肝脏超声血流参数联合肝脾硬度值检测对乙型肝炎肝硬化食管静脉曲张出血的评估价值  

Evaluation of the combined detection of liver ultrasound blood flow parameters and liver-spleen stiffness in predicting esophageal variceal bleeding in hepatitis B cirrhosis patients

作　　者：王娴 李亮 吴新勇[1] 王思思 WANG Xian;LI Liang;WU Xin-yong;WANG Si-si(Department of Ultrasound,Lianyungang Second People′s Hospital,Jiangsu 222000,China;Department of Ultrasound,Lianyungang Hospital Affiliated to Xuzhou Medical University,Jiangsu 222000,China)

机构地区：[1]连云港市第二人民医院超声科,江苏222000 [2]徐州医科大学附属连云港市医院超声科

出　　处：《肝脏》2025年第2期197-200,206,共5页Chinese Hepatology

基　　金：江苏省重点研究和开发计划研究项目(202003AK-581)。

摘　　要：目的探讨肝脏超声血流参数联合肝脾硬度值检测对乙型肝炎肝硬化患者发生食管静脉曲张出血的预测价值。方法选取2021年8月—2024年3月在连云港市第二人民医院接受治疗的乙型肝炎肝硬化患者100例,根据随访期间是否发生食管静脉出血将患者分为出血组34例和未出血组66例,患者均接受多普勒超声、超声造影检查和二维剪切波弹性成像(2D-SWE)肝脾硬度检测,并记录门静脉流速(PVV)、门静脉内径(PVD)、肝静脉到达时间(HVAT)、门静脉充血指数(PV-CI)和肝脏硬度值。结果出血组的PVV和HVAT低于未出血组,而PVD、PV-CI和肝脏硬度值高于未出血组(P<0.05)。ROC曲线结果显示,肝脏硬度值、PVV、PVD、PV-CI、HVAT预测食管静脉曲张出血的灵敏度分别为44.1%、64.7%、76.5%、52.9%和94.1%,特异度分别为83.3%、84.8%、81.8%、92.4%和86.4%,曲线下面积(AUC)分别为0.662、0.810、0.842、0.800和0.953。而当这些参数联合预测时,灵敏度和特异度分别达到95.5%和94.1%,AUC值则达到0.982。结论肝脏超声血流参数联合肝脾硬度值检测能够有效预测乙型肝炎肝硬化患者发生食管静脉曲张出血的风险,具有显著的临床应用价值。通过早期识别高风险患者,可以及时采取预防性干预措施,降低出血风险,改善患者预后。Objective To investigate the predictive value of liver ultrasound blood flow parameters combined with liver-spleen stiffness detection in predicting esophageal variceal bleeding in patients with hepatitis B cirrhosis.Methods From August 2021 to March 2024,100 patients with hepatitis B cirrhosis treated at the Second People′s Hospital of Lianyungang were selected for this study.Based on whether they experienced esophageal variceal bleeding during the follow-up period,the patients were divided into a bleeding group(34 cases)and a non-bleeding group(66 cases).All patients underwent Doppler ultrasound,contrast-enhanced ultrasound,and two-dimensional shear wave elastography(2D-SWE)for liver and spleen stiffness measurement.Parameters such as portal vein velocity(PVV),portal vein diameter(PVD),hepatic vein arrival time(HVAT),portal vein congestion index(PV-CI),and liver stiffness values were recorded.Results The bleeding group had lower PVV and HVAT but higher PVD,PV-CI,and liver stiffness values than the non-bleeding group(P<0.05).Receiver operating characteristic(ROC)curve showed that the sensitivities of liver stiffness value,PVV,PVD,PV-CI,and HVAT in predicting esophageal variceal bleeding were 44.1%,64.7%,76.5%,52.9%,and 94.1%,respectively,and their specificities were 83.3%,84.8%,81.8%,92.4%,and 86.4%,respectively.The area under the curve(AUC)values were 0.662,0.810,0.842,0.800,and 0.953,respectively.When these parameters were combined,the sensitivity and specificity reached 95.5%and 94.1%,respectively,with an AUC value of 0.982.Conclusion The combined assessment of liver ultrasound blood flow parameters and liver-spleen stiffness measurement can effectively predict the risk of esophageal variceal bleeding in patients with hepatitis B-related cirrhosis,demonstrating significant clinical value.Early identification of high-risk patients allows for timely preventive interventions,reducing the risk of bleeding and improving patient outcomes.

关 键 词：肝脏超声血流参数 肝脾硬度值 乙型肝炎肝硬化 食管静脉曲张 出血预测 

分 类 号：R575.2[医药卫生—消化系统]