声脉冲辐射力成像技术测量的肝脏硬度值预测失代偿期乙型肝炎肝硬化患者门静脉高压的价值

摘要/Abstract

摘要： 目的评估声脉冲辐射力成像技术(ARFI)测量的肝脏硬度值(LSM)无创预测失代偿期乙型肝炎肝硬化患者门静脉高压(PH)的诊断效能。方法选取2013年4月至2023年6月于连云港市第二人民医院就诊,并接受肝静脉压力梯度(HVPG)测定及ARFI测量LSM的失代偿期乙型肝炎肝硬化患者74例,男性53例、女性21例,年龄(56.0±13.2)岁。依据HVPG值将患者分为显著门静脉高压(PH)组(HVPG≥10 mmHg)和非显著PH组(HVPG<10 mmHg)。比较两组临床资料,并分析LSM、门脾静脉宽度及HVPG对显著PH及其出血状态的预测效能。结果 74例患者中,显著、非显著PH分别为25例、49例。显著PH组腹水、WBC、INR、LSM、门静脉宽度、脾静脉宽度、HVPG及Child-Pugh评分为16例(64.0%)、(9.4±0.7)×10⁹/L、(1.4±0.2)、(2.3±0.7)m/s、(1.8±0.3)cm、(1.2±0.3)cm、(12.7±2.0)mmHg及(7.3±1.7)分,分别显著高于非显著PH组[13例(26.5%)、(5.9±0.5)×10⁹/L、(1.1±0.3)、(1.8±0.5)m/s、(1.5±0.3)cm、(0.9±0.2)cm、(9.2±1.4)mmHg及(6.2±1.5)分,P<0.05]。随访半年,74例患者中发生食管胃底静脉曲张破裂出血17例,归为出血组,其余归为未出血组。出血组LSM、门静脉宽度、脾静脉宽度及HVPG为(2.4±0.8)m/s、(1.8±0.5)cm、(1.3±0.4)cm及(14.3±2.3)mmHg,分别显著高于未出血组[(1.7±0.7)m/s、(1.5±0.3)cm、(0.9±0.2)cm及(8.9±1.1)mmHg,P<0.05]。以LSM、门静脉宽度、脾静脉宽度及HVPG为检验变量,以显著PH(是/否)为结局变量,通过绘制ROC曲线分析评估其诊断效能。结果显示,LSM、门静脉宽度、脾静脉宽度及HVPG对显著PH均具有良好的诊断价值,其中LSM诊断AUC值显著高于门静脉宽度、脾静脉宽度及HVPG(P<0.05);类似地,以LSM、门静脉宽度、脾静脉宽度及HVPG为检验变量,以出血(发生/未发生)为结局变量,通过绘制ROC曲线得出上述4项指标诊断显著PH均较为理想,其中LSM诊断AUC值显著高于门静脉宽度、脾静脉宽度及HVPG(P<0.05)。结论在失代偿期肝硬化患者中,ARFI通过无创检测LSM对显著PH及其出血状态的诊断具有一定价值,值得在临床实践中推广应用。

关键词: 失代偿期乙型肝炎肝硬化, 声脉冲辐射力成像技术, 肝脏硬度, 门静脉高压

Abstract: Objective To evaluate the diagnostic efficacy of liver stiffness (LS) measured by acoustic radiation force impulse (ARFI) in noninvasive prediction of portal hypertension (PH) in patients with decompensated hepatitis B cirrhosis. Methods Between April 2013 and June 2023, 74 patients with decompensated hepatitis B cirrhosis who received the measurement of hepatic venous pressure gradient (HVPG) and ARFI at the Second People′s Hospital of Lianyungang City from April 2013 to June 2023 were selected, including 53 males and 21 females, with an age of (56.0±13.2) years. According to the previous literature, the patients were divided into significant PH group (HVPG≥10 mmHg) and non-significant PH group (HVPG<10 mmHg). The clinical data of the two groups were compared, and the predictive efficacy of LSM, portal and splenic vein width and HVPG for significant PH and bleeding was analyzed. Results Among 74 patients, the significant and non-significant PH were 49 and 25 respectively. The ascites, WBC, INR, LSM, portal vein width, splenic vein width, HVPG and Child-Pugh score in the significant PH group were 16 cases (64.0%), (9.4±0.7) ×10⁹/L, (1.4±0.2), (2.3±0.7) m/s, (1.8±0.3) cm, (1.2±0.3), (12.7±2.0) mmHg and (7.3±1.7) points, which were significantly higher than those in the non-significant PH group [13 cases (26.5%), (5.9±0.5) ×10⁹/L, (1.1±0.3), (1.8±0.5) m/s, (1.5±0.3) cm, (0.9±0.2) cm and (8.9±1.1) mmHg, P<0.05]. After a six-month follow-up, 17 cases of 74 patients occured esophageal and gastric varices bleeding. LSM, width of portal and splenic vein and HVPG in the bleeding group were (2.4±0.8) m/s, (1.8±0.5) cm, (1.3±0.4) cm and (14.3±2.3) mmHg, which were significantly higher than those in the non-bleeding group [(1.7±0.7) m/s, (1.5±0.3) cm, (0.9±0.2) cm and (8.9±1.1) mmHg, P<0.05]. We respectively evaluated the diagnostic efficacy of the LSM, portal vein width, splenic vein width, and HVPG for significant PH using receiver operating characteristic (ROC) curve. The ROC curve showed that LSM, portal vein width and HVPG were ideal for diagnosis, and the area under the curve (AUC) of LSM was significantly higher than portal vein width and HVPG (P<0.05). Similarly, ROC curves were used to test the diagnostic efficacy of LSM, portal vein width, splenic vein width, and HVPG for bleeding (occurrence/non occurrence). The AUC value of LSM was significantly higher than the width of portal vein and HVPG (P<0.05). Conclusion In patients with decompensated cirrhosis, LSM detected by ARFI has certain value in the diagnosis of significant PH, which is worth popularizing in clinical practice.

Key words: Decompensated hepatitis B cirrhosis, Acoustic radiation force impulse, Liver stiffness, Portal hypertension

苗莉, 朱敏敏, 李伟, 王娴. 声脉冲辐射力成像技术测量的肝脏硬度值预测失代偿期乙型肝炎肝硬化患者门静脉高压的价值[J]. 肝脏, 2025, 30(8): 1080-1083.

MIAO Li, ZHU Min-min, LI Wei, WANG Xian. Value of liver stiffness measured by acoustic radiation force impulse in predicting portal hypertension in patients with decompensated hepatitis B cirrhosis[J]. Chinese Hepatolgy, 2025, 30(8): 1080-1083.

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