Objective: To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis. Methods: The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson's correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. The SWE diagnostic performances of Liver (L-SWE), Spleen (S-SWE) were also evaluated. Results: Of all 58 patients, 47 were found HVPG ≥10 mmHg, diagnosed as clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH), which patients are at increased risk of developing complications. Thirty-four patients were found HVPG≥12 mmHg, diagnosed as SPH, which patients were at increased risk of variceal bleeding. Moderate positive correlation was found between L-SWE and HVPG (r=0.42, P<0.01), and S-SWE were significantly correlated with HVPG (r=0.68, P<0.01), while serological models and HVPG were slightly correlated (r=0.36 and 0.28, all P<0.01). The area under the receiver operating characteristic curves of L-SWE, S-SWE and the combination for CSPH were 0.78, 0.88 and 0.89. When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa, patients were at increased risk of developing complications. The area under the receiver operating characteristic curves for SPH were 0.68, 0.81 and 0.77 and the S-SWE had the highest specificity, so when S-SWE was>41.5 kPa, patients were at increased risk of variceal bleeding. Conclusion: L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.
目的： 探讨实时剪切波弹性成像技术（2D-SWE）获得的肝脾弹性对乙型病毒性肝炎（简称乙肝）肝硬化门脉高压严重程度的预测价值。 方法： 选择2017年9月至2018年4月就诊于复旦大学附属中山医院的乙肝肝硬化门脉高压患者58例，其中男37例、女21例，年龄（55±12）岁，回顾性分析2D-SWE技术获得的肝（L-SWE）脾（S-SWE）弹性值与肝静脉压力梯度（HVPG）的相关性，并与常见血清学模型进行比较，分析其对门脉高压的诊断价值。 结果： 根据HVPG测值，58例患者中HVPG≥10 mmHg（1 mmHg=0.133 kPa）者47例，为临床显著门脉高压（CSPH），食管胃底静脉曲张的风险增高；HVPG≥12 mmHg者34例，为严重门脉高压（SPH），曲张静脉破裂出血的概率增加。相关分析显示L-SWE与HVPG值呈中等程度正相关（r=0.42，P<0.01），S-SWE为高度正相关（r=0.68，P<0.01）。血清学模型为低度正相关（r=0.36及r=0.28，均P<0.01）。L-SWE、S-SWE及二者联合预测CSPH的曲线下面积分别为0.78、0.88、0.89，当L-SWE>12.86 kPa或S-SWE>35.73 kPa时，食管胃底静脉曲张的风险性增高。L-SWE、S-SWE及二者联合预测SPH的曲线下面积分别为0.68、0.81、0.77，且S-SWE特异度最高，当S-SWE>41.5 kPa时，曲张静脉出血风险大。 结论： 2D-SWE技术获得的L-SWE及S-SWE可协助诊断CSPH及SPH，进行危险分级评估。.
Keywords: Elasticity imaging techniques; Hepatic veins; Hypertension, portal; Liver cirrhosisi.