瞬时弹性成像测定肝脾硬度值评估乙型肝炎肝硬化患者食管静脉曲张初步研究

doi:10.3969/j.issn.1672-5069.2021.01.025

摘要/Abstract

摘要： 目的应用瞬时弹性成像技术检测乙型肝炎(CHB)肝硬化患者肝脏硬度值(LSM)和脾脏硬度值(SSM),预测食管胃底静脉曲张(EGV)。方法 2016年1月～2020年1月我院收治的乙型肝炎肝硬化患者166例,接受胃镜检查,将EGV分为无或轻度(非显著)及中和重度(显著),并使用FibroTouch检测LSM和SSM。采用单因素和多因素Logistic回归分析应用显著EGV发生的独立预测因素,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),分析各指标诊断的敏感性、特异性和准确性。结果胃镜检查发现本组患者非显著EGV 92例,显著EGV 74例;非显著EGV组Child-Pugh A级、B级和C级分别占63.0%、37.0%和0.0%,与显著EGV组比,差异显著(分别为40.5%、40.5%和18.0%, P<0.05);非显著EGV组腹水发生率为3.3%,显著低于显著EGV组的59.5%(P<0.05);非显著EGV组血清白蛋白水平为(34.1±5.6)g/L,显著高于显著EGV组;非显著EGV组INR为(1.1±0.4),显著低于显著EGV组;非显著EGV组PLT为(132.8±38.0)×10⁹/L,显著高于显著EGV组;门静脉内径为(12.6±1.8)mm,显著小于显著EGV组;脾脏厚度为(100.4±14.6)mm,显著小于显著EGV组;LSM为(17.2±10.2)kPa,显著低于显著EGV组;SSM为(26.6±9.1)kPa,显著低于显著EGV组;多因素分析结果显示ALB、INR、PLT、门静脉内径、脾脏厚度、LSM和SSM是影响乙型肝炎肝硬化患者发生显著EGV的独立预测因素(P<0.05);应用LSM等于26.6 kPa和SSM等于43.2 kPa为截断点联合诊断显著EGV,其AUC、敏感性、特异性和准确性分别为0.87、83.5%、91.8%和89.6%。结论应用FibroTouch检测乙型肝炎肝硬化患者肝脾硬度能够有效预测患者EGV的发生,值得临床进一步验证。

关键词: 肝硬化, FibroTouch, 食管胃底静脉曲张, 肝硬度测定, 脾脏硬度测定, 受试者工作特征曲线, 诊断

Abstract: Objective The aim of this study was to evaluate esophageal and gastric varices (EGV) by liver and splenic stiffness measurement (LSM and SSM) by elastography in patients with hepatitis B liver cirrhosis (LC). Methods A total of 166 patients with hepatitis B LC were included in our hospital from January 2016 to January 2020, and all of them underwent gastroscopy for EGV finding and FibroTouch for LSM and SSM. The EGV was defined as non-advanced and advanced one. The univariate and multivariate Logistic regression analysis were performed to determine the independent predictors for advanced EGV. The receiver operating characteristic curve (ROC) was drawn, and the area under ROC (AUC), sensitivity, specificity and accuracy were calculated. Results The gastroscopy showed the non-advanced EGV in 92 and advanced EGV in 74 patients with LC in our series; the percentages of Child-Pugh class A, class B and class C in patients with non-advanced EGV were 63.0%, 37.0% and 0.0%, significantly different compared to advanced EGV(40.5%, 40.5% and 18.0%,respectively, P<0.05); the incidence of ascites was 3.3%, significantly lower than 59.5%(P<0.05) in advanced EGV and serum albumin level was (34.1±5.6)g/L, significantly higher than , the INR was (1.1±0.4), much lower than [(1.4±0.6), P<0.05], the platelet count was (132.8±38.0)×10⁹/L, significantly higher than , the diameter of portal vain was (12.6±1.8)mm, much smaller than , the thickness of spleen was (100.4±14.6)mm, significantly smaller than , the LSM was (17.2±10.2) kPa, significantly lower than and the SSM was (26.6±9.1)kPa, much lower than in patients with advanced EGV; the multivariate Logistic regression analysis showed that the serum albumin level, INR, PLT count, diameter of portal vain and thickness of spleen, LSM and SSM were the independent factors for advanced EGV occurrence in patients with LC(P<0.05); when the LSM equal to 26.6 kPa and SSM to 43.2 kPa as the cut-off-value for combination diagnosis of advanced EGV, the AUC, sensitivity, specificity and accuracy were 0.87, 83.5%, 91.8% and 89.6%.Conclusion FibroTouch detection of LSM and SSM in patients with hepatitis B-induced liver cirrhosis could effectively predict the occurrence of EGV, which needs further investigation.

Key words: Liver cirrhosis, FibroTouch, Esophageal and gastric varices, Liver stiffness measurement, Spleen stiffness measurement, Receiver operating characteristic curve, Diagnosis

张昕, 郭悦, 杨军. 瞬时弹性成像测定肝脾硬度值评估乙型肝炎肝硬化患者食管静脉曲张初步研究[J]. 实用肝脏病杂志, 2021, 24(1): 95-98.

Zhang Xin, Guo Yue, Yang Jun. Evaluation ofesophageal and gastric varices by liver and splenic stiffness measurement by elastography in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2021, 24(1): 95-98.

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