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