肝脏超声血流参数联合肝脾硬度值检测对乙型肝炎肝硬化食管静脉曲张出血的评估价值

摘要/Abstract

摘要： 目的探讨肝脏超声血流参数联合肝脾硬度值检测对乙型肝炎肝硬化患者发生食管静脉曲张出血的预测价值。方法选取2021年8月—2024年3月在连云港市第二人民医院接受治疗的乙型肝炎肝硬化患者100例,根据随访期间是否发生食管静脉出血将患者分为出血组34例和未出血组66例,患者均接受多普勒超声、超声造影检查和二维剪切波弹性成像(2D-SWE)肝脾硬度检测,并记录门静脉流速(PVV)、门静脉内径(PVD)、肝静脉到达时间(HVAT)、门静脉充血指数(PV-CI)和肝脏硬度值。结果出血组的PVV和HVAT低于未出血组,而PVD、PV-CI和肝脏硬度值高于未出血组(P<0.05)。ROC曲线结果显示,肝脏硬度值、PVV、PVD、PV-CI、HVAT预测食管静脉曲张出血的灵敏度分别为44.1%、64.7%、76.5%、52.9%和94.1%,特异度分别为83.3%、84.8%、81.8%、92.4%和86.4%,曲线下面积(AUC)分别为0.662、0.810、0.842、0.800和0.953。而当这些参数联合预测时,灵敏度和特异度分别达到95.5%和94.1%,AUC值则达到0.982。结论肝脏超声血流参数联合肝脾硬度值检测能够有效预测乙型肝炎肝硬化患者发生食管静脉曲张出血的风险,具有显著的临床应用价值。通过早期识别高风险患者,可以及时采取预防性干预措施,降低出血风险,改善患者预后。

关键词: 肝脏超声血流参数, 肝脾硬度值, 乙型肝炎肝硬化, 食管静脉曲张, 出血预测

Abstract: Objective To investigate the predictive value of liver ultrasound blood flow parameters combined with liver-spleen stiffness detection in predicting esophageal variceal bleeding in patients with hepatitis B cirrhosis. Methods From August 2021 to March 2024, 100 patients with hepatitis B cirrhosis treated at the Second People's Hospital of Lianyungang were selected for this study. Based on whether they experienced esophageal variceal bleeding during the follow-up period, the patients were divided into a bleeding group (34 cases) and a non-bleeding group (66 cases). All patients underwent Doppler ultrasound, contrast-enhanced ultrasound, and two-dimensional shear wave elastography (2D-SWE) for liver and spleen stiffness measurement. Parameters such as portal vein velocity (PVV), portal vein diameter (PVD), hepatic vein arrival time (HVAT), portal vein congestion index (PV-CI), and liver stiffness values were recorded. Results The bleeding group had lower PVV and HVAT but higher PVD, PV-CI, and liver stiffness values than the non-bleeding group (P<0.05). Receiver operating characteristic (ROC) curve showed that the sensitivities of liver stiffness value, PVV, PVD, PV-CI, and HVAT in predicting esophageal variceal bleeding were 44.1%, 64.7%, 76.5%, 52.9%, and 94.1%, respectively, and their specificities were 83.3%, 84.8%, 81.8%, 92.4%, and 86.4%, respectively. The area under the curve (AUC) values were 0.662, 0.810, 0.842, 0.800, and 0.953, respectively. When these parameters were combined, the sensitivity and specificity reached 95.5% and 94.1%, respectively, with an AUC value of 0.982. Conclusion The combined assessment of liver ultrasound blood flow parameters and liver-spleen stiffness measurement can effectively predict the risk of esophageal variceal bleeding in patients with hepatitis B-related cirrhosis, demonstrating significant clinical value. Early identification of high-risk patients allows for timely preventive interventions, reducing the risk of bleeding and improving patient outcomes.

Key words: Liver ultrasound blood flow parameters, Liver-spleen stiffness, Hepatitis B cirrhosis, Esophageal varices, Bleeding prediction

王娴, 李亮, 吴新勇, 王思思. 肝脏超声血流参数联合肝脾硬度值检测对乙型肝炎肝硬化食管静脉曲张出血的评估价值[J]. 肝脏, 2025, 30(2): 197-200.

WANG Xian, LI Liang, WU Xin-yong, WANG Si-si. Evaluation of the combined detection of liver ultrasound blood flow parameters and liver-spleen stiffness in predicting esophageal variceal bleeding in hepatitis B cirrhosis patients[J]. Chinese Hepatolgy, 2025, 30(2): 197-200.

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参考文献

[1] 金宇, 刘晓玲, 黄怡丹. 免疫球蛋白和自身抗体在乙型肝炎肝硬化发病和进展中的表达及与预后的关系[J]. 中国现代医学杂志,2023,33(4):56-61.
[2] 熊雪丽, 张江春, 胡乃毅, 等. 实时二维剪切波弹性成像对乙型肝炎肝硬化门静脉高压患者曲张静脉出血风险的预测价值分析[J]. 中国现代医学杂志,2023,33(1):76-81.
[3] 张洋, 张德和, 唐诗越, 等. 可溶性CD163联合Charlson指数预测肝硬化患者食管静脉曲张出血的价值[J]. 检验医学,2024,39(1):19-25.
[4] 杜居洁, 郑红, 李金. 超声内镜检查术检查乙型肝炎肝硬化患者食管侧支静脉曲张的价值分析[J]. 肝脏,2021,26(5):505-509.
[5] 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.
[6] 张舰琼, 徐亮, 李萍, 等. 四种方法诊断慢性乙型肝炎合并轻度肝脂肪变患者肝纤维化比较[J]. 实用肝脏病杂志,2016,19(6):663-668.
[7] Ginès P, Krag A, Abraldes J G, et al. Liver cirrhosis[J]. The Lancet, 2021, 398(10308): 1359-1376.
[8] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会消化内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 中华肝脏病杂志,2022,30(10):1029-1043.
[9] 邓泽平, 覃山羽, 姜海行. 辽宁评分与多种无创评分系统预测肝硬化患者高危食管静脉曲张及出血或再出血的价值比较[J]. 中华消化内镜杂志,2022,39(5):388-393.
[10] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志,2019,18(12):1087-1093.
[11] Li T Y, Yang Y, Zhou G, et al. Immune suppression in chronic hepatitis B infection associated liver disease: A review[J]. World J Gastroenterol, 2019, 25(27): 3527-3537.
[12] Selicean S E, Wang C, Guixé Muntet S, et al. Regression of portal hypertension: underlying mechanisms and therapeutic strategies[J]. Hepatol Int, 2021, 15(1): 36-50.
[13] Iwakiri Y, Trebicka J. Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy[J]. JHEP reports, 2021, 3(4): 100316.
[14] Ezhilarasan D. Endothelin-1 in portal hypertension: the intricate role of hepatic stellate cells[J]. Exp Biol Med, 2020, 245(16): 1504-1512.
[15] Morgan J, Shagla E, Kwok R M. Treatment of Acute Hemorrhage from Esophageal Varices in Cirrhotic Patients[J]. AJTES, 2019, 3(1): 319-326.
[16] Aquino-Matus J, Uribe M, Chavez-Tapia N. Liver and spleen elastography as predictor of portal hypertension and esophageal varices[J]. Minerva Gastroentero, 2020, 67(2): 122-128.
[17] Omar M, Salama Z A, Saad Y, et al. Fibroscan in Grading and Prediction of the Risk of Bleeding of Gastro-Esophageal Varices in HCV related Cirrhotic Patients[J]. EJHM, 2023, 91(1): 5157-5161.
[18] M Hussein A, Badr B, Abdelsameea E. Role of Liver and Spleen Stiffness in Predicting the Degree and Bleeding Risk of Esophageal Varices in Cirrhotic Patients[J]. BMJ, 2022, 39(2): 383-396.
[19] Liu C, Chen S, Yan X, et al. Diagnostic Value of Portal Vein Velocity for Portal Hypertension in Patients with Hepatitis B Virus-related Cirrhosis[J]. Curr Med Imaging, 2021, 17(11): 1363-1368.
[20] Garg A, Singh K, Bhardwaj N, et al. Correlation of Portal Vein Diameter as a Reflection of Portal Hypertension With Clinical and Laboratory Parameters in Chronic Liver Disease[J]. J Assoc Physicians India, 2022, 70(4): 11-12.
[21] Tan B G, Tang Z, Ou J, et al. An improved model based on quantitative features of right liver lobe, maximum varices, and portal vein system measured on magnetic resonance imaging to predict oesophagogastric variceal haemorrhage secondary to hepatitis B-related cirrhosis[J]. Quant Imag Med Surg, 2023, 13(12): 7741-7752.
[22] Argaiz E R, Rola P, Gamba G. Dynamic changes in portal vein flow during decongestion in patients with heart failure and cardio-renal syndrome: a POCUS case series[J]. Cardiorenal Med, 2021, 11(1): 59-66.
[23] Hana M M, El-Hammoly M S, Nouh M A, et al. The role of portal congestion index in prediction of esophageal varices in hepatitis C virus-infected patients[J]. MMJ, 2019, 32(3): 1119-1125.