摘要
目的应用声辐射力脉冲成像(ARFI)测量脾脏剪切波(SSW)速度,探讨其能否评价肝硬化患者食管静脉曲张(EV)的存在及其严重程度。方法根据胃镜所见将264例肝硬化患者分为无EV组148例、低风险EV组46例,高风险EV组70例,比较各组患者的非侵入性参数包括血小板计数(PC)、脾脏长径(SL)、脾脏指数(SI)、PC/SI、肝功能Child-Pugh分值(CPS)、肝脏剪切波(LSW)及脾脏剪切波(SSW),计算各参数ROC曲线下面积(AUROC值),确立SSW预测低风险EV和高风险EV的最佳cut-off值及诊断EV的敏感性、特异性、准确性。结果在所有非侵入性参数中,仅SSW在三组间的两两比较中差异均有统计学意义(P<0.05),且具有预测低风险EV和高风险EV的最大AUROC值。以SSW=3.27 m/s诊断低风险EV的敏感性、阴性预测值、准确性分别为97.41%、96.88%、78.03%;以SSW=3.48 m/s诊断高风险EV的敏感性、阴性预测值、准确性分别为97.14%、98.47%、74.62%。结论 SSW是预测肝硬化患者EV的存在和严重性的良好参数,可作为EV初始筛查的非侵入性指标。
Objective To evaluate spleen shear wave （SSW） determined by acoustic radiation force impulse （ARFI） imaging as a predictor for presence and severity of esophageal varice（EV） in patients with liver cirrhosis. Methods According to endoscopic findings, 264 patients with cirrhosis were divided into non-EV（no esophageal varice, NEV） group（n=148）, low-risk EV group（n=46）, high-risk EV group（n=70）. The non-invasive parameters in each group, including platelet count（PC）, spleen Length（SL）, spleen index （SI）, PC/SI, liver function Child-Pugh score（CPS）, spleen shear wave（SSW） and liver shear wave （LSW） were compared. The area under the ROC curve （AUROC） was calculated. The optimal cut-off value of SSW was established and diagnostic sensitivity, specificity and accuracy in predicting low risk EV and high-risk EV were analyzed. Results In all non-invasive parameters, only the SSW had significant difference （P〈0.05）, and it had maximum AUROC for predicting low risk EV and high-risk EV. SSW cut-off value of 3.27 m/s identified patients with low-risk EV with the sensitivity, negative predictive value and accuracy of 97.41%, 96.88% and 78.03%. SSW cut-off value of 3.48 m/s identified patients with high-risk EV with the sensitivity, negative predictive value and accuracy of 97.14%, 98.47% and 74.62%. Conclusion SSW is a good parameter to predict the presence and severity of EV in cirrhotic patients, and it can be used as an initial non-invasive screening indicator for EV.
出处
《临床超声医学杂志》
2013年第12期827-830,共4页
Journal of Clinical Ultrasound in Medicine
关键词
声辐射力脉冲成像
肝硬化
食管静脉曲张
脾脏
剪切波
Acoustic radiation force impulse
Cirrhosis
Esophageal varices
Spleen
Shear wave
