瞬时弹性成像在肝硬化门静脉高压中的临床评价  

Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography

作　　者：刘芳[1] 李庭红[1] 韩涛[1] 向慧玲[1] 张洪生[1] 

机构地区：[1]天津市第三中心医院肝内科天津市肝胆疾病研究所天津市人工细胞重点实验室,300170

出　　处：《中华肝脏病杂志》2013年第11期840-844,共5页Chinese Journal of Hepatology

摘　　要：目的分析瞬时弹性成像（Fibroscan）对肝硬化患者肝脏及脾脏硬度测量值（FS值）与门静脉高压相关指标间的关系，探讨Fibroscan检测在肝硬化门静脉高压中的临床应用价值。方法对259例肝硬化患者进行Fibroscan检查，测量肝脏及脾脏硬度，并做影像学检查，其中101例患者进行胃镜检查，分析肝脏FS值及脾脏FS值与食管静脉曲张程度、门静脉宽度、脾脏厚度及体积、脾静脉宽度之间的相关洼，用受试者工作特征（ROC）曲线及曲线下面积（AUc）判断肝脏及脾脏硬度值对食管静脉曲张的预测价值。结果肝脏病变程度越重，肝脏及脾脏FS值越高，肝硬化患者肝脏FS值与脾脏FS值呈正相关垆〈0．05），肝脏FS值及脾脏FS值与食管静脉曲张程度、门静脉宽度、脾脏厚度及体积、脾静脉宽度呈正相关垆〈0．05），其中脾脏FS值的相关I生均高于肝脏FS值，脾脏FS值与白细胞、血小板计数呈负相关，随着肝硬化患者食管静脉曲张程度加重，肝脏及脾脏FS值进行性增加，AuC脾脏FS值优于肝脏FS值（0．804〉0．737），肝脏及脾脏FS值预测食管静脉曲张的最佳界值点分别为18．0kPa、44．5kPa。结论Fibroman是一种能反映肝硬化门静脉高压的评估方法，肝脏及脾脏测量值与肝硬化门静脉高压指标密切相关，脾脏Fs值对门静脉高压的诊断更具有临床意义。Objective To investigate the clinical value of FibroScan transient elastography for assessing portal hypertension in liver cirrhosis patients by determining the relationship between the liver or spleen stiffness measurement with the imaging parameters of esophageal varices, portal vein width, spleen volume, and splenic vein width. Methods A total of 259 patients with liver cirrhosis underwent FibroScan measurement, ultrasound, computed tomography and routine blood analyses. One-hundred- and-one of those patients also underwent endoscopy to diagnose esophageal varices. Receiver operating characteristic （ROC） curves were generated and the areas under the curves （AUCs） were calculated to assess the accuracy of the FibroScan liver and spleen stiffness measurements to predict esophageal varices. Pearson＇s correlation analysis was used to assess the relationship between clinical features. Results The median liver and spleen stiffness of the cirrhotic patients were 24.27 kPa and 44.64 kPa, respectively. Liver and spleen stiffness increased in conjunction with increases in Child-Pugh score. Liver stitSaess was positively correlated with spleen stiffness （P 〈 0.05）. Liver and spleen stiffness were positively correlated with esophageal varices, portal vein width, spleen thickness, spleen volume, and splenic vein width. The correlation of spleen stiffness was higher than that of liver stiffness. Spleen stiffness was also negatively correlated with white blood cell count and plateletcount. Liver and spleen stiffness also increased in conjunction with increased severity of esophageal varices. The AUC of spleen stiess was higher than that of liver stiffness for predicting esophageal varices （0.804 vs. 0.737）. The optimal cut-off level of spleen stiffness was 44.5 kPa （sensitivity： 88%; specificity： 68%）. The estimated prevalence of esophageal varices was 97.87% and the optimized cut-off level of liver stiffness was 18.0 kPa. Conclusion FibroScan appears to be a clinically valuable non-invasive metho

关 键 词：肝硬化 食管和胃静脉曲张 门静脉 

分 类 号：R575.2[医药卫生—消化系统]