目的

应用超声二维剪切波弹性成像技术（2D-SWE）测量不同病因脾大患儿的脾硬度（以杨氏模量值体现），探讨其差异及2D-SWE对儿童脾大的临床应用价值。

方法

收集2022年1月至2024年5月武汉儿童医院门诊或住院符合脾大诊断标准的患儿93例（病例组）和45例正常儿童（正常组）。病例组根据病因分为感染性疾病组（IDG）23例、血液系统疾病组（BDG）19例、门静脉系统疾病组（PVDG）51例，根据超声诊断是否合并肝硬化分为合并肝硬化组32例和不合并肝硬化组61例。所有受检者脾均行常规超声和2D-SWE检查。测量常规二维超声参数（长径、厚度）和脾中部实质杨氏模量值。正常组与病例组之间脾弹性值差异采用独立样本t检验；合并肝硬化与不合并肝硬化组脾弹性值之间采用点二列相关分析；病例组不同病因之间脾弹性值的关系采用Kruskal-Wallis检验；绘制受试者操作特征（ROC）曲线，计算曲线下面积（AUC），通过约登指数确定不同病因分组最佳截断值，分析其敏感度和特异度；病例组脾大小与脾硬度间的相关性采用Spearman相关性分析。

结果

病例组脾长径、厚度及杨氏模量值高于正常组［（11.24±2.76）cm vs （8.08±1.43）cm；（2.94±0.83）cm vs （2.18±0.39）cm；（24.75±8.23）kPa vs （16.11±2.66）kPa］，差异具有统计学意义（t=7.197、5.809、6.863，P均＜0.001）。合并肝硬化组脾杨氏模量值高于不合并肝硬化组［（30.72±5.82）kPa vs （21.62±7.57）kPa］，2组之间存在正相关关系（r=0.529，P＜0.001）。不同病因亚组脾杨氏模量值为PVDG＞BDG＞IDG［（28.86±5.75）kPa vs （23.90±10.13）kPa vs（16.34±3.18）kPa，H=46.353，P＜0.001］。ROC曲线分析显示IDG与BDG的最佳截断值为20.46 kPa（敏感度为63.16%，特异度为91.30%），BDG与PVDG的最佳截断值为23.80 kPa（敏感度为80.39%，特异度为73.68%）。

结论

2D-SWE可用于脾大患儿的脾硬度评估，脾大患儿脾硬度增高，合并肝硬化者尤著。不同病因所致脾大的脾硬度为PVDG＞BDG＞IDG。2D-SWE对于儿童脾大的病因诊断及脾大合并肝硬化患儿的病情评估和长期随访有潜在的临床应用价值。

Objective

To measure spleen stiffness using two-dimensional shear wave elastography（2D-SWE） in children with splenomegaly of varying etiologies by Young’s modulus values and explore its differences and clinical application value.

Methods

A total of 93 children meeting the diagnostic criteria for splenomegaly （case group） and 45 healthy children （control group） were enrolled from outpatient or inpatient departments of Wuhan Children’s Hospital between January 2022 and May 2024. The case group was further divided into subgroups： infectious disease group （IDG， n=23）， hematological disease group （BDG，n=19）， and portal venous system disease group （PVDG， n=51）. Based on ultrasound-diagnosed cirrhosis， they were classified into a cirrhosis subgroup （n=32） or non-cirrhosis subgroup （n=61）. All participants underwent conventional ultrasound and 2D-SWE examinations. Conventional 2D ultrasound parameters （spleen length and thickness） and Young’s modulus values of the splenic parenchyma were measured. Independent samples t-test was used to compare elasticity between the control and case groups. Point-biserial correlation analysis was applied for elasticity between the cirrhosis and non-cirrhosis subgroups. The Kruskal-Wallis test was used to assess elasticity differences among etiological subgroups. Receiver operating characteristic （ROC）curves were plotted for different etiological subgroups to determine the optimal cutoff values （via Youden index）， area under the curve （AUC）， sensitivity， and specificity. Spearman correlation was used to analyze the relationship between spleen size and stiffness in the case group.

Results

Spleen length， thickness， and Young’s modulus values were higher in the case group than in controls ［（11.24±2.76）cm vs （8.08±1.43）cm， （2.94±0.83）cm vs （2.18±0.39）cm， and （24.75±8.23） kPa vs （16.11±2.66） kPa， t=7.197， 5.809， and 6.863， respectively； all P＜0.001］. The cirrhosis subgroup had higher Young’s modulus values than the non-cirrhosis subgroup ［（30.72±5.82） kPa vs （21.62±7.57） kPa； r=0.529， P＜0.001］. Among etiological subgroups， Young’s modulus value was higher in the PVDG， followed by the BDG and IDG ［（28.86±5.75）kPa， （23.90±10.13） kPa， and （16.34±3.18） kPa， respectively， H=46.353， P＜0.001］. ROC analysis showed optimal cutoff values of 20.46 kPa （sensitivity 63.16%， specificity 91.30%） for distinguishing IDG from BDG and 23.80 kPa （sensitivity 80.39%， specificity 73.68%） for BDG vs PVDG.

Conclusion

2D-SWE is feasible for assessing spleen stiffness in children with splenomegaly， with significantly higher stiffness observed in cirrhotic patients. Stiffness varies by etiology （PVDG ＞ BDG ＞ IDG）. 2D-SWE has potential clinical value in the etiological diagnosis of splenomegaly in children， as well as in the disease assessment and long-term follow-up of pediatric patients with splenomegaly complicated by liver cirrhosis.