CT相关参数判断乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血风险的价值研究

doi:10.3969/j.issn.1672-5069.2020.06.024

摘要/Abstract

摘要： 目的研究CT相关参数诊断乙型肝炎肝硬化患者临床显著性门静脉高压(SCPH)和判断食管胃底静脉曲张破裂出血风险的价值。方法 2016年5月～2019年11月本院收治的62例乙型肝炎肝硬化患者均接受CT检查,记录CT检查相关参数,同时检测肝静脉压力梯度(HVPG)。以HVPG为金标准,采用受试者工作曲线(ROC)分析CT相关参数诊断SCPH和预测食管胃底静脉曲张破裂出血的价值。结果在62例患者中27例存在SCPH;27例SCPH组全肝体积为(1015.7±162.8)cm³,显著低于35例非SCPH组[(1174.2±204.5)cm³,P<0.05],脾脏体积为(852.1±264.3)cm³,显著大于非SCPH组[(593.9±303.4)cm³,P<0.05],门静脉宽度为(1.7±0.2)cm,显著大于非SCPH组[(1.5±0.1)cm³,P<0.05],脾静脉宽度为(1.1±0.2)cm,显著大于非SCPH组[(0.9±0.2)cm,P<0.05],HVPG为(12.9±2.4)mmHg,显著高于非SCPH组[(8.0±1.7)mmHg,P<0.05];ROC分析显示脾脏体积(AUC=0.742,敏感度=0.778)、全肝体积(AUC=0.802,敏感度=0.809)、门静脉宽度(AUC=0.777,敏感度=0.815)和脾静脉宽度(AUC=0.708,敏感度=0.815)诊断SCPH具有较高的价值(P均<0.05);随访半年,62例患者发生食管胃底静脉曲张破裂出血13例;ROC分析结果显示脾脏体积(AUC=0.727,敏感度=0.882)、全肝体积(AUC=0.686,敏感度=0.765)、门静脉宽度(AUC=0.684,敏感度=0.824)和脾静脉宽度(AUC=0.787,敏感度=0.771)判断食管胃底静脉曲张破裂出血具有较高的敏感度(P均<0.05)。结论 CT检查的乙型肝炎肝硬化患者门静脉系统相关参数与HVPG密切相关,监测CT相关参数有助于SCPH的诊断和食管胃底静脉曲张破裂出血的预测。

关键词: 肝硬化, 临床显著性门静脉高压, 门静脉参数, 肝静脉压力梯度, 食管胃底静脉曲张破裂出血

Abstract: Objective To investigate the value of CT-detected portal parameters in the diagnosis ofsignificant clinical portal hypertension (SCPH) and predictingesophageal and gastric variceal bleeding in patients with hepatitis B cirrhosis. Methods 62 patients with hepatitis B liver cirrhosis were admitted to our hospital from May 2016 to November 2019, and all patients received CT examination having relevant portal parameters recorded. The hepatic vein pressure gradient (HVPG) was detected. The receiver operating characteristic curve (ROC) were applied to analyze CT-related parameters to diagnose SCPH when the HVPG was acted as the gold standard, and to predict bleeding of esophageal and gastric varices. Results There were 27 patients having SCPH in our series; the total liver volume in this 27 patient with SCPH was (1015.7±162.8)cm³, significantly smaller than [(1174.2±204.5)cm³,P<0.05] in 35 patients without SCPH, the spleen volume was (852.±264.3) cm³, significantly larger than [(593.9±303.4) cm³, P<0.05],the width of portal vein was (1.2±0.2)cm, significantly wider than [(1.0±0.3) cm³, P<0.05)], and the width of splenic vein was (1.1±0.2) cm, significantly wider than [(0.9±0.2)cm, P<0.05] in patients without SCPH; the ROC analysis showed that the spleen volume (AUC=0.742,the sensitivity = 0.778), the whole liver volume (AUC = 0.802, sensitivity = 0.809), the portal vein width (AUC = 0.777, sensitivity = 0.815) and spleen vein width (AUC = 0.708, sensitivity = 0.815) had good value in the diagnosis of SCPH (P<0.05), and that the spleen volume (AUC = 0.727, sensitivity = 0.882), the whole liver volume (AUC = 0.686, sensitivity = 0.765), the portal vein width (AUC = 0.684, sensitivity = 0.824) and the spleen vein width (AUC = 0.787, sensitivity = 0.771) had higher sensitivity to forecast the esophageal and gastric variceal bleeding (P<0.05). Conclusion The portal parameters by CT scan in patients with hepatitis B cirrhosis are closely related to HVPG, and they might be helpful for the diagnosis of SCPH and judgement of esophageal and gastric variceal bleeding in clinical practice.

Key words: Liver cirrhosis, Significant clinical portal hypertension, CT scan, Portal parameters, Hepatic vein pressure gradient, Esophageal variceal bleeding

吴荣刚, 张必全, 王珍. CT相关参数判断乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血风险的价值研究[J]. 实用肝脏病杂志, 2020, 23(6): 853-856.

Wu Ronggang, Zhang Biquan, Wang Zhen. Value of CT-detected portal parameters in the diagnosis of significant clinical portal hypertension and predicting variceal bleeding in patients with hepatitis B cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(6): 853-856.

参考文献

[1] Chayanupatkul M , Omino R , Mittal S ,et al. Hepatocellular carcinoma in the absence of cirrhosis in patients with chronic hepatitis B virus infection. J Hepatol, 2016,66(2):355-362.
[2] 丹珠永吉,刘芝兰,禄艳艳,等.内镜下序贯套扎和硬化剂治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效及对血流动力学的影响对比研究.实用肝脏病杂志,2019,22(5):692-695.
[3] Baik S K,Lim Y L,Cho Y Z ,et al.Rifaximin and propranolol combination therapy is more effective than propranolol monotherapy in the hepaticvenous pressure gradient response and propranolol dose reduction-a pilot study. J Hepatol, 2015, 62(3):188-189.
[4] Diagnosis and treatment guidelines for aberrant portal hemodynamics. Hepatol Res,2017,47(5):373-386.
[5] Huang J Y , Samarasena J B , Tsujino T, et al. EUS-guided portal pressure gradient measurement with a simple novel device: a human pilot study. Gastrointest Endosc, 2016, 85(5):996-1001.
[6] 李珊玫, 高知玲, 吕茜婷,等.全肝CT灌注成像定量评估肝癌经肝动脉化疗栓塞术后血流状态变化的价值. 中华肝脏病杂志,2018, 26(6):429-435.
[7] Rypins E B , Sankary H , Wynn M J. Bedside micro-method for measuring effective hepatic blood flow, with use of first-order galactose clearance pharmacokinetics. Clin Chem,2020,31(9):1557-1559.
[8] 中华医学会肝病学分会和感染病学分会.慢性乙型肝炎防治指南(2019年版).实用肝脏病杂志,2020,23(1)S9-32.
[9] 中国门静脉高压诊断与监测研究组(CHESS),中华医学会消化病学分会微创介入协作组, 中国医师协会介入医师分会急诊介入专委会,等.中国肝静脉压力梯度临床应用专家共识(2018年版).中华肝脏病杂志, 2018, 26(11):801-812.
[10] Grace L, Liang L Y, Kwok R, et al. Low risk of variceal bleeding in patients with cirrhosis after variceal screening stratified by liver/spleen stiffness. Hepatology, 2019,70(3):971-981.
[11] Yin X Y , Lu M D , Huang J F , et al. Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: correlation with esophageal variceal bleeding.J Clin Ultrasound, 2015, 29(1):7-13.
[12] Lens S , Alvarado E , Zoe Mariño, et al. Effects of all-oral anti-viral therapy on HVPG and systemic hemodynamics in patients with Hepatitis C virus-associated Cirrhosis. Gastroenterology, 2017,153(5):1273-1283.
[13] Mandorfer M , Schwabl P , Paternostro R , et al. Von willebrand factor indicates bacterial translocation, inflammation, and procoagulant imbalance and predicts complications independently of portal hypertension severity. Aliment Pharm Therap, 2018, 47(7):e28-e56.
[14] Yan S P , Wu H , Wang G C , et al. A new model combining the liver/spleen volume ratio and classification of varices predicts HVPG in hepatitis B patients with cirrhosis. Eur J Gastroen Hepat, 2015,27(3):335-343.
[15] Talaki, E, Schaffellner S, Kniepeiss D,et al. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension. Eur Radiol,2017,27(10):4173-4180.
[16] Damsgaard J , Larsen F S , Ytting H . Reversal of acuteliver failure due to Wilson disease by a regimen of high‐volume plasma exchange and penicillamine.Hepatology, 2019, 69(4):1835-1837.
[17] Dillman J R , Trout A T , Costello E N , et al. Quantitative liver MRI-biopsy correlation in pediatric and young adult patients with nonalcoholic fatty liver disease: can one be used to predict the other.Am J Roentgenol, 2017, 210(1):1-9.
[18] Schwabl P , Brusilowska K , Riedl F , et al. The guanylyl cyclase stimulator rloclguat reduces liver fibrosis and portal pressure in cirrhotic rats. J Hepatol, 2016, 64(2):140-148.
[19] Lv Y , Zhang B , Guo W , et al. Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension with or without portal vein thrombosis in 1,171 patients with cirrhosis: A 14-year retrospective study from a single center.J Hepatol, 2016, 64(2):S659-S659.
[20] Jansen C , Bogs C , Verlinden W , et al. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: a prospective multi-center study. Liver Int, 2017, 37(3):396-405.