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

摘要/Abstract

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)×10⁹/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)×10⁹/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均显著高于非EVB组(P<0.05)。结论应用LSM及脾脏ST、SVD等参数预测乙型肝炎肝硬化并发EV有一定的诊断价值,可在临床用于初筛检查,值得进一步研究应用。

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

Abstract: 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) ×10⁹/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) × 10⁹/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 LSM, ST and SVD in the joint diagnosis of EV in patients with hepatitis B cirrhosis was significantly higher than that of LSM, ST and SVD alone (P<0.05), and the AUC value, sensitivity and specificity of LSM, ST and SVD in the joint diagnosis were 0.91 (0.83 ~ 0.98), 89.5% and 83.5% respectively. During a one-year follow-up observation, 21 cases (36.8%) of EV patients developed EVB, and the treatments included esophageal variceal ligation (EVL), sclerosing agent injection, EVL combined with tissue glue injection, EVL combined with sclerosing agent and tissue glue injection were applied in 15 cases (71.4%), 4 cases (19.0%), 1 case (4.8%), and 1 case (4.8%) respectively. LSM, ST and SVD in EVB patients were significantly higher than those in non-EVB groups (P<0.05).Conclusion Using LSM, spleen ST or SVD, and other parameters to predict hepatitis B cirrhosis complicated with EV has certain diagnostic value, which can be used for primary screening in clinic and is worthy of further research and application.

Key words: Hepatitis B cirrhosis, Esophageal varices, Liver stiffness measurement, Spleen thickness, Splenic vein diameter

钱玉鑫, 杜明澍, 张培. 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[J]. 肝脏, 2024, 29(12): 1517-1520.

QIAN Yu-xin, DU Ming-shu, ZHANG Pei. Efficacy evaluation of liver stiffness measurement, spleen thickness and splenic vein diameter in predicting esophageal varices in patients with hepatitis B cirrhosis[J]. Chinese Hepatolgy, 2024, 29(12): 1517-1520.

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