超声血流参数联合APRI评估肝硬化并发门静脉血栓形成价值

肝脏 ›› 2025, Vol. 30 ›› Issue (4): 514-518.

超声血流参数联合APRI评估肝硬化并发门静脉血栓形成价值

王倩, 梁爽, 李静, 徐佳琪, 王方旭

066003 河北北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院)超声科(王倩,梁爽,李静,徐佳琪),放射科(王方旭)

收稿日期:2024-04-08 出版日期:2025-04-30 发布日期:2025-06-17
通讯作者: 王方旭,Email:18603392234@163.com
基金资助:
河北省省级科技计划资助(20377745D)

Ultrasonic blood flow parameters combined with amino-transferase to platelet ratio index to evaluate the value of portal vein thrombosis in cirrhosis

WANG Qian¹, LING Shuang¹, LI Jing¹, XU Jia-qi¹, WANG Fang-xu²

1. Department of Ultrasound, Qinhuangdao Hospital of Beijing University of Chinese Medicine Dongfang Hospital (Qinhuangdao Municipal Hospital of Traditional Chinese Medicine), Hebei 066003, China;
2. Department of Radiology, Qinhuangdao Hospital of Beijing University of Chinese Medicine Dongfang Hospital (Qinhuangdao Municipal Hospital of Traditional Chinese Medicine), Hebei 066003, China

Received:2024-04-08 Online:2025-04-30 Published:2025-06-17
Contact: WANG Fang-xu, Email: 18603392234@163.com

摘要/Abstract

摘要： 目的探讨超声血流参数联合天冬氨酸氨基转移酶-血小板计数指数(APRI)评估肝硬化并发门静脉血栓形成(PVT)价值。方法选择2021年5月至2023年12月行脾切除术的肝硬化患者95例,根据术后1周是否并发PVT分为非发生组与发生组。对比2组APRI、超声血流参数[脾静脉内径、门静脉流速(PVV)与门静脉内径(PVD)]与临床资料,分析肝硬化患者术后并发PVT的影响因素,以及PVD、PVV、APRI及3者联合对肝硬化患者术后并发PVT的预测价值。结果术后1周,并发PVT31例(32.63%),64例未发生PVT。发生组PVV比非发生组低(P<0.05),发生组PVD、脾静脉内径、APRI比非发生组高(P<0.05)。发生组纤维蛋白原(Fig)、D二聚体(D-D)水平高于非发生组(P<0.05)。二元logistic回归分析结果显示,PVD(OR=3.445,95%CI:1.515~7.837)、APRI(OR=2.835,95%CI:1.246~6.449)、PVV(OR=0.697,95%CI:0.306~1.585)、D-D(OR=3.850,95%CI:1.692~8.757)为肝硬化患者术后并发PVT的影响因素(P<0.05)。APRI、PVV、PVD与3者联合预测肝硬化患者术后并发PVT的曲线下面积(AUC)分别为0.819、0.826、0.794、0.901(P<0.05),3者联合的预测价值更高。结论 PVD、APRI联合PVV在预测肝硬化术后并发PVT风险中的价值更高。

关键词: 超声血流参数, 天冬氨酸氨基转移酶-血小板计数指数, 肝硬化, 门静脉血栓形成, 预测价值

Abstract: Objective To evaluate the value of ultrasound blood flow parameters combined with aminotransferase to platelet ratio index (APRI) in the assessment of portal vein thrombosis (PVT) in liver cirrhosis. Methods Ninety-five patients with cirrhosis who underwent splenectomy from May 2021 to December 2023 were selected and divided into non-developing group and developing group according to whether PVT occurred one week after surgery. The ultrasound blood flow parameters [portal vein diameter (PVD), portal vein velocity (PVV), splenic vein diameter], APRI and clinical data of the two groups were compared to analyze the influencing factors of postoperative PVT in patients with cirrhosis, and analyze the predictive value of PVD, PVV, APRI and their combination on postoperative PVT in patients with cirrhosis. Results One week after operation, 31 cases had PVT, the incidence was 32.63%, and the remaining 64 cases did not have PVT. The PVV in the developing group was lower than non-developing group (P<0.05), and the PVD, splenic vein diameter and APRI in the developing group were higher than non-developing group (P<0.05). The levels of fibrinogen (Fib) and D-dimer (D-D) in the developing group were higher than non-developing group (P<0.05).Binary Logistic regression analysis showed that PVD (OR=3.445, 95%CI: 1.515~7.837), APRI (OR=2.835, 95%CI: 1.246~6.449), PVV (OR=0.697, 95%CI: 0.306-1.585) and D-D (OR=3.850, 95%CI: 1.692-8.757) were the influencing factors of postoperative PVT in patients with cirrhosis (P<0.05). The area under the curve (AUC) values of APRI, PVV, and PVD were 0.819, 0.826, and 0.794, while the combination of APRI, PVV and PVD (AUC=0.901) showed superior predictive performance compared to individual parameters (all P<0.05). Conclusion PVD and APRI combined with PVV have higher value in predicting the risk of postoperative PVT.

Key words: Ultrasonic blood flow parameters, Amino-transferase to platelet ratio index, Liver cirrhosis, Portal vein thrombosis, Predictive value

王倩, 梁爽, 李静, 徐佳琪, 王方旭. 超声血流参数联合APRI评估肝硬化并发门静脉血栓形成价值[J]. 肝脏, 2025, 30(4): 514-518.

WANG Qian, LING Shuang, LI Jing, XU Jia-qi, WANG Fang-xu. Ultrasonic blood flow parameters combined with amino-transferase to platelet ratio index to evaluate the value of portal vein thrombosis in cirrhosis[J]. Chinese Hepatolgy, 2025, 30(4): 514-518.

/ 推荐

参考文献

[1] Senzolo M, Garcia-Tsao G, Garcia-Pagan J C. Current knowledge and management of portal vein thrombosis in cirrhosis[J]. J Hepatol, 2021,75(2):442-453.
[2] Ju C, Li X, Gadani S, et al. Portal vein thrombosis: diagnosis and endovascular management[J]. Rofo, 2022,194(2):169-180.
[3] Molvar C, Amin P. Portal vein thrombosis in cirrhosis: interventional treatment options[J]. Curr Gastroenterol Rep, 2021,23(12):24.
[4] 赵小利,秦博,李东风,等. 乙型肝炎肝硬化并发食管静脉曲张患者超声检测肝脏血流参数和红细胞分布宽度与淋巴细胞比值变化[J]. 实用肝脏病杂志,2023,26(4):528-531.
[5] 张文军,李雪琳. 肝硬化门静脉高压术后血栓风险与术前超声血流参数及凝血功能指标的关系[J]. 血栓与止血学,2021,27(5):725-727,731.
[6] Xing Y, Tian Z, Jiang Y, et al. A practical nomogram based on systemic inflammatory markers for predicting portal vein thrombosis in patients with liver cirrhosis[J]. Ann Med, 2022,54(1):302-309.
[7] 崔燕,王婷,杨亚俊,等. 天冬氨酸氨基转移酶-血小板计数指数联合血氨对肝硬化并发肝性脑病的诊断价值[J]. 中西医结合肝病杂志,2022,32(4):331-334.
[8] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志,2019,27(11):846-865.
[9] 中华医学会消化病学分会肝胆疾病学组. 肝硬化门静脉血栓管理专家共识(2020年,上海)[J]. 临床肝胆病杂志,2020,36(12):2667-2674.
[10] Li J, Wu Q Q, Zhu R H, et al. Machine learning predicts portal vein thrombosis after splenectomy in patients with portal hypertension: comparative analysis of three practical models[J]. World J Gastroenterol, 2022,28(32):4681-4697.
[11] Martens K, McMurry H S, Koprowski S, et al. Anticoagulation in cirrhosis: evidence for the treatment of portal vein thrombosis and applications for prophylactic therapy[J]. J Clin Gastroenterol, 2022,56(6):536-545.
[12] Bohula E A, Berg D D, Lopes M S, et al. Anticoagulation and antiplatelet therapy for prevention of venous and arterial thrombotic events in critically Ill patients with COVID-19: COVID-PACT[J]. Circulation, 2022,146(18):1344-1356.
[13] Ruberto M F, Piras M S, Sorbello O, et al. Chronic intravascular coagulation in liver cirrhosis predicts a high hemorrhagic risk[J]. Eur Rev Med Pharmacol Sci, 2021,25(17):5518-5524.
[14] Premkumar M, Kulkarni A V, Kajal K, et al. Principles, interpretation, and evidence-based role of viscoelastic point-of-care coagulation assays in cirrhosis and liver failure[J]. J Clin Exp Hepatol, 2022,12(2):533-543.
[15] 朱海艳,范晓棠. 肝硬化并发门静脉血栓形成患者列线图预测模型分析及外部验证[J]. 实用肝脏病杂志,2022,25(6):848-852.
[16] 刘小娇,王政强,马超,等. 肝硬化门静脉血栓形成风险预测列线图模型的建立与验证[J]. 中华消化内镜杂志,2023,40(1):47-52.
[17] Dong Y, Li L. Influences of jieyu ruanjian huoxue prescription on hepatic fibrosis indices and APRI in patients with hepatitis B cirrhosis[J]. Am J Transl Res, 2021,13(7):8514-8521.
[18] Zhao L Y, Yang D D, Ma X K, et al. The prognostic value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for overall survival of hepatocellular carcinoma patients treated with palliative treatments[J]. J Cancer, 2019,10(10):2299-2311.
[19] Zanetto A, Campello E, Burra P, et al. Increased platelet ratio in patients with decompensated cirrhosis indicates a higher risk of portal vein thrombosis[J]. Liver Int, 2023,43(1):155-159.
[20] Wang T, Tan W, Wang X, et al. Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis[J]. JHEP Rep, 2022,4(10):100529.
[21] Itakura J, Kurosaki M, Setoyama H, et al. Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis[J]. J Gastroenterol, 2021,56(5):470-478.