肝脏硬度值、脾脏厚度及脾静脉直径预测乙型肝炎肝硬化患者食管静脉曲张的效能评价  

Efficacy evaluation of liver stiffness measurement,spleen thickness and splenic vein diameter in predicting esophageal varices in patients with hepatitis B cirrhosis

作　　者：钱玉鑫 杜明澍 张培 QIAN Yu-xin;DU Ming-shu;and ZHANG Pei(Department of Health Medicine,the Third Medical Center of the General Hospital of the People's Liberation Army,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心健康医学科,北京100039

出　　处：《肝脏》2024年第12期1517-1520,共4页Chinese Hepatology

基　　金：北京市科委科技计划项目(BY2012003-2)。

摘　　要：目的探讨无创检测指标肝脏硬度值(LSM)、脾脏厚度(ST)和脾静脉直径(SVD)预测乙型肝炎肝硬化患者EV发生的效能。方法回顾2019年4月—2022年12月期间解放军总医院第三医学中心收治的乙型肝炎肝硬化患者154例。乙型肝炎肝硬化、EV诊断符合标准。根据胃镜检查,将EV程度分为轻、中及重度。比较并发或未并发EV及不同EV程度患者临床资料,分析LSM、ST及SVD预测EV的诊断效能差异,随访观察EV患者EVB发生情况,并与EVB未发生的病例作比较。结果154例乙型肝炎肝硬化患者中未并发、并发EV分别为97例、57例。并发EV患者Child-Pugh A、B及C级为22例(38.6%)、24例(42.1%)及11例(19.3%),未并发EV患者Child-Pugh A、B及C级为58例(59.8%)、39例(40.2%)及0(0),差异具有统计学意义(P<0.05);并发EV组腹水、PLT、Alb、INR、LSM、ST及SVD为31例(54.4%)、(76.1±11.7)×10^(9)/L、(27.9±4.6)g/L、(1.3±0.4)、(29.1±10.4)kPa、(45.6±12.4)mm及(10.4±3.2)mm,与未并发EV组[2例(2.1%)、(129.5±16.4)×10^(9)/L、(34.0±3.9)g/L、(1.0±0.2)、(14.6±5.5)kPa、(35.3±8.0)mm及(7.6±2.1)mm]比,差异具有统计学意义(P<0.05)。经胃镜检查结果,并发EV乙型肝炎肝硬化患者中轻、中及重度例数分别为23例、19例及15例。重度EV患者LSM、ST及SVD为(40.2±17.6)kPa、(53.3±15.0)mm及(13.8±3.2)mm,与轻度EV[(21.6±9.2)kPa、(40.2±11.1)mm及(7.9±2.3)mm]、中度EV[(29.3±13.2)kPa、(46.0±12.7)mm及(10.7±3.2)mm]比,差异显著(P<0.05)。经ROC曲线分析显示,LSM、ST及SVD联合诊断乙型肝炎肝硬化患者EV发生时AUC值分别显著高于单纯LSM、ST及SVD(P<0.05),LSM、ST及SVD联合诊断AUC值、敏感度及特异度分别为0.91(0.83~0.98)、89.5%及83.5%。随访观察1年,EV患者发生EVB 21例(36.8%),治疗方式包括食管静脉曲张套扎术(EVL)15例(71.4%)、硬化剂注射术4例(19.0%)、EVL联合组织胶注射术及EVL联合硬化剂、组织胶注射术各1例(4.8%)。EVB患者LSM、ST及SVD均显著高于�Objective To explore the efficacy of noninvasive indexes such as liver stiffness measurement(LSM),spleen thickness(ST)and splenic vein diameter(SVD)in predicting esophageal varices(EV)in patients with hepatitis B cirrhosis.Methods 154 patients with hepatitis B cirrhosis admitted to the Third Medical Center of the General Hospital of the People's Liberation Army between April 2019 and December 2022 were reviewed.The diagnosis of hepatitis B cirrhosis and EV meets the standard.According to gastroscopy,the degree of EV is divided into mild,moderate and severe.We compared the clinical data of patients with or without EV and different EV degrees,analyzed the difference of diagnostic efficiency of LSM,ST and SVD in predicting EV,followed up and observed the occurrence of EVB in EV patients,and compared it with cases without EVB.Results Among 154 patients with hepatitis B cirrhosis,there were 97 cases without EV and 57 cases with EV.22 cases(38.6%),24 cases(42.1%)and 11 cases(19.3%)were Child-Pugh A,B and C in patients with EV,and 58 cases(59.8%),39 cases(40.2%)and 0(0)were Child-Pugh A,B and C in patients without EV.The difference was statistically significant(P<0.05).In EV group,ascites,PLT,Alb,INR,LSM,ST and SVD were 31 cases(54.4%),(76.1±11.7)×10^(9)/L,(27.9±4.6)g/L,(1.3±0.4)and(29.1±10.4)kPa,(45.6±12.4)mm and(10.4±3.2)mm,and,there was a statistically significant difference when compared with the group without EV[2 cases(2.1%),(129.5±16.4)×10^(9)/L,(34.0±3.9)g/L,(1.0±0.2),(14.6±5.5)kPa,(35.3±8.0)mm and(7.6±2.1)mm](P<0.05).According to the results of gastroscopy,there were 23 cases of mild,19 cases of moderate and 15 cases of hepatitis B cirrhosis complicated with EV.The LSM,ST and SVD of patients with severe EV were(40.2±17.6)kPa,(53.3±15.0)mm and(13.8±3.2)mm,compared with mild EV[(21.6±9.2)kPa,(40.2±11.1)mm and(7.9±2.3)mm]and moderate EV[(29.3±13.2)kPa,(46.0±12.7)mm and(10.7±3.2)mm],the difference was statistically significant(P<0.05).According to the analysis of ROC curve,the AUC value of LS

关 键 词：乙型肝炎肝硬化 食管静脉曲张 肝脏硬度值 脾脏厚度 脾静脉直径 

分 类 号：R57[医药卫生—消化系统]