超声联合剪切波弹性成像评估肝硬化门脉高压症患者并发高风险食管静脉曲张价值分析*

doi:10.3969/j.issn.1672-5069.2025.01.026

摘要/Abstract

摘要： 目的探讨应用超声和剪切波弹性成像检测参数评估肝硬化门脉高压症患者发生食管静脉曲张(EV)的价值。方法 2022年1月～2024年4月我院收治的肝硬化并发门静脉高压症患者92例,使用超声检测门静脉内径(PVD)、脾静脉内径(SVD)、门静脉峰值流度(PVVmax)和脾静脉峰值流速(SVVmax),使用超声剪切波弹性成像(SWE)技术行肝脏硬度检测(LSM)和脾脏硬度检测(SSM),应用多因素Logistic回归分析影响因素,绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析超声联合SWE参数诊断肝硬化患者发生高风险EV(HREV)的效能。结果经内镜检查发现,92例肝硬化门静脉高压症患者发生HREV 者35例(38.0%);HREV组Child-Pugh分级和外周血血小板计数与非-HREV组比,差异有统计学意义(P＜0.05); HREV组PVD和SVD分别为(16.7±3.1)mm和(11.2±2.1)mm,均显著大于非HREV组【分别为(13.4±1.7)mm和(8.6±1.7)mm,P＜0.05】,而PVVmax和SVVmax分别为(12.6±2.4)cm/s和(14.3±3.0)cm/s,均显著小于非HREV组【分别为(15.7±1.9)cm/s和(17.2±2.1)cm/s,P＜0.05】;HREV组LSM和SSM分别为(18.4±3.8)kPa和(31.5±6.4)kPa,均显著大于非-HREV组【分别为(12.3±2.4)kPa和(25.7±5.8)kPa,P＜0.05】;多因素Logistic分析显示PVD和LSM是影响肝硬化患者发生HREV的独立危险因素,而PVVmax是影响肝硬化患者发生HREV的保护性因素(均P＜0.05);ROC分析显示应用PVD、 PVVmax和LSM评估肝硬化患者发生HREV均有一定的应用价值(Z=2.87,P=0.13;Z=2.74,P=0.15;Z=2.35,P=0.37),但三者联合会降低诊断的敏感度,而提高特异度。结论超声联合SWE检测参数评估肝硬化患者发生HREV具有一定的临床应用价值,值得进一步研究。

关键词: 肝硬化, 高危食管静脉曲张, 门静脉直径, 剪切波弹性成像, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of ultrasonography and shear wave elastography (SWE) in predicting high risk esophageal varices (HREV) in patients with liver cirrhosis (LC). Methods 92 patients with LC and cirrhotic portal hypertension were admitted to our hospital between January 2022 and April 2024, and all underwent ultrasonography for portal vein diameter (PVD), splenic vein diameter (SVD), portal vein maximum velocity (PVVmax) and splenic vein maximum velocity (SVVmax). Liver stiffness measurement (LSM) and splenic stiffness measurement (SSM) were measured by using SWE mode. Multivariate Logistic regression analysis was applied to reveal impacting factors, and receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy. Results Endoscopy found HREV in 35 cases (38.0%) in 92 patients with cirrhotic portal hypertension in our series; there were significant differences as respect to percentages of Child-Pugh class B/C and blood platelet counts between HREV and non-HREV groups (P＜0.05); PVD and SVD in HREV group were (16.7±3.1)mm and (11.2±2.1)mm, both significantly greater than [(13.4±1.7) mm and (8.6±1.7)mm, respectively, P＜0.05], while PVVmax and SVVmax were (12.6±2.4)cm/s and (14.3±3.0) cm/s, both significantly less than [(15.7±1.9)cm/s and (17.2±2.1)cm/s, respectively, P＜0.05] in non-HREV group; LSM and SSM were (18.4±3.8)kPa and (31.5±6.4)kPa, both much greater than [(12.3±2.4)kPa and (25.7±5.8)kPa, respectively, P＜0.05] in non-HREV group; multivariate Logistic regression analysis showed that PVD and LSM were independent risk factors impacting occurrence of HREV, while the PVVmax was a protecting factor (all P＜0.05); ROC analysis demonstrated that PVD, PVVmax and LSM had a diagnostic efficacy in predicting existence of HREV (Z=2.87, P=0.13; Z=2.74, P=0.15; Z=2.35, P=0.37), while combination of the three parameters could improve specificity with a slight reduction of sensitivity. Conclusion Ultrasonography and SWE have a certain clinical implication in predicting occurrence of HREV in cirrhotics with portal hypertension, which warrants further investigation.

Key words: Liver cirrhosis, High risk esophageal varices, Portal vein diameter, Shear wave elastography, Diagnosis

司同, 朱家宝, 吴彬彬. 超声联合剪切波弹性成像评估肝硬化门脉高压症患者并发高风险食管静脉曲张价值分析^*[J]. 实用肝脏病杂志, 2025, 28(1): 100-103.

Si Tong, Zhu Jiabao, Wu Binbin. Ultrasonography and shear wave elastography in predicting high risk esophageal varices in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(1): 100-103.

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超声联合剪切波弹性成像评估肝硬化门脉高压症患者并发高风险食管静脉曲张价值分析^*

Ultrasonography and shear wave elastography in predicting high risk esophageal varices in patients with liver cirrhosis

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