肝脏超声血流参数联合肝脾硬度检测预测乙型肝炎肝硬化并发食管静脉曲张破裂出血价值研究*

doi:10.3969/j.issn.1672-5069.2025.03.024

摘要/Abstract

摘要： 目的探讨肝脏超声血流参数联合肝脏硬度检测(LSM)和脾脏硬度检测(SSM)预测乙型肝炎肝硬化并发食管静脉曲张(EV)患者发生EV破裂出血(EVB)的价值。方法 2022年1月～2023年2月我院收治的乙型肝炎肝硬化患者89例,接受胃镜检查,记录EV情况。接受多普勒超声检查,检测门静脉内径(PVD)、门静脉充血指数(PV-CI)、门静脉血流流速(PVV)和肝静脉减振指数(HV-DI)。使用FibroTouch检测LSM和SSM。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析各指标预测EVB的效能。结果经胃镜检查发现并发EV患者57例(64.1%);肝硬化并发EV组HV-DI、PVD、PV-CI、LSM和SSM分别为(0.9±0.2)、(1.7±0.4)cm、(0.4±0.1)cm/s、(19.3±3.6)kPa和(46.1±11.6)kPa,均显著高于肝硬化组【分别为(0.7±0.1)、(1.4±0.2)cm、(0.2±0.1)cm/s、(12.3±3.1)kPa和(34.5±7.9)kPa,P<0.05】,而PVV为(15.8±3.3)cm/s,显著低于肝硬化组【(19.2±2.5)cm/s,P<0.05】;16例重度EV患者HV-DI、PVD、PV-CI、LSM和SSM均显著高于20例中度或21例轻度患者,而PVV则显著低于中度或轻度患者 (P<0.05);在随访的1年里,本组并发EV患者发生EVB者34例(59.7%); 经ROC曲线分析显示,HV-DI、PVV、PVD、PV-CI、LSM和SSM预测肝硬化患者发生EVB具有较高的效能,而各指标联合预测的AUC为0.885(95%CI:0.757～0.916),其敏感性为97.1%,特异性为80.0%,显著优于单一指标预测(P<0.05)。结论应用肝脏超声血流参数联合LSM和SSM预测乙型肝炎肝硬化患者发生EVB有一定的临床价值,值得深入研究。

关键词: 肝硬化, 食管静脉曲张破裂出血, 肝脏硬度检测, 脾脏硬度检测, 门静脉内径, 诊断

Abstract: Objective The aim of this study was to explore prediction of esophageal varices bleeding (EVB) by liver ultrasound blood flow parameters and liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) in patients with liver cirrhosis (LC). Methods 89 patients with hepatitis B-induced LC were enrolled in our hospital between January 2022 and February 2023, all underwent gastroscopy and EV was recorded and classified. All patients underwent Doppler ultrasonography to detect portal vein diameter (PVD), congestion index of portal vein (PV-CI), portal vein velocity (PVV) and damping index of hepatic vein (HV-DI). LSM and SSM were detected by FibroTouch. The sensitivity (Se) and specificity (Sp) of different indexes in predicting EVB were analyzed by area under the receiver operating characteristic (ROC) curve (AUC). Results Gastroscopy showed EV in 57 cases(64.1%)in our series; HV-DI, PVD, PV-CI as well as LSM and SSM in patients with EV were (0.9±0.2), (1.7±0.4)cm, (0.4±0.1)cm/s, (19.3±3.6)kPa and (46.1±11.6)kPa, all significantly higher than [(0.7±0.1), (1.4±0.2)cm, (0.2±0.1)cm/s, (12.3±3.1)kPa and (34.5±7.9)kPa, respectively, P<0.05], while PVV was (15.8±3.3)cm/s, significantly lower than [(19.2±2.5)cm/s, P<0.05] in those without EV; HV-DI, PVD, PV-CI, LSM and SSM in 16 patients with severe EV were significantly higher than in 20 patients with moderate EV or in 21 patients with mild EV, while PVV was much lower than in with moderate or mild EV (P<0.05); during one year of follow-up, EVB occurred in 34 cases (59.7%) of 57 patients with EV; ROC analysis showed that HV-DI, PVV, PVD, PV-CI, LSM and SSM could predict EVB occurrence, and combination of them had a satisfactory efficacy, with the AUC of 0.885(95%CI:0.757-0.916), Se of 97.1% and Sp of 80.0%, much superior to mono-parameter(P<0.05). Conclusion Liver ultrasonic blood flow parameters and LSM and SSM combination has a high efficacy in predicting EVB occurrence in patients with LC, which warrants further clinical investigation.

Key words: Liver cirrhosis, Esophageal varices bleeding, Portal vein diameter, Liver stiffness measurement, Spleen stiffness measurement, Prediction

刘玉华, 张源, 郭家婷. 肝脏超声血流参数联合肝脾硬度检测预测乙型肝炎肝硬化并发食管静脉曲张破裂出血价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 414-417.

Liu Yuhua, Zhang Yuan, Guo Jiating. Prediction of esophageal varices bleeding by liver ultrasound blood flow parameters and liver and spleen stiffness measurement in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(3): 414-417.

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肝脏超声血流参数联合肝脾硬度检测预测乙型肝炎肝硬化并发食管静脉曲张破裂出血价值研究^*

Prediction of esophageal varices bleeding by liver ultrasound blood flow parameters and liver and spleen stiffness measurement in patients with liver cirrhosis

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