超声剪切波成像技术检测预测肝硬化患者并发食管静脉曲张破裂出血价值分析*

doi:10.3969/j.issn.1672-5069.2026.02.023

摘要/Abstract

摘要： 目的分析超声剪切波成像(SWE)技术检测指标预测肝硬化患者发生食管静脉曲张破裂出血(EVB)的价值。方法 2022年5月～2024年2月我院诊治的肝硬化患者79例,行胃镜检查了解曲张静脉(EV)发生情况,使用SWE检测感兴趣区(ROI)杨氏模量最大值(Emax)、最小值(Emin)和平均值(Emean),采用多因素Logistic回归分析危险因素,应用受试者工作特征(ROC)曲线分析预测效能。结果胃镜检查发现本组肝硬化患者存在轻度EV者12例,中度EV者32例,重度EV者35例;随访1年,79例肝硬化患者发生EVB者30例(38.0%);EVB组基线有腹水和Child C级占比分别为53.3%和90.0%,均显著高于非EVB组的10.2%和18.4%(P<0.05),血清ALB水平和PLT计数分别为(30.7±2.6)g/L和(65.9±13.2)×10⁹/L,均显著低于非EVB组【分别为(35.9±4.2)g/L和(94.2±11.8)×10⁹/L,P<0.05】;EVB组Emax、Emin和Emean分别为(17.4±3.1)kPa、(11.3±2.1)kPa和(14.0±2.6)kPa,均显著大于非EVB组【分别为(12.7±2.6)kPa、(8.7±1.8)kPa和(11.2±2.2)kPa,P<0.05】;多因素Logistic回归分析显示PLT计数((OR=1.458,95% CI:1.140～2.162)、Emax(OR=1.415,95% CI:1.103～1.815)、Emin(OR=1.318,95% CI:1.056～1.645)和Emean(OR=1.631,95%CI:1.232～2.158)是肝硬化患者发生EVB的危险因素;ROC曲线显示,PLT计数联合任一SWE参数预测EVB发生的曲线下面积(AUC)为0.900(95% CI:0.812～0.956),其灵敏度为70.0%,特异度为95.9%。结论应用PLT联合SWE检测肝脏杨氏模量可以帮助初步评估肝硬化患者发生EVB的风险。

关键词: 肝硬化, 食管静脉曲张破裂出血, 超声剪切波成像, 预测

Abstract: Objective The aim of this study was to investigate efficacy of ultrasound shear wave elastography (SWE) in predicting esophageal variceal bleeding (EVB) in patients with liver cirrhosis (LC). Methods 79 patients with LC were encountered in our hospital between May 2022 and February 2024, and all underwent gastroscopy to determine esophageal varices (EV). SWE was conducted to record Yang’s modulus in region of interest (ROI) as maximum value (Emax), minimum value (Emin) and mean value (Emean). The risk factors of EVB in patients with LC were explored by multivariate Logistic regression analysis, and predicting efficacy was analyzed by receiver operating characteristic (ROC) curve. Results Gastroscopy found mild EV in 12 cases, moderate in 32 cases and severe in 35 cases; by end of one-year follow-up, EVB occurred in 30 cases (38.0%) in our series; percentages of ascites and Child-Pugh class C in patients with EVB were 53.3% and 90.0%,both significantly higher than 10.2% and 18.4%(P<0.05), and serum ALB level and peripheral blood PLT count were (30.7±2.6)g/L and (65.9±13.2)×10⁹/L, both much lower than [(35.9±4.2)g/L and (94.2±11.8)×10⁹/L,respectively, P<0.05] in those without EVB; Emax, Emin and Emean in patients with EVB were (17.4±3.1)kPa, (11.3±2.1)kPa and (14.0±2.6)kPa,all much greater than [(12.7±2.6)kPa, (8.7±1.8)kPa and (11.2±2.2)kPa,respectively, P<0.05] in those without EVB; multivariate Logistic regression analysis showed that PLT counts((OR=1.458,95% CI:1.140-2.162), Emax(OR=1.415,95% CI:1.103-1.815),Emin(OR=1.318,95% CI:1.056-1.645) and Emean(OR=1.631,95%CI:1.232-2.158) were all the independent risk factors for EVB occurrence; ROC analysis demonstrated that the AUC was 0.900(95% CI:0.812-0.956), with sensitivity of 70.0% and specificity of 95.9%, when PLT count combined with SWE parameters was set in predicting EVB risk. Conclusion SWE parameters in combination with PLT counts is valuable in predicting EVB risk in patients with decompensated LC, which might help clinicians making appropriate measures early in clinical practice.

Key words: Liver cirrhosis, Esophageal variceal bleeding, Ultrasound shear wave elastography, Yang’s modulus, Prediction

岳国栋, 孙山峰, 常书娟, 刘钟歆. 超声剪切波成像技术检测预测肝硬化患者并发食管静脉曲张破裂出血价值分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 253-256.

Yue Guodong, Sun Shanfeng, Chang Shujuan, et al. Efficacy of ultrasound shear wave elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2026, 29(2): 253-256.

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超声剪切波成像技术检测预测肝硬化患者并发食管静脉曲张破裂出血价值分析^*

Efficacy of ultrasound shear wave elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis

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