瞬时弹性成像在非肝硬化门静脉高压症患者诊断中的应用

摘要/Abstract

摘要： 目的探讨瞬时弹性成像(TE)对非肝硬化门静脉高压症(PHT)患者的诊断价值。方法选取沈阳市第十人民医院2016年10月至2018年10月诊断为门静脉高压症并进行TE检查86例患者的临床资料,根据活组织检查结果将患者分为非肝硬化PHT组(51例)和肝硬化PHT组(35例),比较两组患者的肝硬度值、脾硬度值、肝功能和凝血功能,并利用受试者工作特征曲线(ROC)评价肝硬度值和脾硬度值对非肝硬化PHT的诊断价值。结果非肝硬化PHT组患者的肝硬度值为(6.21±5.27)kPa,低于肝硬化PHT组的(24.15±15.79)kPa,脾硬度值(59.56±17.22)kPa高于肝硬化PHT组的(40.49±13.78)kPa,差异有统计学意义(t=7.055、5.699,均P<0.05)。非肝硬化PHT患者的TBil、AST、ALT水平分别为(16.26±4.28)μmol/L、(38.64±5.69)U/L、(40.23±5.74)U/L,均低于肝硬化PHT组的(24.94±5.24)μmol/L、(59.64±9.33)U/L、(60.32±8.14)U/L,(t=8.413、12.601、13.226,均P<0.05)。PLT、PT水平两组比较差异无统计学意义(P>0.05)。ROC分析结果显示,肝硬度值和脾硬度值诊断非肝硬化PHT的AUC分别为0.934、0.824,95%CI分别为:0.871～0.998、0.736～0.913,Cutoff值分别为14.05 kPa、52.84 kPa。结论 TE对于非肝硬化PHT患者诊断具有操作简单、无创、准确性高等优点,当肝硬度值为14.05 kPa、脾硬度值为52.84 kPa时,诊断非肝硬化PHT的约登指数最大。

关键词: 门静脉高压症, 非肝硬化, 瞬时弹性成像, 诊断

Abstract: Objective To investigate application value of transient elastography (TE) in diagnosis of non-cirrhotic portal hypertension (PHT).Methods A total of 86 patients diagnosed with PHT in our hospital from October 2016 to October 2018 who underwent TE were enrolled. They were divided into non-cirrhotic PHT group (51 cases) and cirrhotic PHT group (35 cases) according to biopsy results. The liver stiffness value, spleen stiffness value, liver function indexes and coagulation function indexes were compared between the 2 groups. The diagnostic values of liver stiffness value and spleen stiffness value in non-cirrhotic PHT were evaluated by receiver operating characteristic (ROC) curves. Results The liver stiffness value of non-cirrhotic PHT group was lower than that of cirrhotic PHT group [(6.21 ± 5.27) vs (24.15 ± 15.79) kPa, P<0.05]. The spleen stiffness value of non-cirrhotic PHT group was higher than that of cirrhotic PHT group [(59.56 ± 17.22) vs (40.49 ± 13.78) kPa, P<0.05]. The levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in non-cirrhotic PHT group were lower than those in cirrhotic PHT group [(16.26 ± 4.28) vs (24.94 ± 5.24) μmol/L, (38.64 ± 5.69) vs (59.64 ± 9.33) U/L, (40.23 ± 5.74) vs (60.32 ± 8.14) U/L, P<0.05]. However, there was no significant difference in platelet or prothrombin time between the 2 groups (P>0.05). Besides, the area under ROC curve (AUC) and 95% confidence interval (CI) of liver stiffness value to diagnose non-cirrhotic PHT were 0.934 and 0.871-0.998, respectively, with the cutoff value of 14.05 kPa. The AUC and 95% CI of spleen stiffness value were 0.824 and 0.736-0.913, respectively, with the cutoff value of 52.8 kPa.Conclusion TE is simple and non-invasive with high accuracy to diagnose non-cirrhotic PHT. When the liver stiffness value is 14.05 kPa and spleen stiffness value is 52.84 kPa, Youden index for diagnosis of non-cirrhotic PHT is the maximum.

Key words: Portal hypertension, Non-cirrhotic, Transient elastography, Diagnosis

吕玉翠, 何丽娟. 瞬时弹性成像在非肝硬化门静脉高压症患者诊断中的应用[J]. 肝脏, 2019, 24(11): 1237-1239.

LV Yu-cui, HE Li-juan. Application of transient elastography in diagnosis of non-cirrhotic portal hypertension[J]. Chinese Hepatolgy, 2019, 24(11): 1237-1239.

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瞬时弹性成像在非肝硬化门静脉高压症患者诊断中的应用

Application of transient elastography in diagnosis of non-cirrhotic portal hypertension

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