超声半定量评分结合瞬时弹性成像技术评估乙型肝炎肝硬化并发食管静脉曲张价值研究*

doi:10.3969/j.issn.1672-5069.2024.01.019

摘要/Abstract

摘要： 目的探讨采用超声半定量评分联合瞬时弹性成像技术评估乙型肝炎肝硬化患者并发食管静脉曲张(EV)的价值。方法 2020年4月～2023年4月我院诊治的乙型肝炎肝硬化患者116例,所有受试者均接受胃肠镜检查,评估EV程度。常规行肝脏超声检查并评估超声半定量评分,使用Fibroscan行肝脏硬度检测(LSM)。采用Logistic多因素分析,应用受试者工作特征曲线(ROC)并根据曲线下面积(AUC)评估各指标评估乙型肝炎肝硬化发生中重度EV的诊断价值。结果在本组患者中,胃镜检出EV者72例(62.1%),其中轻度30例(41.7%)、中度24例(33.3%)和重度18例(25.0%);中重度患者超声半定量评分为(13.2±1.6)分,显著高于轻度组【(11.7±1.3)分,P＜0.05】或无EV组【(10.4±1.2)分,P＜0.05】;中重度EV患者LSM为(23.9±4.2)kPa,显著大于轻度EV患者【(18.1±3.7)kPa,P＜0.05】或无EV患者【(13.6±2.1)kPa,P＜0.05】;多因素分析显示,超声半定量评分和LSM均是影响中重度EV发生的独立危险因素(P＜0.05);ROC分析显示,超声半定量评分联合LSM评估中重度EV发生的灵敏度和特异度分别为78.6%和83.8%,显著优于两指标单独预测(P＜0.05)。结论超声半定量评分联合瞬时弹性成像技术评估乙型肝炎肝硬化患者并发EV的严重程度具有一定的临床应用价值,值得进一步探讨。

关键词: 肝硬化, 食管静脉曲张, 超声半定量评分, 肝脏硬度检测, 诊断

Abstract: Objective This study was conducted to explore the evaluation of esophageal varices (EV) by semi quantitative ultrasound scoring (SQUS) and elastography in patients with hepatitis B viral infection-induced liver cirrhosis (LC). Methods 116 patients with hepatitis B-induced LC were encountered in our hospital between April 2020 and April 2023, and all patients underwent esophagogastroscopy as the gold standard for the diagnosis of EV. Simultaneously, the SQUS was evaluated by ultrasonography, and the liver stiffness measurement (LSM) was detected by transient elastography. The multivariate Logistic regression analysis was applied to reveal the risk factors and the area under the receiver operating characteristic curve was applied to evaluate the diagnostic performance. Results Out of our series, the esophagogastroscopy found patients with EV in 72 cases (62.1%), including mild EV in 30 cases (41.7%), moderate in 24 cases (33.3%) and severe in 18 cases (25.0%); the SQUS in 42 patients with moderate/severe EV was (13.2±1.6), much higher than [(11.7±1.3), P＜0.05] in patients with mild EV or [(10.4±1.2), P＜0.05] in individuals without EV; the LSM in patients with moderate/severe EV was (23.9±4.2)kPa, significantly greater than [(18.1±3.7)kPa, P＜0.05] in patients with mild EV or [(13.6±2.1)kPa, P＜0.05] in individuals without EV; the Logistic regression analysis showed that the SQUS and LSM were both the independent risk factors for the occurrence of moderate/severe EV (P＜0.05); the ROC analysis demonstrated the sensitivity and specificity were 78.6% and 83.8%, respectively, when the SQUS and LSM was combined in predicting the moderate/severe EV, much superior to any parameter did alone(P＜0.05). Conclusion The diagnostic efficacy of SQUS and LSM combination in predicting the severity of EV in patients with LC is promising, and warrants further clinical investigation.

Key words: Liver cirrhosis, Esophageal varices, Semi quantitative ultrasound scoring, Liver stiffness measurement, Diagnosis

宋一凡, 郑帅, 许芸, 唐铁骑. 超声半定量评分结合瞬时弹性成像技术评估乙型肝炎肝硬化并发食管静脉曲张价值研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 72-75.

Song Yifan, Zheng Shuai, Xu Yun, et al. Evaluation of esophageal varices by semi quantitative ultrasound scoring and elastography in patients with hepatitis B viral infection-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(1): 72-75.

参考文献

[1] GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol Hepatol,2020,5(3):245-266.
[2] Jakab S S, Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis,2020,24(3):335-350.
[3] Lesmana C, Raharjo M, Gani R A. Managing liver cirrhotic complications: overview of esophageal and gastric varices. Clin Mol Hepatol,2020,26(4):444-460.
[4] de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - renewing consensus in portal hypertension. J Hepatol,2022,76(4):959-974.
[5] Zuckerman M J, Elhanafi S, Mendoza L A. Endoscopic treatment of esophageal varices. Clin Liver Dis,2022,26(1):21-37.
[6] Jothimani D, Rela M, Kamath P S. Liver cirrhosis and portal hypertension: how to deal with esophageal varices. Med Clin North Am,2023,107(3):491-504.
[7] Roberts D, Best L M, Freeman S C, et al. Treatment for bleeding oesophageal varices in people with decompensated liver cirrhosis: a network meta-analysis. Cochrane Database Syst Rev,2021,4(4):D13155.
[8] 中华医学会肝病学分会,中华医学会感染病学分会. 慢性乙型肝炎防治指南. 中华流行病学杂志,2006,27(1):79-88.
[9] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[10] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 临床肝胆病杂志,2016,32(2):203-219.
[11] Payal B, M S. Ratio of platelet count to splenic diameter as a predictor of esophageal varices in cirrhosis of liver. J Assoc Physicians India,2022,70(4):11-12.
[12] Northup P G, Garcia-Pagan J C, Garcia-Tsao G, et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American association for the study of liver diseases. Hepatology,2021,73(1):366-413.
[13] Rana A, Malik A, Krishnan V, et al. Doppler hemodynamic liver index and hepatic elastic modulus: advanced ultrasonographic techniques for non-invasive prediction of esophageal varices in cirrhosis. J Clin Ultrasound,2022,50(3):354-363.
[14] Galante A, De Gottardi A. Portal vein thrombosis: an overview of current treatment options. Acta Gastroenterol Belg,2021,84(2):327-332.
[15] Munoz-Codoceo C, Amo M, Martin A, et al. Diagnostic accuracy of liver and spleen stiffness measured by fibroscan(R) in the prediction of esophageal varices in HCV-related cirrhosis patients treated with oral antivirals. Gastroenterol Hepatol,2021,44(4):269-276.
[16] Luo X, Hernandez-Gea V. Update on the management of gastric varices. Liver Int,2022,42(6):1250-1258.
[17] Glisic T, Stojkovic L M, Milovanovic T, et al. Diagnostic value of non-invasive scoring systems in the prediction of esophageal varices in patients with liver cirrhosis-single center experience. Medicina (Kaunas),2022,58(2):158.
[18] 李响,张铁英,张旭辉,等. 基于超声参数的半定量评分评估乙型肝炎肝硬化EV价值探讨. 实用肝脏病杂志,2022,25(6):857-860.
[19] Gunarathne L S, Rajapaksha H, Shackel N, et al. Cirrhotic portal hypertension: from pathophysiology to novel therapeutics. World J Gastroenterol,2020,26(40):6111-6140.
[20] Aquino-Matus J, Uribe M, Chavez-Tapia N. Liver and spleen elastography as predictor of portal hypertension and esophageal varices. Minerva Gastroenterol (Torino),2021,67(2):122-128.
[21] 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静脉曲张初步研究. 实用肝脏病杂志,2021,24(1):95-98.

超声半定量评分结合瞬时弹性成像技术评估乙型肝炎肝硬化并发食管静脉曲张价值研究^*

Evaluation of esophageal varices by semi quantitative ultrasound scoring and elastography in patients with hepatitis B viral infection-induced liver cirrhosis

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