基于剪切波弹性成像以及静脉血流动力学参数的logistic回归模型预测乙型肝炎肝硬化曲张静脉出血风险

摘要/Abstract

摘要： 目的探讨剪切波弹性成像(SWE)及静脉血流动力学参数预测乙型肝炎肝硬化患者曲张静脉出血(EVB)风险的应用价值。方法选取2020年7月—2023年7月期间德阳市第二人民医院收治的126例乙型肝炎肝硬化患者作为研究对象。采用多因素回归分析确定乙型肝炎肝硬化患者发生EVB风险的危险因素,并通过ROC曲线评估剪切波弹性成像及静脉血流动力学参数的预测价值。结果单因素分析显示,出血组在静脉曲张程度为重的占比(61.29%)以及MCT(6.50±1.35)s、PET(15.18±2.21)s、LSM(16.54±5.55)kPa、SSM(32.73±8.70)kPa值均高于未出血组[静脉曲张程度为重的占比41.05%,MCT(4.37±1.46)s、PET(12.53±2.95)s、LSM(13.14±4.95)kPa、SSM(25.14±8.59)kPa],而PLT水平(75.20±21.37)×10⁹/L低于未出血组[(102.45±26.21)×10⁹/L, P<0.05]。多因素回归分析表明,静脉曲张程度、PLT、MCT、PET、LSM、SSM是乙型肝炎肝硬化患者发生EVB的独立危险因素(P<0.05)。ROC曲线分析表明,MCT、PET、LSM、SSM等参数联合应用于预测乙型肝炎肝硬化患者发生EVB风险的AUC值为0.957,灵敏度为90.3%,特异度为92.6%。结论 MCT、PET、LSM、SSM的测量值与乙型肝炎肝硬化患者发生EVB风险密切相关,可作为有效的预测评估测量指标。

关键词: 剪切波弹性成像, 静脉血流动力学参数, 乙型肝炎肝硬化, 曲张静脉出血

Abstract: Objective To investigate the application value of shear wave elastography (SWE) and venous hemodynamic parameters in predicting the risk of esophageal variceal bleeding (EVB) in patients with Hepatitis B virus (HBV) cirrhosis. Methods A total of 126 patients with HBV cirrhosis admitted to our hospital from July 2020 to July 2023 were selected as the subjects of this study. Multifactorial regression analysis was employed to identify the risk factors for the occurrence of EVB in patients with HBV cirrhosis, and the predictive value of SWE and venous hemodynamic parameters was assessed using the receiver operating characteristic (ROC) curve. Results Univariate analysis indicated that the proportions of severe varices (61.29)% and the values of MCT (6.50±1.35) s, PET (15.18±2.21) s, LSM (16.54±5.55) kPa, and SSM (32.73±8.70) kPa in the bleeding group were significantly higher than that in the non-bleeding group (severe varices proportion 41.05)%, MCT (4.37±1.46) s, PET (12.53±2.95) s, LSM (13.14±4.95) kPa, SSM (25.14±8.59) kPa, while PLT levels (75.20±21.37) × 10⁹/L were lower than that in the non-bleeding group (102.45±26.21) × 10⁹/L (P<0.05). Multifactorial regression analysis revealed that the degree of varices, PLT, MCT, PET, LSM, and SSM were independent risk factors for EVB in patients with HBV-related cirrhosis (P<0.05). ROC curve analysis demonstrated that the combination of MCT, PET, LSM, and SSM parameters had an AUC of 0.957, with a sensitivity of 90.3% and a specificity of 92.6%. Conclusion The measurements of MCT, PET, LSM, and SSM are closely related to the risk of EVB in HBV patients with cirrhosis and can serve as effective predictive assessment indicators.

Key words: Shear wave elastography, Venous hemodynamic parameters, Hepatitis B cirrhosis, Esophageal variceal bleeding

陈慧琴, 王双, 韩宇. 基于剪切波弹性成像以及静脉血流动力学参数的logistic回归模型预测乙型肝炎肝硬化曲张静脉出血风险[J]. 肝脏, 2025, 30(2): 201-206.

CHEN Hui-qin, WANG Shuang, HAN Yu. Objective prediction of esophageal variceal bleeding risk in hepatitis b cirrhosis based on shear wave elastography and venous hemodynamic parameters using logistic regression model[J]. Chinese Hepatolgy, 2025, 30(2): 201-206.

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