Non-invasive Evaluation Of Varices Needing Treatment By Splenic Shear Wave Elastography In Hepatitis B Cirrhosis

Objective: To investigate the noninvasive evaluation of spleen stiffness(SS)measured by shear wave elastography(SWE)for the development of varices needing treatment(VNT)in patients with hepatitis B cirrhosis and to compare its assessment capability with that of other non-invasive assessment indicators: Platelet(PLT)count,Albumin(ALB),Total bilirubin(TBIL),Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),spleen thickness,Aspartate aminotransferase and platelet ratio index(APRI)and hepatic Fibrosis 4 score index(FIB-4).Methods: A total of 70 patients with hepatitis B liver cirrhosis and 42 normal controls who were admitted to our hospital and underwent gastroscopy from April 2017 to December 2020 were subjected to routine abdominal ultrasound and splenic SWE examination,and the general data,serological test results and gastroscopy results were collected.All valid subject data were grouped based on cirrhosis and the presence of VNT.Mann-Whitney U test was used to distinguish whether there were statistical differences between normal control group and VNT group.The same method was used to distinguish whether the differences between the indicators of VNT in patients with cirrhosis were statistically significant.Logistic regression analysis was used to analyze the predictive ability of included statistically different indicators for the diagnosis of VNT and they were compared.The receiver operating characteristic curve(ROC curve)was then used to assess the diagnostic efficacy of the predictors.Results: A total of 70 patients with hepatitis B liver cirrhosis were collected in the study,and 64 cases were successfully measured for SS.23 cases combined with VNT.A total of 42 cases of normal control group were collected,and 37 cases with successful SS measurement were included.The differences of each index between the normal control group and the VNT group as well as the non-VNT group were statistically significant.In patients with liver cirrhosis,Mann-Whitney U test results showed that only PLT,albumin,FIB-4,spleen thickness and SS were statistically significant when distinguishing the presence of VNT(P < 0.05).Binary Logistic regression analysis was used to evaluate the predictive ability of statistically significant indicators for VNT.In the study of VNT,only the two variables of SS and spleen thickness were considered to be statistically significant(P < 0.05),and the finally obtained Logistic model was statistically significant and fitted well.The sensitivity,specificity,positive predictive value and negative predictive value of the model were 78.3%,92.7% 85.7% and 88.4%respectively.The ROC curve was drawn using the spleen thickness and SS as variables,and the prediction probability after combination of the two,and the AUC of the area under the curve was calculated to be 0.879,0.901,and 0.924,respectively.These results indicated that the combined diagnosis of SS and spleen thickness could improve the diagnostic ability of VNT.Conclusions: The differences of each index between the normal control group and the VNT group as well as the non-VNT group were statistically significant.In patients with cirrhosis of liver,the differences of PLT,albumin,FIB-4,spleen thickness and spleen elasticity have statistical significance when distinguishing the presence of VNT.Both spleen thickness and SS have the predictive ability for the diagnosis of VNT,and the combination of SS and spleen thickness can improve the diagnostic ability for VNT.