通过2D-SWE结合非侵入性参数评估肝硬度作为晚期慢性肝病患

StephenW

Evaluation of liver stiffness by 2D-SWE in combination with non-invasive parameters as predictors for esophageal varices in patients with advanced chronic liver disease
Golo Petzold ORCID Icon, Birgit Tsaknakis, Sebastian C. B. Bremer ORCID Icon, Richard F. Knoop, Robert G. Goetze, Ahmad Amanzada, show all
Received 12 Feb 2019, Accepted 15 Feb 2019, Published online: 17 Mar 2019

    Download citation https://doi.org/10.1080/00365521.2019.1585571



Abstract

Background/aims: Esophageal varices (EV) are common complications in patients with advanced chronic liver disease (ACLD). Non-invasive parameters to exclude EV in patients with ACLD would be desirable. The aim of this study was the evaluation of liver stiffness measurement (LSM) using 2D-shear wave elastography (GE Logiq E9) and other non-invasive parameters as predictors for EV.

Methods: Hundred patients with ACLD were enrolled. Abdominal sonography, including measurement of gall bladder wall thickness (GBWT), spleen diameter and LSM, gastroscopy and blood test results were evaluated. Statistical analyses were performed for the association between EV and non-invasive parameters.

Results: Fifty-one per cent of the patients had EV. The mean LSM (14.6 kPa) and GBWT (3.88 mm) in the group with EV were significantly higher than in the group without EV (10.6 kPa; 2.94 mm; p < .01). Performing area under the receiver operating characteristic curve, LSM has a better diagnostic performance (0.781) than GBWT (0.707), spleen diameter (0.672) and platelet count (0.635). Combining LSM (cut-off 13.58 kPa) and GBWT (cut-off 3.07 mm) resulted in a sensitivity of 86.3% and a specificity of 71.4% for the presence of EV. A sensitivity of 100% (negative predictive value 1.0) was achieved at LSM >9 kPa or GBWT >4 mm. Following these criteria in our current study population, 18% of the gastroscopies could have been avoided.

Conclusions: Combining LSM with non-invasive parameters, especially GBWT, improves the diagnostic accuracy for predicting EV. We suggest reconsidering screening gastroscopy in patients with ACLD who show LSM <9 kPa and GBWT <4 mm due to the very low risk of having varices.
Keywords: 2D-shear wave elastography, Logiq E9, GE, gall bladder wall thickness, esophageal varices, non-invasive parameters, advanced chronic liver disease

StephenW

通过2D-SWE结合非侵入性参数评估肝硬度作为晚期慢性肝病患者食管静脉曲张的预测因子
Golo Petzold ORCID Icon，Birgit Tsaknakis，Sebastian C. B. Bremer ORCID Icon，Richard F. Knoop，Robert G. Goetze，Ahmad Amanzada，显示全部
2019年2月12日收到，2019年2月15日接受，在线发布：2019年3月17日

下载引文https://doi.org/10.1080/00365521.2019.1585571



抽象

背景/目的：食管静脉曲张（EV）是晚期慢性肝病（ACLD）患者的常见并发症。在ACLD患者中排除EV的非侵入性参数是理想的。本研究的目的是使用二维剪切波弹性成像（GE Logiq E9）和其他非侵入性参数作为EV的预测因子评估肝硬度测量（LSM）。

方法：招募了100名ACLD患者。评估腹部超声检查，包括测量胆囊壁厚度（GBWT），脾脏直径和LSM，胃镜检查和血液检查结果。对EV和非侵入性参数之间的关联进行统计分析。

结果：51％的患者有EV。 EV组的平均LSM（14.6 kPa）和GBWT（3.88 mm）显着高于无EV的组（10.6 kPa; 2.94 mm; p <.01）。在接收器工作特性曲线下执行面积，LSM具有比GBWT（0.707），脾脏直径（0.672）和血小板计数（0.635）更好的诊断性能（0.781）。结合LSM（截止值13.58kPa）和GBWT（截止值3.07mm），对EV的存在产生86.3％的灵敏度和71.4％的特异性。在LSM> 9kPa或GBWT> 4mm时实现100％的灵敏度（负预测值1.0）。根据我们目前研究人群中的这些标准，可以避免18％的胃镜检查。

结论：将LSM与非侵入性参数（尤其是GBWT）相结合，可提高预测EV的诊断准确性。我们建议重新考虑ACLD患者的筛查胃镜检查，因为患有静脉曲张的风险非常低，因此LSM <9 kPa且GBWT <4 mm。
关键词：二维剪切波弹性成像，Logiq E9，GE，胆囊壁厚度，食管静脉曲张，无创参数，晚期慢性肝病