| Objectives The conventional ultrasound and Shear wave elastography(SWE)technology were used to detect the changes of ultrasonic indexes of spleen and liver during the process of chronic hepatitis B liver fibrosis,to analyze the correlation between the elastic modulus of spleen and that of liver,and to calculate the elastic modulus of spleen and shear wave velocity of spleen to evaluate the diagnostic cutoff value of chronic hepatitis B liver fibrosis.Methods A total of 162 patients with chronic hepatitis B with normal Alanine aminotransferase(ALT)levels who were admitted to our hospital from October 2020 to December 2021 were selected,and the general information and liver function indexes of the patients were collected.Perform conventional ultrasound and shear wave elastography of the liver and spleen,and collect the two-dimensional ultrasound features of liver parenchyma,capsule,and edge,spleen long and thick diameters,spleen elastic modulus,spleen shear wave velocity,and portal vein diameter(Dpv),Portal vein velocity(Vpv),Diameter of splenic vein(Dsv),Splenic venous blood flow velocity(Vsv),etc.They were divided into normal group,liver fibrosis group,liver cirrhosis group and undefined group(liver fibrosis or cirrhosis cannot be determined if the liver elasticity value is in the range of 8.5 to 11.0 k Pa,and further liver biopsy is required.)according to the mean elasticity value(Emean)of the liver.SPSS 24.0 statistical software was used for statistical analysis,and the differences in liver parenchyma echo,capsule,edge,spleen long and thick diameter,spleen elastic modulus,spleen shear wave velocity,Dpv,Vpv,Dsv,and Vsv among the four groups were compared and analyzed.Enumeration data were shown as an example,and inter-group comparison was performed using Chi-square test.Measurement data in accordance with the normal distribution is expressed as ((?)±s),comparison between groups using the analysis of variance.The non-normal distribution of measurement data was expressed as M(IQR),and the comparison among multiple groups was performed using Kruskal-wallis H test.The Spearman correlation analysis was used to analyze the correlation between the elastic modulus of the spleen,shear wave velocity of the spleen,long diameter and thick diameter of the spleen,and Dpv,Vpv,Dsv,Vsv and the elastic modulus of the liver.Using the liver elastic modulus for the diagnosis of liver fibrosis as the reference standard,the liver fibrosis group,the undefined group,and the liver cirrhosis group were defined as liver fibrosis,and the ROC curve of the spleen elastic modulus and spleen shear wave velocity for the diagnosis of liver fibrosis was constructed,and the diagnostic cutoff values of the spleen elastic modulus and the spleen shear wave velocity for the diagnosis of liver fibrosis were calculated.P<0.05 indicated that the difference was statistically significant.Results 1 Comparison of the characteristics of conventional ultrasound among the four groups: With the aggravation of hepatic fibrosis,the liver parenchyma echo became thicker,the capsule was not smooth,and the edge became blunt(P<0.05).The overall comparison among the four groups showed that the differences in the long and thick diameter of spleen,Dpv,Dsv,Vpv and Vsv were statistically significant(P<0.05).After pairwise comparison,there was no significant difference in the splenic long diameter between the normal group and the hepatic fibrosis group,or between the hepatic fibrosis group and the indefinable group,while the difference was statistically significant in the pairwise comparison among other groups.The differences of spleen thickness diameter and Dpv between the liver fibrosis group and the undefined group were not statistically significant,but the differences were statistically significant when compared with the pairwise arrangement in other groups(P<0.05).The differences of Vpv,Dsv and Vsv between the normal group and the liver fibrosis group were not statistically significant,but the differences were statistically significant between the other groups(P<0.05).Among them,the long diameter and thick diameter of spleen,Dpv and Dsv increased with the increasing severity of hepatic fibrosis,while Vpv and Vsv decreased with the increasing severity of hepatic fibrosis.2Comparison of ultrasonic elastography results: The differences of spleen elastic modulus and spleen shear wave velocity among the four groups were statistically significant(P<0.05),and the values tended to increase with the increase of the severity of hepatic fibrosis,and the differences were statistically significant between the two groups.3Correlation analysis: There was a positive correlation between the elastic modulus of spleen,shear wave velocity of spleen,long diameter and thick diameter of spleen,Dpv and Dsv,and the elastic modulus of liver(correlation coefficients were 0.813,0.811,0.575,0.545,0.639 and 0.682,respectively);there was a negative correlation between Vpv and Vsv and the elastic modulus of liver(correlation coefficients were 0.523 and 0.529,respectively).4 When the cutoff values of spleen elastic modulus and spleen shear wave velocity were 22.25 k Pa and 2.75m/s,respectively,for the diagnosis of hepatic fibrosis,the diagnostic efficacy was higher(AUC values were 0.83 and 0.82,respectively),and the sensitivity and specificity were 81%,85% and 75%,90%,respectively.Under this condition,the Jordan index was the largest.Conclusions 1 The spleen elastic modulus and spleen shear wave velocity in patients with chronic hepatitis B have a positive correlation with the liver elastic modulus,and they will increase with the progression of liver fibrosis.When the elastic modulus of the spleen≥ 22.25 k Pa or the shear wave velocity of the spleen ≥ 2.75m/s,the probability of liver fibrosis was high.2 The long diameter,thick diameter,Dpv,Dsv of spleen of patients with chronic hepatitis B are positively correlated with liver elastic modulus,while Vpv,Vsv are negatively correlated with liver elastic modulus.Figure 6;Table 8;Reference 158... |
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