超声内镜检查诊断乙型肝炎肝硬化患者食管胃底静脉曲张的价值及对EVL治疗效果的评价

摘要/Abstract

摘要： 目的探讨超声内镜检查(EUS)对乙型肝炎肝硬化患者食管胃底静脉曲张的诊断价值,并利用EUS对食管静脉曲张套扎术疗效进行评价。方法收集2020年1月—2022年6月接受食管静脉曲张套扎术(EVL)治疗,并定期来院进行内镜复诊的乙型肝炎肝硬化合并食管胃底静脉曲张患者,共67例,依据来院前是否出现静脉曲张再出血进行分组,观察组(n=31)在来院前出现静脉曲张再出血,对照组(n=36)在来院前未出现静脉曲张再出血。比较两组EUS参数及血生化指标差异。结果观察组食管穿支静脉、胃穿支静脉、胃旁静脉的检出率分别为58.1%,64.5%,61.2%,显著高于对照组[分别为30.1%,27.7%,22.2%,P<0.05]。观察组的总横断面表面积、胃左静脉直径、肠系膜上静脉直径、脾静脉直径、门静脉直径分别为(0.7±0.1)cm²、(6.4±0.3)mm、(13.3±0.8)mm、(14.9±0.7)mm、(17.1±0.5)mm,显著高于对照组[分别为(0.4±0.1)cm²、(5.1±0.2)mm、(9.9±0.7)mm、(12.6±1.0)mm、(14.3±0.3)mm,P<0.05],而观察组的曲张静脉壁厚度为(0.5±0.1)mm,显著低于对照组(0.7±0.1)mm,P<0.05。观察组的血小板、白蛋白分别为(127.0±40.1)×10⁹/L、(28.8±5.2)g/L,显著低于对照组,分别为[(141.2±22.5)×10⁹/L、(34.1±9.6)g/L,P<0.05],观察组的凝血酶原时间为(16.5±3.7)s,显著高于对照组(12.9±2.6)s,P<0.05。两组的总胆红素与直接胆红素有显著差异。通过二元logistic回归模型分析,伴有食管穿支静脉(OR=1.66,P=0.011,95%CI=1.24~2.48)和胃底穿支静脉(OR=1.70,P=0.014,95%CI=1.36~2.92)、曲张静脉总横断面表面积增大(OR=2.40,P=0.021,95%CI=1.01~5.16)、脾静脉直径增大(OR=2.10,P=0.028,95%CI=1.10~4.40)及门静脉直径增宽(OR=2.40,P=0.026,95%CI=1.12~4.58)以及凝血酶原时间延长(OR=1.80,P=0.011,95%CI=1.75~2.70)是食管胃底静脉曲张患者再出血的危险因素,曲张静脉壁厚度较小(OR=0.66,P=0.031,95%CI=0.22~0.81)是食管胃底静脉曲张患者再出血的保护性因素。结论 EUS对于评估乙型肝炎肝硬化患者并发食管胃底静脉曲张具有显著优势,可以较好地评价EVL的治疗效果,预测出血风险。

关键词: 乙型肝炎肝硬化, 食管胃底静脉曲张, 超声内镜, 食管静脉曲张套扎术, 风险因素

Abstract: Objective To explore the diagnostic value of Endoscopic Ultrasound (EUS) for esophagogastric varices in patients with hepatitis B-induced cirrhosis and evaluate the therapeutic effect of endoscopic variceal ligation (EVL) using EUS. Methods Between January 2020 and June 2022, 67 patients with hepatitis B-related cirrhosis and esophagogastric varices who received EVL treatment at our hospital and regularly underwent endoscopic follow-up were included. The patients were grouped based on whether they experienced variceal rebleeding before the follow-up. The observation group (n=31) had variceal rebleeding, while the control group (n=36) did not. EUS parameters and biochemical indicators were compared between the two groups. Results The detection rates of esophageal perforating veins, gastric perforating veins, and paracholedochal veins in the observation group were 58.1%, 64.5%, and 61.2%, respectively, which were significantly higher than those of 30.1%, 27.7%, and 22.2% in the control group (P<0.05). The total cross-sectional area, diameter of the left gastric vein, superior mesenteric vein, splenic vein, and portal vein in the observation group were (0.7±0.1) cm², (6.4±0.3) mm, (13.3±0.8) mm, (14.9±0.7) mm, and (17.16±0.53) mm, respectively, which were significantly higher than those of (0.4±0.1) cm², (5.1±0.2) mm, (9.9±0.7) mm, (12.6±1.0) mm, and (14.3±0.3) mm in the control group (P<0.05). The thickness of variceal wall in the observation group was (0.5±0.1) mm, which was significantly lower than that of (0.7±0.1) mm in the control group (P<0.05). Platelet count and albumin level in the observation group were (127.0±40.1) ×10⁹/L and (28.8±5.2) g/L, respectively, which was significantly lower than those of (141.2±22.5) ×10⁹/L and (34.1±9.6) g/L in the control group (P<0.05). The prothrombin time in the observation group was (12.9±2.6) s, which was significantly higher than that of (12.9±2.6) s in the control group (P<0.05). There was no significant difference in total bilirubin and direct bilirubin between the two groups. Binary logistic regression analysis revealed that the presence of esophageal perforating veins (OR=1.66, P=0.011, 95%CI:1.24-2.48), gastric perforating veins (OR=1.70, P=0.014, 95%CI:1.36-2.92), increased total cross-sectional area of varices (OR=2.40, P=0.021, 95%CI:1.01-5.16), enlarged splenic vein diameter (OR=2.10, P=0.028, 95%CI:1.10-4.40), widened portal vein diameter (OR=2.40, P=0.026, 95%CI:1.12-4.58), and prolonged prothrombin time (OR=1.80, P=0.011, 95%CI:1.75-2.70) were risk factors for variceal rebleeding in patients with esophagogastric varices. Thinner (thicker Please check) variceal wall thickness (OR=0.66, P=0.031, 95%CI:0.22-0.81) was a (risk)protective factor (for) against rebleeding. Conclusion EUS has significant advantages in assessing esophagogastric varices in cirrhotic patients and can effectively evaluate the therapeutic effect of EVL and predict bleeding risk.

Key words: Cirrhosis, Esophageal and gastric varices, Endoscopic ultrasonography, Esophageal variceal ligation, Risk factors

张志博, 李静, 邱婧琪, 王倩, 梁爽, 刘翠翠. 超声内镜检查诊断乙型肝炎肝硬化患者食管胃底静脉曲张的价值及对EVL治疗效果的评价[J]. 肝脏, 2025, 30(5): 613-616.

ZHANG Zhi-bo, LI Jing, QIU Jing-qi, WANG Qian, LIANG Shuang, LIU Cui-cui. The value of endoscopic ultrasonography in diagnosing esophageal and gastric varices in patients with hepatitis B-related cirrhosis and an evaluation of the efficacy of esophageal variceal ligation treatment[J]. Chinese Hepatolgy, 2025, 30(5): 613-616.

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