单点剪切波弹性成像联合超声造影定量参数检测评估TIPS治疗肝硬化并发门静脉高压症的价值

摘要/Abstract

摘要： 目的探讨单点剪切波弹性成像(pSWE)联合超声造影(CEUS)定量参数检测评估经颈静脉肝内门体分流术(TIPS)治疗肝硬化(LC)并发门静脉高压症(PHT)的应用价值。方法纳入2022年7月至2024年12月江南大学附属无锡五院收治的LC-PHT患者108例,均接受TIPS治疗,分别于治疗前、治疗后3个月行pSWE、CEUS检测,对比定量参数[肝脏、脾脏剪切波速度(SWV),门静脉曲线到达时间(AT)、峰值时间(TTP)、峰值强度(PI)、上升支斜率(AS)]及弗莱堡术后生存指数(FIPS),采用Pearson相关性分析评估pSWE、CEUS定量参数与FIPS评分的关系。结果 LC-PHT患者TIPS治疗后的脾脏SWV及FIPS评分分别为(2.4±0.7)m/s、(-0.86±0.21)分,均低于治疗前[(3.8±0.8)m/s、(-0.56±0.14)分,P<0.05],TTP为(29.5±2.9)s,短于治疗前的[(35.6±3.8)s,P<0.05],PI、AS分别为(18.6±2.5)dB、(1.3±0.4)dB/s,均高于治疗前[(13.4±2.0)dB、(1.0±0.3)dB/s,P<0.05]。LC-PHT患者TIPS治疗后,脾脏SWV、TTP均与FIPS评分呈正相关(r=0.47,P<0.05;r=0.51,P<0.05),PI、AS均与FIPS评分呈负相关(r=-0.38,P<0.05;r=-0.41,P<0.05);但肝脏SWV、AT与FIPS评分均无相关性(r=0.08,P>0.05;r=0.14,P>0.05)。结论 pSWE联合CEUS定量参数检测在评估TIPS治疗LC-PHT患者疗效方面,具有较高的临床应用价值。

关键词: 肝硬化, 门静脉高压症, 单点剪切波弹性成像, 超声造影, 定量参数, 经颈静脉肝内门体分流术, 疗效

Abstract: Objective Investigate the application value of point shear wave elastography (pSWE) combined with quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating the curative effect of transjugular intrahepatic portosystemic shunt (TIPS) for liver cirrhotic patients complicated with portal hypertension (LC-PHT). Methods 108 patients with LC-PHT undergoing TIPS were enrolled in Jiangnan University Affiliated Wuxi Fifth Hospital between July 2022 and December 2024. Before treatment and at 3 months after treatment, pSWE and CEUS were performed to compare quantitative parameters [shear wave velocity (SWV) of liver and spleen, arrival time (AT), time to peak (TTP), peak intensity (PI), ascending branch slope (AS)] and Freiburg index of post-TIPS survival (FIPS). The relationship between pSWE, CEUS quantitative parameters and FIPS score was analyzed by Pearson correlation analysis. Results After TIPS, spleen SWV and FIPS score were (2.4±0.7) m/s and (-0.86±0.21) points, which were lower than those of (3.8±0.8) m/s, and (-0.56±0.14) points before treatment [P<0.05], TTP was shorter than that before treatment [(29.5±2.9) s vs. (35.6±3.8) s, P<0.05], PI and AS were (18.6±2.5) dB and (1.3±0.4) dB/s, which were higher than those of (13.4±2.0) dB and (1.0±0.3) dB/s before treatment [P<0.05]. In LC-PHT patients after TIPS, spleen SWV and TTP were positively correlated with FIPS score (r=0.47, P<0.05; r=0.51, P<0.05), while PI and AS were negatively correlated with it (r=-0.38, P<0.05; r=-0.41, P<0.05); However, liver SWV and AT was not correlated with FIPS score (r=0.08, P>0.05; r=0.14, P>0.05). Conclusion The clinical application value of pSWE combined with CEUS quantitative parameters is high in evaluating the curative effect of TIPS in LC-PHT patients.

Key words: Liver cirrhosis, Portal hypertension, Point shear wave elastography, Contrast-enhanced ultrasound, Quantitative parameter, Transjugular intrahepatic portosystemic shunt, Curative effect

陈津津, 胡欣, 秦菲, 蒋骏麟, 李琳. 单点剪切波弹性成像联合超声造影定量参数检测评估TIPS治疗肝硬化并发门静脉高压症的价值[J]. 肝脏, 2026, 31(2): 200-203.

CHEN Jin-jin, HU Xin, QIN Fei, JIANG Jun-lin, LI Lin. The application value of point shear wave elastography combined with contrast-enhanced ultrasound quantitative parameters in detecting the curative effect of TIPS in liver cirrhotic patients complicated with portal hypertension[J]. Chinese Hepatolgy, 2026, 31(2): 200-203.

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参考文献

[1] Chinese Society of Gastroenterology, Chinese Medical Association. Chinese consensus on the management of liver cirrhosis[J]. J Dig Dis, 2024, 25(6): 332-352.
[2] Kotani K, Kawada N. Recent advances in the pathogenesis and clinical evaluation of portal hypertension in chronic liver disease[J]. Gut Liver, 2024 , 18(1): 27-39.
[3] Lee H L, Lee S W. The role of transjugular intrahepatic portosystemic shunt in patients with portal hypertension: advantages and pitfalls[J]. Clin Mol Hepatol, 2022, 28(2): 121-134.
[4] Qiu Z, Wang G, Yan H, et al. TIPS plus sequential systemic therapy of advanced HCC patients with tumour thrombus-related symptomatic portal hypertension[J]. Eur Radiol, 2022, 32(10): 6777-6787.
[5] 陈思艳,郭道宁,邹晓攀,等. 彩色多普勒超声评估肝硬化门静脉高压症患者TIPS术后支架功能研究[J]. 实用肝脏病杂志, 2024, 27(6): 899-902.
[6] Guo D F, Fan L W, Le Q, et al. Transjugular intrahepatic portosystemic shunt for the prevention of rebleeding in patients with cirrhosis and portal vein thrombosis: systematic review and meta-analysis[J]. Front Pharmacol, 2022, 13: 968-988.
[7] Xu X, Liu J, Zhu Y, et al. Spleen stiffness measurement as a non-invasive assessment in patients with portal hypertension[J]. eGastroenterology, 2024, 2(1): e100031.
[8] Wang P, Hu X, Xie F. Predictive value of liver and spleen stiffness measurement based on two-dimensional shear wave elastography for the portal vein pressure in patients with compensatory viral cirrhosis[J]. PeerJ, 2023, 11: e15956.
[9] Yang M, Qin F, Zhou Y, et al. Evaluation and clinical significance of contrast-enhanced ultrasound on changes in liver blood flow perfusion after TIPS surgery[J]. Medicine (Baltimore), 2024, 103(17): e37899.
[10] 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.
[11] 中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南(2019版) [J]. 中华医学杂志, 2019, 99(45): 3534-3546.
[12] 北京医师协会门静脉高压专科医师分会,中国研究型医院学会肝病专业委员会门静脉高压学组,中国研究型医院学会肝病专业委员会. 肝硬化门静脉高压症多学科诊治(基于肝静脉压力梯度)专家共识[J]. 临床肝胆病杂志, 2021, 37(9): 2037-2044.
[13] 赖瑞敏,朱月永. 门静脉高压症:经颈静脉肝内门体分流术的合理应用及其相关并发症的预防和处理[J]. 实用肝脏病杂志, 2023, 26(1): 4-7.
[14] Zhu H, Guo H, Yin X, et al. Spleen stiffness predicts survival after transjugular intrahepatic portosystemic shunt in cirrhotic patients[J]. Biomed Res Int, 2020, 2020: 386-390.
[15] Han H, Yang J, Jin W K, et al. Diagnostic value of conventional ultrasound and shear wave elastography in detecting transjugular intrahepatic portosystemic shunt dysfunction[J]. Acta Radiol, 2021, 62(12):1575-1582.
[16] Zhou H, Zhang Z, Zhang J, et al. Spleen stiffness performance in the noninvasive assessment of gastroesophageal varices after transjugular intrahepatic portosystemic shunts[J]. Biomed Res Int, 2021, 20(11): 5530004-5530012.
[17] Puttawibul P, Kritsaneepaiboon S, Chotsampancharoen T, et al. The relationship between liver stiffness by two-dimensional shear wave elastography and iron overload status in transfusion-dependent patients[J]. Pediatr Hematol Oncol, 2024, 41(6): 409-421.
[18] Lupuşoru R, Sporea I, Raţiu I, et al. Contrast-enhanced ultrasonography with arrival time parametric imaging as a non-invasive diagnostic tool for liver cirrhosis[J]. Diagnostics (Basel), 2022, 12(12): 3013.
[19] Chang J, Dumitrache A, Böhling N,et al. Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS) [J]. Sci Rep, 2020, 10(1): 20682.
[20] Bettinger D, Sturm L, Pfaff L, et al. Refining prediction of survival after TIPS with the novel freiburg index of post-TIPS survival[J]. J Hepatol, 2021,74(6): 1362-1372.