剪切波弹性成像与门静脉血流动力学预测乙型肝炎肝硬化患者胃底静脉曲张破裂风险的临床评价

摘要/Abstract

摘要： 目的探讨剪切波弹性成像(SWE)技术与门静脉血流动力学参数在预测乙型肝炎相关肝硬化患者胃底静脉曲张(GV)破裂风险中的应用价值。方法选取2021年8月至2024年5月苏州市中西医结合医院收治的81例HBV相关肝硬化患者作为研究对象,根据日本门静脉高压症研究会的分类系统评估其GV破裂的风险,分为高风险组(n=18)和低风险组(n=63)。所有患者均进行彩色多普勒超声及SWE检查,评估Child-Pugh肝功能分级、门静脉血流参数和脾脏弹性。分析Child-Pugh肝功能分级与门静脉血流参数、脾脏弹性的相关性。通过ROC曲线评估各指标及其联合的预测效能。结果高风险组Child-Pugh A级为3例(16.67%),Child-Pugh B级为8例(44.44%),Child-Pugh C级为7例(38.89%);低风险组Child-Pugh A级为37例(58.73%),Child-Pugh B级为20例(31.75%),Child-Pugh C级为6例(9.52%),两组患者的Child-Pugh肝功能分级比较差异有统计学意义(χ²=13.190,P＜0.05)。高风险组患者的门静脉内径(PVD)为(1.62±0.09)cm、门静脉流量(PVQ)为(1424.83±186.37)mL/min、脾脏指数(SI)为(77.29±8.12)cm²,脾脏弹性硬度值为(16.36±3.18)kPa,均高于低风险组,分别为(1.41±0.07)cm、(1320.95±171.19)mL/min、(71.58±7.03)cm²和(12.22±2.27)kPa;同时,高风险组的门静脉流速(PVV)为(10.49±1.37)cm/s,低于低风险组的(13.84±1.52)cm/s(P＜0.05)。采用Spearman相关性分析发现Child-Pugh肝功能分级与PVD、PVQ、SI、脾脏弹性硬度值存在正相关(r=0.303、0.302、0.361、0.464;均P＜0.05),与PVV存在负相关(r=-0.311;P＜0.05)。ROC曲线表明,SWE联合门静脉血流参数在预测GV破裂方面具有较高的临床价值,AUC值为0.974,灵敏度为94.4%,特异度为98.4%。结论 SWE与门静脉血流动力学参数能有效预测HBV相关肝硬化患者GV破裂的风险,可作为临床评估该患者群体破裂风险的重要工具。

关键词: 剪切波弹性成像, 门静脉血流动力学, 乙型肝炎, 肝硬化, 胃底静脉曲张, 风险预测

Abstract: Objective To investigate the application value of shear wave elastography (SWE) technology and portal vein hemodynamic parameters for predicting the risk of gastric varices (GV) rupture in patients with hepatitis B virus (HBV)-related cirrhosis. Methods A total of 81 patients with HBV-related cirrhosis admitted to Suzhou Hospital of Traditional Chinese and Western Medicine from August 2021 to May 2024 were selected as study subjects. Based on the classification system of the Japan Society for Portal Hypertension, patients were categorized into a high-risk group (n=18) and a low-risk group (n=63) according to their risk of GV rupture. All participants underwent color Doppler ultrasound and SWE to assess Child-Pugh classification, portal venous hemodynamics [portal vein diameter (PVD), portal venous flow volume (PVQ), splenic index (SI), portal venous velocity (PVV)], and spleen stiffness. The correlations between Child-Pugh classification and hemodynamic/spleen stiffness parameters were analyzed. Receiver operating characteristic (ROC) curves were generated to evaluate predictive performance. Results The high-risk group exhibited significantly higher proportions of Child-Pugh-B (44.44%) and Child-Pugh-C (38.89%) patients compared to that of the low-risk group (31.75% and 9.52%, respectively; χ²=13.190, P<0.05). Elevated PVD (1.62±0.09 cm vs. 1.41±0.07 cm), PVQ (1424.83±186.37 mL/min vs. 1320.95±171.19 mL/min), SI (77.29±8.12 cm² vs. 71.58±7.03 cm²), and spleen stiffness (16.36±3.18 kPa vs. 12.22±2.27 kPa) were observed in patients of the high-risk group (all P<0.05), whereas their PVV was reduced (10.49±1.37 cm/s vs. 13.84±1.52 cm/s, P<0.05). Child-Pugh classifications were positively correlated with PVD (r=0.303), PVQ (r=0.302), SI (r=0.361), and spleen stiffness (r=0.464), but negatively correlated with PVV (r=-0.311; all P<0.05). ROC analysis demonstrated superior predictive performance of the combined SWE-hemodynamic model (AUC=0.974, sensitivity=94.4%, specificity=98.4%). Conclusion The integration of SWE and portal venous hemodynamic parameters provides an effective noninvasive approach for stratifying GV rupture risk in patients with HBV-related cirrhosis, supporting its clinical utility in the risk assessment.

Key words: Shear wave elastography, Portal vein hemodynamics, Hepatitis B, Cirrhosis, Gastric varices, Risk prediction

李锋, 牛娜, 吴英. 剪切波弹性成像与门静脉血流动力学预测乙型肝炎肝硬化患者胃底静脉曲张破裂风险的临床评价[J]. 肝脏, 2025, 30(8): 1071-1075.

LI Feng, NIU Na, WU Ying. Predicting the risk of gastric variceal rupture in patients with hepatitis B-related cirrhosis by shear wave elastography and portal venous hemodynamics[J]. Chinese Hepatolgy, 2025, 30(8): 1071-1075.

/ 推荐

参考文献

[1] 刘韵, 徐云, 韩亮, 等. 实时组织弹性成像评估慢性乙型肝炎患者食管静脉曲张的研究[J]. 肝脏,2024,29(4):423-428.
[2] 曹俊杰, 姚志超, 曾宇琪, 等. 球囊辅助顺行栓塞术联合经颈静脉肝内门体静脉分流术在门静脉高压性食管GV破裂出血治疗中的初步探索[J]. 血管与腔内血管外科杂志,2024,10(4):456-460.
[3] 张春洋, 陈付群, 陈兆云. 老年肝硬化患者发生门脉高压性上消化道出血的危险因素分析及无创预测模型的建立[J]. 新疆医科大学学报,2023,46(12):1623-1627,1635.
[4] Ferraioli G, Maiocchi L, Dellafiore C, et al. Performance and cutoffs for liver fibrosis staging of a two-dimensional shear wave elastography technique[J]. Eur J Gastroenterol Hepatol, 2021, 33(1): 89-95.
[5] 刘水澎, 张国顺. 彩色多普勒超声检测门静脉、脾静脉血流动力学在肝硬化食管GV患者中的临床应用研究[J]. 中国实验诊断学,2023,27(4):436-439.
[6] 中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 中国肝脏病杂志(电子版),2019,11(4):5-27.
[7] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志,2019,27(11):846-865.
[8] 马丽君, 何聪. APRI及S指数与乙型肝炎肝硬化Child-Pugh肝功能分级的关系[J]. 肝脏,2019,24(4):448-449.
[9] Singh A, Verma N, Rathi S, et al. New classification of gastric varices: a twenty-year experience[J]. J Dig Endosc, 2021, 12(01): 024-030.
[10] Shan S, Zhao X, Wood-Trageser M A, et al. Obliteration of portal venules contributes to portal hypertension in biliary cirrhosis[J]. J Pathol, 2024, 263(2): 178-189.
[11] 王省, 胡兵, 李异玲, 等. 中国门静脉高压食管胃静脉曲张内镜治疗现状调研分析[J]. 中华消化内镜杂志,2024,41(1):43-51.
[12] Giri S, Jearth V, Seth V, et al. Comparison of efficacy and safety of endoscopic and radiological interventions for gastric varices: a systematic review and network meta-analysis[J]. Clin Exp Hepatol, 2023, 9(1): 57-70.
[13] Katwal S, Ansari M A, Suwal S, et al. Measurement of portal vein indices and splenic index by ultrasound and their association with gastroesophageal varices in cirrhosis of liver[J]. Ann Med Surg (Lond), 2023, 85(12): 5926-5931.
[14] 武雯雯, 仇艳坤. 慢性乙型肝炎患者二维剪切波肝脏弹性成像定量和外周血ALP/PLT比值的变化研究[J]. 实用肝脏病杂志,2024,27(1):24-27.
[15] Malakar S, Yadav R R, Pandey G, et al. Portal vein reconstruction-trans jugular intrahepatic portosystemic shunt and portal vein stenting in patients with extrahepatic portal vein obstruction[J]. J Clin Exp Hepatol, 2024, 14(6): 101437.
[16] 逯世林, 张娜, 王琳, 等. 抗凝血酶Ⅲ在乙型肝炎肝硬化失代偿期和并发食管胃底静脉曲张破裂出血中的评估价值[J]. 中华消化杂志,2022,42(11):770-776.
[17] Wang J, Li J, Wang W, et al. Portal vein velocity predicts portal vein system thrombosis after splenectomy with esophagogastric devascularization[J]. Surg Endosc, 2024, 38(2): 648-658.
[18] Coelho F F, Herman P, Kruger J A P, et al. Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies[J]. Surgery, 2023, 174(3): 581-592.
[19] 郭国强, 张嘉辉, 许琴, 等. 剪切波弹性成像技术在不同谷丙转氨酶水平的乙型肝炎患者胆囊疾病及脾脏大小研究中的价值[J]. 新发传染病电子杂志,2023,8(6):47-51.
[20] Petrenko O, Königshofer P, Brusilovskaya K, et al. Transcriptomic signatures of progressive and regressive liver fibrosis and portal hypertension[J]. iScience, 2024, 27(3):109301.