目的:探讨肝脏、脾脏的声触诊弹性成像与声触诊弹性测量技术在评估肝硬化食管胃底静脉曲张(esophageal and gastric varices,EGV)中的应用价值。方法:收集临床诊断肝硬化患者87例,经胃镜结果分为无曲张组(44例)、轻度曲张组(13例)和中重度曲张组(30例)。通过超声弹性成像技术分别测量肝脏声触诊弹性成像值(liver-sound touch elastography,L-STE)、肝脏声触诊弹性测量值(liver-sound touch quantify,L-STQ)、脾脏声触诊弹性成像值(spleen-sound touch elastography,S-STE)、脾脏声触诊弹性测量值(spleen-sound touch quantify,S-STQ),比较各组肝脾STE及STQ指标。绘制受试者工作特征曲线分析各参数诊断EGV的效能,计算曲线下面积。结果:肝硬化无曲张组与曲张组肝脾STE与STQ值比较差异均有统计学意义(P＜0.05)。采用Spearman相关系数进行相关分析显示,L-STE、L-STQ、S-STE及S-STQ值与食管胃底静脉曲张程度呈正相关(r=0.505、0.487、0.558、0.535)。应用受试者工作特征曲线分析, L-STE、L-STQ、S-STE、S-STQ值诊断EGV的曲线下面积为0.788、0.770、0.804、0.785,预测EGV的最佳界值分别为9.29 kPa、13.58 kPa、23.34 kPa、26.44 kPa。L-STE、L-STQ、S-STE、S-STQ值预测轻度静脉曲张的曲线下面积为0.781、0.730、0.721、0.692,均P＜0.05。L-STE、L-STQ、S-STE、S-STQ值预测中重度静脉曲张的曲线下面积为0.831、0.828、0.873、0.862,均P＜0.05。结论:STE与STQ技术测量肝脾硬度对肝硬化EGV具有很好的预测价值;肝脾剪切波弹性硬度随肝硬化EGV程度加重而升高并可作为判断曲张程度的有效指标。
Objective: To investigate the application value of sound touch elastography and sound touch quantify of liver and spleen in the evaluation of esophageal and gastric varices(EGV) in liver cirrhosis. Methods: A total of 87 patients with liver cirrhosis were collected and divided into the non-varices group (44 cases), mild varices group (13 cases) and moderate to severe varices group (30 cases) based on gastroscopic results. Ultrasonic elastography were used to measure the values of liver sound touch elastography (L-STE), liver sound touch quantify (L-STQ), spleen sound touch elastography (S-STE), and spleen sound touch quantify (S-STQ). STE and STQ indexes of liver and spleen were compared in each group. The receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of each parameter, and the area under the curve (AUC) was calculated. Results: There were significant differences in the STE and STQ values of liver and spleen between the non-varicose group and the varicose groups (P＜0.05). Spearman correlation coefficient was used for correlation analysis, and the values of L-STE, L-STQ, S-STE and S-STQ were positively correlated with the degree of esophageal and gastric varices (r=0.505, 0.487, 0.558,0.535). The AUCs of L-STE, L-STQ, S-STE and S-STQ for diagnosing EGV were 0.788,0.770, 0.804 and 0.785, and the optimal cut-off values for predicting EGV were 9.29 kPa, 13.58 kPa, 23.34 kPa and 26.44 kPa, respectively. L-STE, L-STQ, S-STE, S-STQ values predicted the AUC of mild varicose veins was 0.781, 0.730, 0.721, 0.692, all P＜0.05. The areas under the curve of L-STE, L-STQ, S-STE and S-STQ predicted moderate and severe varicose were 0.831, 0.828, 0.873 and 0.862(P＜0.05). Conclusion: Using STE and STQ to measure liver and spleen stiffness has good predicting value to EGV in live cirrhosis. The shear wave elastic hardness of liver and spleen increasing with the severity of EGV in liver cirrhosis can be used as an effective index to determine the severity of varicosity.
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