瞬时弹性成像技术对乙型肝炎肝硬化食管静脉曲张反复出血的预测价值  

Predictive value of Fibro Scan for repeated hemorrhage from esophageal varices in patients with cirrhosis secondary to hepatitis B

作　　者：孙树申 向慧玲[3] 刘芳[3] 王茂军[2] 侯运萌 李岩[3] 梁静[3] 唐飞[3] 韩涛[3] 

机构地区：[1]天津医科大学第三中心临床学院,天津市300170 [2]天津市津南区咸水沽医院内科,天津市300350 [3]天津市第三中心医院消化内科,天津市300170

出　　处：《世界华人消化杂志》2015年第3期456-461,共6页World Chinese Journal of Digestology

摘　　要：目的:利用瞬时弹性成像技术(Fibro Scan)对乙型肝炎肝硬化患者肝脏及脾脏硬度的测量,评估其对乙型肝炎肝硬化食管静脉曲张反复多次破裂出血的预测价值.方法:170例明确诊断为乙型肝炎肝硬化患者(其中未出血组110例,单次食管静脉曲张破裂出血组21例,多次出血组39例)检测血常规、凝血常规、肝功能、腹部彩超、电子胃镜及进行Fibro Scan检查测量肝脏与脾脏硬度.结果:170例患者根据Child-Pugh分级标准分为A、B、C三级,Child A级患者的肝硬度及脾硬度值为6.12 kpa±2.31 kpa、20.94 kpa±7.92 k p a,C h i l d B级患者的肝硬度及脾硬度值分别为19.00 kpa±4.58 kpa、41.00 kpa±14.77 kpa,Child C级组的肝硬度值及脾硬度值为33.00 kpa±9.76 kpa、51.33 kpa±16.28k p a,表明C h i l d-P u g h分级越高,肝硬度及脾硬度值越高(P<0.05).结合电子胃镜的检查结果,无食管静脉曲张表现的患者,其肝硬度值、脾硬度值为14.36 kpa±12.68 kpa、18.78 k p a±9.96 k p a;有轻度食管静脉曲张表现患者的肝硬度、脾硬度值为13.81 kpa±6.63 kpa、27.53 kpa±7.85 kpa;中度食管静脉曲张患者的肝硬度、脾硬度值别为22.72kpa±14.96 kpa、47.28 kpa±9.23 kpa;重度食管静脉曲张组的肝硬度值、脾硬度值为28.75 kpa±19.26 kpa、71.43 kpa±5.93 kpa.结合患者病史,食管静脉曲张反复多次破裂出血患者肝硬度值及脾硬度值分别为29.20kpa±12.07 kpa、70.40 kpa±16.19 kpa均高于单次出血患者的24.60 kpa±10.78 kpa、65.12 kpa±9.38 kpa,明显高于未出血组患者的18.67 kpa±14.23 kpa、31.59 kpa±15.69k p a(P<0.05).根据绘制的R O C曲线可知,反复多次出血组患者的肝硬度最佳界值为31.3k p a,曲线下面积为0.857,特异度为74%,敏感度为83%,脾硬度最佳界值为68.5 kpa,曲线下面积为0.928,特异度为85%,敏感度为94%.结论:应用瞬时弹性成像技术检测肝脏硬度、脾脏硬度对高危乙型肝炎肝硬化食管静脉曲张反复多次破裂�AIM：To assess the predictive value of FibroScan for repeated hemorrhage from esophageal varices in patients with cirrhosis secondary to hepatitis B.METHODS：Liver and spleen stiffness values were measured by FibroScan in 170 patients diagnosed with cirrhosis secondary to hepatitis B,including 110 without hemorrhage,21 with a single episode of hemorrhage and39 with repeated hemorrhage.The patients were divided into three groups based on Child-Pugh classification：A,B and C.All the patients underwent routine blood tests,blood coagulation tests,liver function tests,abdominal B-ultrasound and upper endoscopy.RESULTS：The liver and spleen stiffness values were 6.12 kpa ± 2.31 kpa and 20.94 kpa± 7.92 kpa in patients with Child-Pugh class A cirrhosis,19.00 kpa ± 4.58 kpa and 41.00 kpa± 14.77 kpa in patients with Child-Pugh class B,and 33.00 kpa ± 9.76 kpa and 51.33 kpa ±16.28 kpa in patients with Child-Pugh class C,respectively.According to the results of upper endoscopy,the liver and spleen stiffness values were 14.36 kpa ± 12.68 kpa and 18.78 kpa ± 9.96 kpa in patients without esophageal varices,13.81 kpa ± 6.63 kpa and 27.53 kpa± 7.85 kpa in patients with mild esophageal varices,22.72 kpa ± 14.96 kpa and 47.28 kpa ±9.23 kpa in patients with moderate esophageal varices,and 28.75 kpa ± 19.26 kpa and71.43 kpa ± 5.93 kpa in patients with severe esophageal varices,respectively.The liver and spleen stiffness values were 29.20 kpa ±12.07 kpa and 70.40 kpa ± 16.19 kpa in patients with repeated hemorrhage,respectively,significantly higher than those in patients without hemorrhage（18.67 kpa ± 14.23 kpa and 31.59 kpa ± 15.69 kpa,P〈0.05）,while the corresponding values in patients with a single episode of hemorrhage were 24.60 kpa ± 10.78 kpa and 65.12 kpa ± 9.38 kpa.According to the ROC curve analysis,the optimal cut-off value of liver stiffness for patients with repeated hemorrhage was 31.3 kpa,the area under the curve was 0.857,and the sensitivity and specificity were 74%and 83%,respectively.The

关 键 词：乙型肝炎 肝硬化 食管静脉曲张 食管静脉曲张反复多次破裂出血 脾硬度 肝硬度 瞬时弹性扫描仪 

分 类 号：R575.2[医药卫生—消化系统]