乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化*

doi:10.3969/j.issn.1672-5069.2023.04.019

摘要/Abstract

摘要： 目的探讨乙型肝炎肝硬化并发食管静脉曲张(EV)患者肝血流超声参数和红细胞分布宽度(RDW)与淋巴细胞比值(RLR)的变化。方法 2018年4月～2021年3月我院收治的乙型肝炎肝硬化患者188例,均接受多普勒超声和超声造影检查,检测肝静脉减震指数(HV-DI)、门静脉流速(PVV)、门静脉内径(PVD)和门静脉充血指数(PV-CI)。接受胃镜检查,记录EV及其程度。结果内镜检查发现,120例并发EV;肝硬化并发EV组PVV和HVAT分别为(15.2±2.3)cm/s和(15.3±2.4)s,显著低于肝硬化组【分别为(18.9±2.4)cm/s和(22.1±3.5)s,P<0.05】,而PVD、PV-CI、HV-DI和RLR分别为(1.6±0.2)cm、(0.4±0.1)cm/s、(0.8±0.1)和(24.2±3.5),均显著高于肝硬化组【分别为(1.3±0.2)cm、(0.2±0.1)cm/s、(0.6±0.1)和(9.2±1.1),P<0.05】;33例重度EV患者PVV和HVAT分别为(12.8±2.5)cm/s和(8.2±0.9)s,显著低于42例中度EV患者【分别为(14.2±2.1)cm/s和(12.5±3.1)s,P<0.05】或45例轻度EV患者【分别为(17.9±2.1)cm/s和(23.1±3.4)s,P<0.05】,而PVD、PV-CI、HV-DI和RLR分别为(2.2±0.3)cm、(0.7±0.1)cm/s、(1.5±0.1)和(32.7±4.1),显著高于中度EV患者【分别为(1.5±0.1)cm、(0.4±0.1)cm/s、(0.7±0.1)和(26.7±2.8),P<0.05】或轻度EV患者【分别为(1.3±0.1)cm、(0.2±0.1)cm/s、(0.4±0.1)和(15.6±1.5),P<0.05】;在随访的12个月里,EV患者发生EV出血(EVB)72例,出血组PVV和HVAT显著低于未出血组,而PVD、PV-CI、HV-DI和RLR均显著高于未出血组(P<0.05)。结论监测肝血流超声参数和RLR变化可能为预测乙型肝炎肝硬化并发EVB提供预警,值得进一步研究应用。

关键词: 肝硬化, 食管静脉曲张, 肝静脉减震指数, 门静脉充血指数, 红细胞分布宽度/淋巴细胞比值

Abstract: Objective The aim of this study was to investigate the changes of hepatic blood flow parametersobtained by ultrasonography and red blood cell distribution width (RDW) to lymphocyteratio (RLR) in patients with liver cirrhosis andesophageal varices (EV). Methods 188 patients with hepatitis B livercirrhosis and EV were encountered in our hospital between April 2018 and March 2021, and all underwent Doppler ultrasonography and contrast-enhanced ultrasonography to obtain hepatic vein damping index (HV-DI), portal vein velocity (PVV), internal diameter of portal vein (PVD) and portal vein congestion index (PV-CI), andgastroscope to determine the severity of EV. Results The gastroscopy found EV in 120 patients; the PVV and HVAT in patients with EV were (15.2±2.3)cm/s and (15.3±2.4)s, much lower than [(18.9±2.4)cm/s and (22.1±3.5)s, P<0.05], while the PVD, PV-CI, HV-DI and RLR were (1.6±0.2)cm, (0.4±0.1)cm/s, (0.8±0.1) and (24.2±3.5), much higher than [(1.3±0.2)cm, (0.2±0.1)cm/s, (0.6±0.1) and (9.2±1.1), respectively, P<0.05] in patients without EV; the PVV and HVAT in 33 patients with severe EV were (12.8±2.5)cm/s and (8.2±0.9)s, much lower than [(14.2±2.1)cm/s and (12.5±3.1)s, P<0.05] in 42 patients with moderate EV or [(17.9±2.1)cm/s and (23.1±3.4)s, P<0.05] in 45 patients with mild EV, while the PVD, PV-CI, HV-DI and RLR were (2.2±0.3)cm, (0.7±0.1)cm/s, (1.5±0.1) and (32.7±4.1), all much higher than [(1.5±0.1)cm, (0.4±0.1)cm/s, (0.7±0.1) and (26.7±2.8), respectively, P<0.05] in patients with moderate EV or [(1.3±0.1)cm, (0.2±0.1)cm/s, (0.4±0.1) and (15.6±1.5), respectively, P<0.05] in patients with mild EV; during the 12-month follow-up, the EV bleeding (EVB) occurred in 72 cases, and the PVV and HVAT in patients with EVB was significantly lower, while the PVD, PV-CI, HV-DI and RLR was significantly higher than in patients without EVB (P<0.05). Conclusion The monitoring of hepatic blood flow parameters by ultrasonography and RLR might provide clues for predicting EVB in patients with liver cirrhosis and EV, which warrants further clinical investigation.

Key words: Liver cirrhosis, Esophageal varices, Hepatic vein damping index, Portal vein congestion index, Red blood cell distribution width

赵小利, 秦博, 李东风, 王娟. 乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化^*[J]. 实用肝脏病杂志, 2023, 26(4): 528-531.

Zhao Xiaoli, Qin Bo, Li Dongfeng, et al. Changes of hepatic blood flow parameters by ultrasonography and red blood cell distribution width to lymphocyte ratio in patients with hepatitis B cirrhosis and esophageal varices[J]. Journal of Practical Hepatology, 2023, 26(4): 528-531.

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乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化^*

Changes of hepatic blood flow parameters by ultrasonography and red blood cell distribution width to lymphocyte ratio in patients with hepatitis B cirrhosis and esophageal varices

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