关键词: 食管静脉曲张, 肝硬化, 超声检查, 弹性成像技术, 实时剪切波弹性成像

Abstract: Objective To evaluate the clinical value of VTQ in the measurement of hepatic and spleen SWV non-invasive evaluation of endoscopic sclerotherapy for severe EV in patients with hepatitis B cirrhosis. Methods Ninety patients with severe EV who underwent sclerotherapy and microsurgery were enrolled, 59 of whom underwent microsurgical sclerotherapy (group A) and 31 underwent routine gastroscopy (group B). The blood, routine liver function, blood coagulation and ultrasonography were collected on the next day. The liver and spleen SWV were measured one day before, one day after and one month after surgery in group A. The liver and spleen underwent SWVmeasurement before and after gastroscopy in group B. Group A underwent EUS to evaluate the effect of sclerotherapy in the first month after surgery. EUS results were used as the gold standard to evaluate the efficacy of subsurgical sclerotherapy with liver and spleen SWV. Results The SWV of liver and spleen in group A was significantly higher than that before operation [(2.68±0.54) m/s VS (1.98±0.36) m/s, P<0.05; (3.75±0.33) m/s VS (3.15±0.28) m/s, P<0.05]. There was no significant change in SWV of liver and spleen before and after endoscopy in group B [[1.91±0.43) m/s VS(1.87±0.64) m/s, P>0.05; (3.18±0.36) m/s VS (3.32±0.48) ) m/s, P>0.05]. At 1 month after operation, the liver and visceral SWV of the hardened group were slightly higher than that of the day after surgery [[2.88±0.42] m/s VS (2.79±0.38) m/s, P>0.05; (3.81±0.28) m/s VS (3.79±0.26) m/s, P>0.05], SWV of liver and spleen in the incomplete group was lower than that in the day after surgery [(2.21±0.29) m/s VS(2.49±0.36) m/s, P<0.05 ]; [(3.15±0.41) m/S VS (3.61±0.38) m/s, P<0.05]. The SWV 2.55m/s was used as the threshold for complete hardening under the microscope. The sensitivity was 0.78 and the specificity was 0.73. The spleen SWV 3.61m/s was used as the threshold for complete hardening under the microscope. The sensitivity was 0.89 and the specificity was 0.77. The AUROC of the spleen SWV for the evaluation of subsurgical varicose veins was 0.88, and the predictive power was higher than that of the liver SWV (AUROC: 0.71, Z= 2.5, P= 0.025). Conclusion The sclerotherapy of the liver can significantly increase the SWV of the liver. The application of VTQ technique to measure the liver and spleen SWV can evaluate the curative effect of subsurgical sclerotherapy to a certain extent. The evaluation efficacy of spleen SWV is higher than that of liver SWV which means it has certain potential value for affecting the clinical efficacy of EV sclerotherapy.

Key words: Esophageal varices, Cirrhosis, Ultrasonography, Elastography, Real-time shear wave elastography