脾硬度诊断乙型肝炎肝硬化患者食管静脉曲张的临床价值

摘要/Abstract

摘要： 目的探索乙型肝炎肝硬化患者的超声、肝脾硬度值及实验室数据中可用于评估食管静脉曲张(EV)的无创参数。方法纳入2019年3月至2022年3月首都医科大学附属北京地坛医院收治的202例乙型肝炎肝硬化患者。收集患者内镜、腹部超声、肝硬度(LSM)、脾硬度(SSM)及实验室数据。根据内镜结果分为EV组及无EV组。计算患者血小板/脾长径(PC/SD)、肝硬度×脾长径/血小板(LSPS)的比值。采用单因素及多因素logistic回归分析评估EV的独立影响因子。采用ROC曲线评估独立影响因子诊断EV的效能,并与PC/SD、LSPS比较诊断EV的准确性。结果 202例患者中,EV组136例,无EV组66例。EV组的LSM、SSM、门静脉内径、脾静脉内径、脾指数、INR、Child-Pugh评分分别为19.69(13.86,27.01)kPa、48.78(40.89,54.67)kPa、13.20(12.00,14.50)mm、10.95 (8.63,13.00)mm、47.01(36.81,58.28)cm²、1.30(1.18,1.45)、6(5,8),均高于无EV组的13.37(8.08,22.30) kPa、24.51(20.90,33.34)kPa、11.60(1.80, 12.50)mm、6.60(5.58,8.00)mm、24.69(18.96,32.92)cm²、1.17(1.06,1.31)、5(5,7),差异有统计学意义(P＜0.05);EV组血小板为57.85(44.18,82.75)×10⁹/L,低于无EV组的112.50(72.50,150.50)×10⁹/L。多因素分析显示SSM为EV的独立影响因子(HR=1.234,95%CI:1.137~1.339,P＜0.001)。SSM诊断EV的曲线下面积为0.947(95％CI:0.906~0.973,P＜0.001),最优截断值为35.2 kPa。SSM诊断准确性优于PC/SD(Z=4.162,P＜0.001)、LSPS(Z=4.356,P＜0.001)。结论 SSM可作为评估乙型肝炎肝硬化患者EV的初筛方法,为临床诊断EV提供参考。

关键词: 乙型肝炎肝硬化, 食管静脉曲张, 脾硬度

Abstract: Objective To explore the non-invasive parameters that can be used to evaluate esophageal varices (EV) from ultrasound, liver and spleen stiffness measurement and laboratory data of patients with hepatitis B-related cirrhosis. Methods A total of 202 patients with hepatitis B-related cirrhosis admitted to Beijing Ditan Hospital Affiliated to Capital Medical University from March 2019 to March 2022 were enrolled in this study. The patients′ endoscopies, abdominal ultrasounds, liver stiffness measurements, spleen stiffness measurements (SSM), and laboratory data were collected. According to the endoscopic results, they were divided into an EV group and a non- EV group. The values of platelet count to spleen diameter ratio (PC/SD) and liver stiffness measurement-spleen diameter to platelet ratio (LSPS) were calculated. Univariate and multivariate logistic regression analyses were conducted to identify the independent influencing factors of EV. The effectiveness of these factors in diagnosing EV was evaluated with receiver operating characteristic (ROC) curve analysis. The accuracy of them in diagnosing EV was compared with those of PC/SD and LSPS. Results Among the 202 patients, there were 136 in the EV group and 66 in the non-EV group. LSM, SSM, portal vein diameter, splenic vein diameter, splenic index, INR and Child Pugh score in patients with EV were 19.69 (13.86, 27.01) kPa, 48.78 (40.89, 54.67) kPa, 13.20 (12.00, 14.50) mm, 10.95 (8.63, 13.00) mm, 47.01 (36.81, 58.28) cm², 1.30 (1.18, 1.45) and 6 (5,8) respectively, which were significantly higher than those of 13.37 (8.08, 22.30) kPa, 24.51 (20.90, 33.34) kPa, 11.60 (1.80, 12.50) mm, 6.60 (5.58, 8.00) mm, 24.69 (18.96, 32.92) cm², 1.17 (1.06,1.31), and 5 (5,7) in patients without EV (P<0.05). The PLT of the EV group was 57.85 (44.18,82.75)×10⁹/L, which was lower than that of 112.50 (72.50,150.50)×10⁹/L in the non-EV group. Multivariate analysis showed that SSM was an independent influencing factor of EV (HR=1.234, 95%CI:1.137~1.339, P<0.001). The area under the curve (AUC) for diagnosing EV with SSM was 0.947 (95%CI: 0.906-0.973, P<0.001) with the optimal cutoff value of 35.2 kPa. The diagnostic accuracy of SSM was better than that of PC/SD (Z=4.162, P<0.001) and LSPS (Z=4.356, P<0.001). Conclusion SSM can be used as a primary screening method to evaluate EV in patients with hepatitis B-related cirrhosis. SSM can be used as a reference for diagnosing EV.

Key words: Hepatitis B cirrhosis, Esophageal varices, Spleen stiffness

杨学平, 王雪梅, 何楠, 潘国栋, 张瑶, 于静. 脾硬度诊断乙型肝炎肝硬化患者食管静脉曲张的临床价值[J]. 肝脏, 2026, 31(2): 182-186.

YANG Xue-ping, WANG Xue-mei, HE Nan, PAN Guo-dong, ZHANG Yao, YU Jing. The clinical value of spleen stiffness in the diagnosis of esophageal varices in patients with hepatitis B-related cirrhosis[J]. Chinese Hepatolgy, 2026, 31(2): 182-186.

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