| Part I The clinical study of evaluation portal hypertension by CDFI combined with SWEObjective: To explore the clinical application value of combined use of color Doppler ultrasonography(CDFI)and shear wave elastography(SWE)in the assessment of portal hypertension in cirrhotic patients.Methods: 246 patients with cirrhosis associated portal hypertension(PHT)who met the inclusion criteria and were hospitalized in the First People?s Hospital of Jingdezhen from August 2017 to December 2019 were collected.According to Child-Pugh liver function grade,82 cases were grade A,115 cases were grade B,and 49 cases were grade C.At the same time,150 healthy examiners were selected as the control group.All subjects measured color Doppler parameters by CDFI: portal vein diameter(PVD),portal vein blood flow velocity(PVV),portal venous blood flow(PVQ),splenic vein diameter(SVD),splenic vein blood flow velocity(SVV),splenic venous blood flow(SVQ),hepatic artery resistance index(HARI),hepatic artery pulsatility index(HAPI),splenic artery resistance index(SARI),splenic artery pulsatility index(SAPI)and portal venous congestion index(PVCI)and portal Pulse hypertension index(PHI).Use the portal vein pressure(PVP)formula :PVP=(0.066?SAPI-0.044)?PVQ to estimate the portal vein pressure.The liver stifffness(LSM)was measured by SWE.All the above parameters were compared between the control group and the portal hypertension group to see if the difference was statistically significant.Each parameter was divided into three subgroups according to liver function grade(grade A,grade B,grade C),and complete the single factor analysis of variance to compare the differences.Pearson correlation analysis was performed between all parameters and portal venous pressure of PHT group.Multiple linear regression was used to determine the independent risk factors affecting PVP.Results: 1.All the values of the PVD,PVQ,SVD,SVQ,HAPI,SARI,SAPI,PVCI and PHI of the PHT group were significantly higher than those of the controlgroup.There was significant statistical significance between the two(P(27)0.001),while HARI was slightly higher compared with the control group,the difference was also statistically significant(P(27)0.05).However,the PVV and SVV of the PHT group were lower than those of the control group,and the comparison between the two was statistically significant(P(27)0.001).2.Compare the PVD parameters between Child-Pugh grades of different liver functions in PHT patients: Comparing grade A(1.41±0.24)mm and grade B(1.47±0.31)mm showed that the difference is not statistically significant(q=2.17,P(29)0.05);Comparing grade A and grade C(q=6.18,P(27)0.01),and comparing grade B and C(q=4.76,P(27)0.01),the difference was both statistically significant.3.Comparing the parameters HAPI between three subgroups showed that there was no significant difference between grade A(1.51±0.34)and grade B(1.62±0.57)(q=2.36,P(29)0.05),grade B(1.62±0.57)and grade C(1.73±0.29)(q=2.00,P(29)0.05).However comparing with grade A and grade C,the difference was statistically significant(q=3.78,P(27)0.05).4.Comparison of PVV,SVD,SVQ,PVCI,PHI and LSM among the three subgroups,the differences were statistically significant(P(27)0.01).Comparison of PVQ,SVV,HARI,SARI,SAPI and PVP among the three subgroups showed no significant difference(P(29)0.05).5.The parameters PVD(P =0.045),HARI(P =0.002),HAPI(P =0.010),SARI(P =0.009),SAPI(P =0.002),LSM(P =0.000)were correlated with portal venous pressure(PVP),while the parameters PVV,PVQ,SVD,SVV,SVQ,PVCI and PHI have no significant correlation with portal venous pressure(P(29)0.05).6.Set the target variable portal venous pressure(PVP)as the dependent variable,and the six parameters(PVD,HARI,HAPI,SARI,SAPI,LSM)that are related to PVP as independent variables for multiple linear regression analysis.The results show: HAPI and LSM are independent risk factors affecting PVP.Conclusions: 1.The value of Color Doppler parameters PVD,HARI,HAPI,SARI,SAPI and the value of LSM measured by shear wave elastography were positively correlated with portal venous pressure.Those values could indirectly reflect the changes of portal venous pressure.Among the six parameters,LSM had the highest correlation.2.The values of color Doppler parameters PVV,SVD,SVQ,HAPI,PVCI,PHI and the value of LSM could be used as sensitive indicators to determine the severity of liver function in patients with PHT,providing clinical basis for the diagnosis of the disease.The parameters PVQ,SVV,HARI,SARI and SAPI can not be used as criteria to determine the severity of liver function in patients with PHT.3.The values of the HAPI and LSM were independent risk factors affecting portal venous pressure.Combined application of them had a better judgment effect.The values of the HAPI and LSM could be used as quantitative indicators.4.The portal pressure calculated by the PVP calculation formula could predict the severity of portal hypertension patients semi-quantitatively,which could be used for the preliminary screening of PHT patients.5.SWE technology was simple,repeatable and non-invasive which can become a new technology and method for clinical evaluation of the degree of portal hypertension in patients with liver cirrhosis.Part II The clinical study of prediction of esophageal varices by SWE combined with multi-parameterObjective:To explore the clinical value of shear wave elastography(SWE)measurement of liver stiffness(LSM)in predicting liver cirrhosis complicated by esophageal varices(EVs).Methods: 468 patients with liver cirrhosis who met the inclusion criteria and were hospitalized in the First People?s Hospital of Jingdezhen from August 2017 to December 2019 were collected.The value of SWE was used to measure liver stiffness and endoscopy was used to check esophageal varices.Record the basic information of all patients including hemoglobin,platelets,serum albumin,total bilirubin,aspartate aminotransferase(AST),alanine aminotransferase(ALT)and prothrombin time.Calculate the parameter model platelet count and spleen length to diameter ratio(PC/SD).The area under the receiver operating characteristic curve(AUROCs)was used to compare the diagnostic accuracy of the parameters of platelet,PC/SD and LSM.Take the maximum combined value of sensitivity and specificity as the cut-offvalue.Use De Long test to compare between AUROCS.Multivariate logistic regression analysis was used to determine the risk factors of esophageal varices and high-risk esophageal varices in liver cirrhosis.Results: 1.The patient's age,gender,body mass index(BMI)and ALT were not related to the presence and extent of EVs.AST,total bilirubin,spleen long diameter and LSM values in the EVs group were higher than those in the no EVs group(P(27)0.05).AST,total bilirubin,spleen long diameter and LSM values in the high-risk EVs group were higher than those in the non-high-risk EVs group(P(27)0.05).Platelets,serum albumin and PC/SD in the EVs group were lower than the no EVs group(P(27)0.05).Platelets,serum albumin and PC/SD in the high-risk EVs group were significantly lower than the non-high-risk EVs group(P(27)0.001).2.Among 468 patients with liver cirrhosis,271 had no EVs(57.9%),139 had mild EVs(F1)(29.7%),and 58 had high-risk EVs(12.4%).The average liver stiffness of patients with liver cirrhosis is 18.4k Pa(6.8-52.5k Pa).The LSM value of patients with liver cirrhosis was significantly correlated with the incidence of EVs,and it increased with the increase of EVs.3.The area under the ROC curve for platelet count(PC),PC/SD and LSM to predict EVs is 0.792(95% confidence interval 0.684-0.842),0.814(95% confidence interval 0.658-0.875)and 0.895(95% confidence interval 0.813-0.918).The diagnostic power of LSM in predicting EVs was greater than that of PC and PC/SD,and the difference was statistically significant(P(27)0.05).The best cut-off values for PC,PC/SD and LSM to predict the existence of EVs are 112?109/L,8.4?109/L/cm and 18.5KPa,respectively.4.The areas under the ROC curve for PC,PC/SD and LSM to predict the occurrence of high-risk EVs are 0.826(95% confidence interval 0.753-0.886),0.843(95% confidence interval 0.766-0.904)and 0.872(95% confidence interval 0.812-0.947),respectively.PC,PC/SD and LSM had no significant difference in the diagnostic efficacy of predicting high-risk EVs(P(29)0.05).The best cut-off values for PC,PC/SD and LSM to predict the existence of high-risk EVs were 94?109/L,7.3?109/L/cm and 20.4KPa,respectively.5.The results of multivariate logistic regression analysis showed that the odds ratio(OR value)of LSM predicted EVs and high-risk EVs were 1.642(95%CI: 1.365-1.984,P =0.004)and 1.38(95%CI: 1.142-1.546,P = 0.026).PC/SD predicted the OR values of EVs and high-risk EVs were 0.924(95%CI: 0.714-1.276,P =0.042)and 0.883(95%CI: 0.682-1.034,P =0.284),respectively.Conclusions: 1.The value of LSM of patients with liver cirrhosis could reflect the degree of esophageal varices.The use of LSM cut-off value could provide a theoretical basis for reasonable clinical examination,judgment of the illness and timely treatment.2.LSM and PC/SD could be used as independent factors to predict esophageal varices in liver cirrhosis and the predictive effect of LSM was higher than that of PC/SD.LSM was an independent factor in the prediction of high-risk esophageal varices.3.SWE technology could become a new technology and new method for non-invasive prediction of esophageal varices in liver cirrhosis.Part III The application value of evaluating common types of liver cirrhosis by SWEObjective: To explore the application value of SWE technology in the evaluation and identification of common types of liver cirrhosis.Methods: A total of 478 patients with liver cirrhosis who met the inclusion criteria and were hospitalized in the First People?s Hospital of Jingdezhen from August 2017 to August 2020 were collected.Among them,187 were hepatitis B,88 hepatitis C,138 alcoholic liver,45 non-alcoholic fatty liver diseases,and 20 autoimmune liver diseases.During the same period,150 healthy persons were selected as the normal control group.All subjects were examined by SWE and measured the liver stiffness(LSM)value to analyze and compare the difference between the normal control group and the five common types of liver cirrhosis groups.Results: 1.The liver LSM of the normal control group was(5.24±1.13)k Pa.The liver LSM value of the non-alcoholic fatty liver cirrhosis group,the post-hepatitis B cirrhosis group,the post-hepatitis C cirrhosis group,the autoimmune cirrhosis group and the alcoholic cirrhosis group showed a trend of gradually increasing,and the LSM value was(11.14±5.30)k Pa,(13.70±6.13)k Pa,(14.25±5.94)k Pa,(15.93±5.87)k Pa and(27.33±8.61)k Pa.2.The LSM value of each type of cirrhosis group was significantly higher than that of the normal control group,with statistically significant differences(P(27)0.001).Comparing among the groups of various types of cirrhosis,the difference was statistically significant(F value=171.33,P(27)0.001).3.Comparisons among various types of liver cirrhosis groups: Comparison of non-alcoholic fatty liver cirrhosis group with post-hepatitis B cirrhosis group,post-hepatitis C cirrhosis group,autoimmune cirrhosis group,alcoholic cirrhosis group showed statistically significant differences(P(27)0.01).Comparison of the alcoholic cirrhosis group with the other four groups of patients with liver cirrhosis also showed statistically significant differences(P(27)0.001),but but there were no statistical significant difference between the post-hepatitis B cirrhosis group and the post-hepatitis C cirrhosis group and autoimmune cirrhosis group(P(29)0.05).Conclusions: 1.There were certain differences in LSM of patients with liver cirrhosis caused by different causes.2.SWE technology had certain clinical application value for the assessment and differential diagnosis of common types of liver cirrhosis. |
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