法选择2014年1月—2021年12月期间三台县人民医院诊治的PBC患者114例(男22例,女92例),年龄54(48,63)岁。PBC诊断符合要求。根据指南分级标准,曲张静脉>5 mm者,破裂出血风险高,定义为高危EV组;<5 mm及无静脉曲张者为低危EV组,比较两组资料并分析肝脏硬度值(LSM)对高危EV的诊断效能。结果 114例PBC患者中高危、低危EV组分别为41例、73例,比较资料可知,高危、低危EV组年龄为60(52,66)岁、53(47,60)岁,差异具有统计学意义(P<0.05);高危EV组PLT、Alb、ALT及PT分别为77(50,104)×10⁹/L、38.0(34.4,41.2)g/L、39(24,65)U/L及12.4(11.4,13.5)s,与低危EV组[142(91,180)×10⁹/L、44.4(41.2,46.8)g/L、47(30,94)U/L及11.0(10.6,12.0)s]相比,差异具有统计学意义(P<0.05);高危EV组APRI、FIB-4及LSM分别为1.8(1.3,2.5)、7.2(4.5,10.2)及17.2(13.1,22.5)kPa,与低危EV组[1.1(0.7,1.7)、3.0(1.6,5.5)及9.3(7.2,12.1)kPa]相比,差异具有统计学意义(P<0.05)。114例PBC患者APRI、FIB-4及LSM分别为1.3(0.7,2.5)、4.1(1.6,9.8)及13.2(7.2,21.6)kPa,Pearson相关性分析提示,它们与PBC患者EV程度分别呈低度、中度及高度正相关(r=0.68、0.54、0.38,P<0.05)。APRI诊断高危EV时AUC值、截断点、敏感度及特异度分别为0.69、1.4、87.8%(36/41)及42.5%(31/73);FIB-4诊断时AUC值、截断点、敏感度及特异度分别为0.72、4.6、80.5%(33/41)及63.0%(46/73);LSM诊断时AUC值、截断点、敏感度及特异度分别为0.87、13.2 kPa、90.2%(37/41)及75.3%(55/73)。在诊断高危EV时,2D-SWE检测LSM诊断AUC值均显著高于APRI及FIB-4(P<0.05)。结论 2D-SWE检测LSM可以有效预测PBC患者中重度EV的发生。

关键词: 原发性胆汁性胆管炎, 二维剪切波弹性成像, 食管静脉曲张, 肝脏硬度值, 诊断效能

Abstract: Objective To investigate the predictive value of two-dimensional shear wave elastography (2D-SWE) for esophageal varices (EV) in patients with primary biliary cholangitis (PBC).Methods A total of 114 PBC patients (22 males and 92 females) admitted to our hospital from January 2014 to December 2021 were selected, aged 54 (48,63) years. PBC diagnosis meets the requirements. According to the guideline grading criteria, those with varicose veins >5 mm had a high risk of rupture and bleeding and were defined as high-risk EV group; those with <5 mm and no varicose veins were defined as low-risk EV group, comparing the data of the two groups and analyzing the diagnostic efficacy of liver stiffness measurement (LSM) on high-risk EV.Results There were 41 cases in the high-risk and 73 cases in the low-risk EV groups respectively. According to the comparative data, the ages of high-risk and low-risk EV groups were 60 (52, 66) years and 53 (47, 60) years, and the difference was statistically significant (P<0.05). The platelet (PLT), albumin (Alb), alanine aminotransferase (ALT) and prothrombin time (PT) in the high-risk EV group were 77 (50, 104) ×10⁹/L, 38.0 (34.4, 41.2) g/L, 39 (24, 65) U/L and 12.4 (11.4, 13.5) s, which were significantly higher than those in the low-risk EV group [142 (91, 180) ×10⁹/L, 44.4 (41.2, 46.8) g/L, 47 (30, 94) U/L and 11.0 (10.6, 12.0) s, P<0.05]. The Aspartate aminotransferase/platelet ratio index (APRI), fibrosis-4 index (FIB-4) and LSM of high-risk EV group were 1.8 (1.3, 2.5), 7.2 (4.5, 10.2) and 17.2 (13.1, 22.5) kPa, which were higher than those of low-risk EV group [1.1 (0.7, 1.7), 3.0 (1.6, 5.5) and 9.3(7.2, 12.1) kPa, P<0.05]. The value of APRI, FIB-4 and LSM of 14 PBC patients were 1.3 (0.7, 2.5), 4.1 (1.6, 9.8) and 13.2 (7.2, 21.6) kPa, respectively. Pearson correlation analysis showed that they were positively correlated with the EV degree of PBC patients (r=0.68, 0.54, and 0.38, respectively). The area under the curve (AUC) value, cutoff point, sensitivity and specificity of APRI, FIB-4 and LSM in diagnosing high-risk EV were [0.69, 1.4, 87.8% (36/41) and 42.5% (31/73)], [0.72, 4.6, 80.5% (33/41) and 63.0% (46/73)] and [0.87,13.2 kPa, 90.2% (37/41) and 75.3% (55/73)]. In the diagnosis of high-risk EV, the AUC values of LSM detected by 2D-SWE were significantly higher than those of APRI and FIB-4 (P<0.05).Conclusion 2D-SWE detection of LSM can effectively predict the occurrence of moderate to severe EV in PBC patients.

Key words: Primary biliary cholangitis, Two-dimensional shear wave elastic imaging, Esophageal varices, Liver stiffness measurement, Diagnostic efficacy

龚丽, 张云江. 二维剪切波弹性成像对原发性胆汁性胆管炎食管静脉曲张的预测[J]. 肝脏, 2023, 28(5): 541-543.

GONG Li, ZHANG Yun-jiang. Prediction value of esophageal varices in patients with primary biliary cholangitis by two-dimensional shear wave elastography[J]. Chinese Hepatolgy, 2023, 28(5): 541-543.

参考文献

[1] Patanwala I, McMeekin P, Walters R, et al. A validated clinical tool for the prediction of varices in PBC: the Newcastle Varices in PBC Score. J Hepatol, 2013, 59(2):327-335.
[2] Liu Y, Tian S, Jia G, et al. Symptoms burden and health-related quality of life in Chinese patients with primary biliary cholangitis. J Clin Transl Hepatol, 2021, 9(6):860-867.
[3] de Franchis R; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3):743-752.
[4] Hirschfield GM, Dyson JK, Alexander GJM, et al. The British Society of Gastroenterology/ UK-PBC primary biliary cholangitis treatment and management guidelines. Gut, 2018, 67(9):1568-1594.
[5] Gao Y, Zheng J, Liang P, et al. Liver fibrosis with two-dimensional US shear-wave elastography in participants with chronic hepatitis B: A prospective multicenter study. Radiology, 2018, 289(2):407-415.
[6] Elkrief L, Rautou PE, Ronot M, et al. Prospective comparison of spleen and liver stiffness by using shear-wave and transient elastography for detection of portal hypertension in cirrhosis. Radiology, 2015, 275(2):589-598.
[7] Furlan A, Tublin ME, Yu L, et al. Comparison of 2D shear wave elastography, transient elastography, and MR elastography for the diagnosis of fibrosis in patients with nonalcoholic fatty liver disease. AJR Am J Roentgenol, 2020, 214(1):W20-W26.
[8] Yoo HW, Kim YS, Kim SG, et al. Usefulness of noninvasive methods including assessment of liver stiffness by 2-dimensional shear wave elastography for predicting esophageal varices. Dig Liver Dis, 2019, 51(12):1706-1712.
[9] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol, 2017, 67(1): 145- 172.
[10] Kim TY, Kim TY, Kim Y, et al. Diagnostic performance of shear wave elastography for predicting esophageal varices in patients with compensated liver cirrhosis. J Ultrasound Med, 2016, 35(7):1373-1381.
[11] Mendoza YP, Rodrigues SG, Delgado MG, et al. Inflammatory activity affects the accuracy of liver stiffness measurement by transient elastography but not by two-dimensional shear wave elastography in non-alcoholic fatty liver disease. Liver Int, 2022, 42(1):102-111.
[12] Alam MS, Kamrul-Hasan ABM, Kalam ST, et al. Liver stiffness measurement by using transient elastography in Bangladeshi patients with type 2 diabetes mellitus and ultrasonography-diagnosed nonalcoholic fatty liver disease. Diabetes Metab Syndr Obes, 2021, 14:3089-3096.
[13] Qu Y, Song YY, Chen CW, et al. Diagnostic performance of FibroTouch ultrasound attenuation parameter and liver stiffness measurement in assessing hepatic steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Clin Transl Gastroenterol, 2021, 12(4):e00323.
[14] Xu N, Xie Q, Li J, et al. Improvement in liver stiffness measurement for diagnosis of liver fibrosis in patients with concurrent chronic hepatitis B and nonalcoholic fatty liver disease. J Int Med Res, 2020, 48(2):300060520903667.
[15] Ferraioli G, Wong VW, Castera L, et al. Liver ultrasound elastography: an update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol, 2018, 44(12):2419-2440.
[16] Herrmann E, de Lédinghen V, Cassinotto C, et al. Assessment of biopsy-proven liver fibrosis by two-dimensional shear wave elastography: An individual patient data-based meta-analysis. Hepatology, 2018, 67(1):260-272.
[17] Yan Y, Xing X, Lu Q, et al. Two-dimensional shear wave elastography for screening varices in Asian patients with primary biliary cholangitis. Expert Rev Gastroenterol Hepatol, 2021, 15(8):965-973.