瞬时弹性成像结合门静脉血流动力学评估慢性乙型肝炎患者肝纤维化的价值

摘要/Abstract

摘要： 目的探讨瞬时弹性成像结合门静脉血流动力学评估慢性乙型肝炎(CHB)患者肝纤维化的价值。方法纳入山西省汾阳医院于2021年1月至2024年1月收治的CHB患者102例。通过瞬时弹性成像技术检测患者肝硬度值(LSM),彩色多普勒超声诊断仪检测门静脉主干内径(PVD) 、最大流速(Vmax) 和平均流速(Vmean)。Logistic回归分析评估影响肝纤维化发生的因素,ROC曲线分析瞬时弹性成像结合门静脉血流动力学鉴别CHB患者肝纤维化的效能。结果 102例CHB患者中,非显著性肝纤维化41例,显著性肝纤维化61例;两组患者LSM分别为(13.0±2.6)和(7.1±1.9)kPa,PVD分别为(13.6±2.7)和(10.9±2.1)mm,Vmax分别为(28.9±3.6)、(36.7±4.4)cm/s,Vmean分别为(25.3±3.3)、(30.9±4.1)cm/s(均P<0.05)。Logistic回归分析显示,LSM 和 PVD更高,而Vmax 和 Vmean更低的患者,肝纤维化的风险更高(P<0.05);ROC曲线显示,LSM与门静脉血流动力学联合诊断的准确度为0.974(0.949~0.999),灵敏度为91.8%,特异度为92.7%。结论 LSM与门静脉血流动力学联合应用在评估CHB患者肝纤维化方面具有较高的诊断效能。

关键词: 瞬时弹性成像, 门静脉血流动力学, 慢性乙型肝炎, 肝纤维化

Abstract: Objective To evaluate the value of transient elastography combined with portal vein hemodynamics in assessing liver fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 102 CHB patients were admitted to Shanxi Fenyang Hospital from January 2021 to January 2024. Liver stiffness measurement (LSM) was evalued using transient elastography, while a color Doppler ultrasound diagnostic device was used to measure the portal vein diameter (PVD), maximum flow velocity (Vmax), and mean flow velocity (Vmean). Multivariate logistic regression analysis was conducted to identify the factors influencing the occurrence of liver fibrosis. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of combining transient elastography with portal vein hemodynamics in differentiating liver fibrosis in CHB patients. Results In this study, 102 patients with chronic hepatitis B (CHB) were included. Liver biopsy diagnosed 41 cases (40.20%) with non-significant liver fibrosis and 61 cases (59.80%) with significant liver fibrosis. The LSM of patients with significant liver fibrosis were (13.0±2.6) kPa and (13.6±2.7) mm, respectively, which were higher than those in patients with non-significant fibrosis [(7.1±1.9) kPa and (10.9±2.1) mm]. Additionally, the Vmax and Vmean in significant fibrosis patients were (28.9±3.6) cm/s and (25.3±3.3) cm/s, respectively, which were lower than those in non-significant fibrosis patients [(36.7±4.4) cm/s and (30.9±4.1) cm/s], with statistical significance (P<0.05). Multivariate analysis indicated that patients with higher LSM and PVD, and lower Vmax and Vmean had a higher risk of liver fibrosis (P<0.05). ROC curve analysis showed that the combination of transient elastography and portal vein hemodynamics had a diagnostic accuracy of 0.974 (95% CI: 0.949~0.999), with a sensitivity of 91.8% and specificity of 92.7%. Conclusion The combined application of LSM and portal vein hemodynamics is highly effective in assessing liver fibrosis in patients with CHB, offering superior diagnostic accuracy.

Key words: Transient elastography, Portal vein hemodynamics, Chronic hepatitis B, Liver fibrosis

张莺, 王栩, 曹文婷, 张宇涵. 瞬时弹性成像结合门静脉血流动力学评估慢性乙型肝炎患者肝纤维化的价值[J]. 肝脏, 2025, 30(11): 1511-1514.

ZHANG Ying, WANG Xu, CAO Wen-ting, ZHANG Yu-han. Value of transient elastography combined with portal vein hemodynamics in assessing liver fibrosis in patients with chronic hepatitis B[J]. Chinese Hepatolgy, 2025, 30(11): 1511-1514.

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