肝血流超声参数对乙型肝炎肝硬化并发食管静脉曲张的评估价值

摘要/Abstract

摘要： 目的探讨肝血流超声参数对乙型肝炎肝硬化并发食管静脉曲张(EV)的评估价值。方法选取2022年10月至2023年11月喀什地区第一人民医院收治的118例乙型肝炎肝硬化患者。通过肝血流超声参数、肝纤维化-4因子指数(FIB-4)及胃镜评估EV的发生情况及程度。结果胃镜检查发现,共80例患者存在EV,其中重度21例,中度30例,轻度29例。EV组门静脉流速(PVV)和肝静脉到达时间(HVAT)分别为(15.42±2.63) cm/s和(15.55±2.74)s,低于无EV组的(18.71±2.43) cm/s和(21.82±3.84)s(P<0.001)。而门静脉直径(PVD)、门静脉压指数(PV-CI)、肝静脉直径指数(HV-DI)和FIB-4指数分别为(1.71±0.34) cm、(0.41±0.13) cm/s、0.82±0.21和4.81±1.70,均高于无EV组的(1.32±0.31) cm、(0.22±0.11) cm/s、0.61±0.13和2.82±1.02(P<0.05)。重度EV患者的PVV和HVAT分别为(12.42±2.92) cm/s和(9.26±2.94)s,低于中度EV患者的(14.92±2.20) cm/s和(13.03±2.46)s或轻度EV患者的(18.11±2.24) cm/s和(22.71±2.52)s(P<0.001)。重度EV患者的PVD、PV-CI、HV-DI和FIB-4指数分别为(2.39±0.52) cm、(0.81±0.24) cm/s、1.22±0.23和6.71±1.91,高于中度EV患者的(1.62±0.20) cm、(0.32±0.10) cm/s、0.83±0.21和4.93±1.74及轻度EV患者的(1.31±0.21) cm、(0.21±0.10) cm/s、0.52±0.10和3.31±1.16(P<0.001)。随访12个月,发生食管静脉曲张出血(EVB)的患者共54例,出血组的PVV和HVAT分别为(14.72±2.51) cm/s和(12.91±2.13)s,低于未出血组的(16.87±2.77) cm/s和(21.03±3.24)s(P<0.001),而PVD、PV-CI、HV-DI和FIB-4分别为(1.85±0.42) cm、(0.49±0.23) cm/s、0.90±0.22和5.40±1.93,高于未出血组的(1.42±0.32) cm、(0.24±0.11) cm/s、0.65±0.11和3.58±1.40(P<0.001)。结论肝血流超声参数如PVV、HVAT、PVD、PV-CI及FIB-4在评估乙型肝炎肝硬化患者并发食管静脉曲张的严重程度和出血风险方面具有重要的临床价值。

关键词: 乙型肝炎, 肝硬化, 食管静脉曲张, 超声参数, 门静脉流速, 肝纤维化-4因子指数

Abstract: Objective To explore the evaluation value of hepatic blood flow ultrasound parameters in assessing esophageal varices (EV) in patients with hepatitis B cirrhosis and to assess their potential role in predicting the occurrence and severity of EV. Methods A total of 118 patients with hepatitis B-related cirrhosis who underwent Doppler ultrasound and contrast-enhanced ultrasound from October 2022 to November 2023 at our hospital were selected. Liver blood flow ultrasound parameters and the Fibrosis-4 (FIB-4) index were measured, and all patients underwent gastroscopy to assess the occurrence and severity of EV. Results Gastroscopy revealed that 80 patients had esophageal varices (EV), with 21 severe EVs, 30 moderate EVs, and 29 mild EVs. In the cirrhosis with EV group, the portal vein velocity (PVV) and hepatic vein arrival time (HVAT) were (15.42 ± 2.63) cm/s and (15.55 ± 2.74) s, respectively, lower than those in the cirrhosis-only group, which were (18.71 ± 2.43) cm/s and (21.82 ± 3.84) s (P<0.001). The portal vein diameter (PVD), portal vein pressure index (PV-CI), hepatic vein diameter index (HV-DI), and FIB-4 index were (1.71 ± 0.34) cm, (0.41 ± 0.13) cm/s, (0.82 ± 0.21), and (4.81 ± 1.70), respectively, higher than those in the cirrhosis-only group, which were (1.32 ± 0.31) cm, (0.22 ± 0.11) cm/s, (0.61 ± 0.13), and (2.82 ± 1.02) (P<0.001).In the different severity groups of EV, patients with severe EV had a PVV of (12.42 ± 2.92) cm/s and HVAT of (9.26 ± 2.94) s, lower than the PVV of (14.92 ± 2.20) cm/s and HVAT of (13.03 ± 2.46) s in the moderate EV group, or the PVV of (18.11 ± 2.24) cm/s and HVAT of (22.71 ± 2.52) s in the mild EV group (P<0.001), the PVD, PV-CI, HV-DI, and FIB-4 index in the severe EV group were (2.39 ± 0.52) cm, (0.81 ± 0.24) cm/s, (1.22 ± 0.23), and (6.71 ± 1.91), higher than those in the moderate EV group, which were (1.62 ± 0.20) cm, (0.32 ± 0.10) cm/s, (0.83 ± 0.21), and (4.93 ± 1.74), and the mild EV group, which were (1.31 ± 0.21) cm, (0.21 ± 0.10) cm/s, (0.52 ± 0.10), and (3.31 ± 1.16) (P<0.001).In a 12-month follow-up, 54 patients had bleeding from esophageal varices (EVB). The PVV and HVAT in the bleeding group were (14.72 ± 2.51) cm/s and (12.91 ± 2.13) s, lower than those in the non-bleeding group, which were (16.87 ± 2.77) cm/s and (21.03 ± 3.24) s (P<0.001). The PVD, PV-CI, HV-DI, and FIB-4 index in the bleeding group were (1.85 ± 0.42) cm, (0.49 ± 0.23) cm/s, (0.90 ± 0.22), and (5.40 ± 1.93), higher than those in the non-bleeding group, which were (1.42 ± 0.32) cm, (0.24 ± 0.11) cm/s, (0.65 ± 0.11), and (3.58 ± 1.40) (P<0.001). Conclusion Hepatic blood flow ultrasound parameters, such as PVV, HVAT, PVD, PV-CI, and FIB-4, are of significant clinical value in evaluating the severity of esophageal varices and the risk of bleeding in patients with hepatitis B cirrhosis, providing an effective tool for clinical assessment.

Key words: Hepatitis B, Cirrhosis, Esophageal varices, Ultrasound parameters, Portal vein velocity, FIB-4 index

努丽曼姑·麦麦提, 布阿吉姑丽·牙森江, 宋涛, 刘环, 吴仕吉, 迪丽努尔·约提库尔. 肝血流超声参数对乙型肝炎肝硬化并发食管静脉曲张的评估价值[J]. 肝脏, 2025, 30(12): 1678-1681.

NUlimangu·Maimaiti, BUajiguli·Yasenjiang, SONG Tao, LIU Huan, WU Shi-ji, DIlinuer·Yuetikuer. Evaluation of hepatic blood flow ultrasound parameters in assessing esophageal varices in patients with hepatitis B cirrhosis[J]. Chinese Hepatolgy, 2025, 30(12): 1678-1681.

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