乙型肝炎肝硬化患者自发性脾肾分流的发生情况及其临床特点

摘要/Abstract

摘要： 目的分析乙型肝炎肝硬化患者自发性脾肾分流的发生情况及其临床特点,为提高患者预后提供依据。方法回顾2021年2月至2025年2月期间在青海红十字医院诊治的乙型肝炎肝硬化患者126例,根据是否发生自发性脾肾分流分为发生组(n=40)和未发生组(n=86)。比较发生组、未发生组的临床资料,依据自发性脾肾分流超声学表现进行分型,并比较各分型临床资料,采用多因素logistic回归分析评估自发性脾肾分流发生的影响因素。结果 126例患者中,40例患者发生自发性脾肾分流,发生率为31.7%(40/126)。发生组血清总胆红素、门静脉、脾静脉内径、肝性脑病、腹水发生率分别为(40.2±5.3)μmol/L、(15.8±3.2)mm、(14.7±3.3)mm、45.0%、52.5%,高于未发生组[分别为(34.6±4.5)μmol/L、(13.2±2.1)mm、(12.5±1.4)mm、19.8%、16.3%],血清白蛋白水平为(26.2±5.6)g/L,低于未发生组[(35.3±5.2)g/L,P<0.05]。自发性脾肾分流见明显脾静脉至左肾静脉之间扩张的侧支循环,呈管状或蛇行形态,包括脾静脉直接汇入左肾静脉(直接型,25例);经多个侧支绕行后汇入左肾静脉(间接型,11例);伴胃肾分流或食管胃静脉曲张血管融合形成复杂型(复杂型,4例)。各分型门静脉内径、脾静脉内径、肝性脑病及腹水比较差异具有统计学意义(P<0.05)。多因素logistic回归分析结果显示,血清总胆红素、白蛋白水平、门静脉、脾静脉内径、肝性脑病、腹水发生率是乙型肝炎肝硬化患者自发性脾肾分流发生的影响因素(OR=3.442、3.677、3.540、3.710、3.582、3.732,P<0.05)。结论乙型肝炎肝硬化患者自发性脾肾分流发生率较高,血清总胆红素、白蛋白水平、门静脉内径、脾静脉内径、肝性脑病、腹水发生率是其发生的影响因素,临床可借助以上临床特征预测自发性脾肾分流发生风险,提高患者预后。

关键词: 乙型肝炎肝硬化, 自发性脾肾分流, 发生情况, 临床特点

Abstract: Objective To analyze the incidence and clinical characteristics of spontaneous splenorenal shunts (SSRS) in patients with hepatitis B-related liver cirrhosis, aiming to provide insight into improving patients′ prognosis. Methods A retrospective study was conducted on 126 patients with hepatitis B-relate cirrhosis who were admitted and treated between February 2021 and February 2025. The patients were divided into a shunt group (n=40) and a non-shunt group (n=86) based on the presence or absence of SSRS. The clinical data of the patients in both groups were collected. SSRS were classified based on ultrasonographic features, and clinical data were compared across different shunt types. Multivariate logistic regression analysis was used to identify factors associated with the occurrence of SSRS. Results Among the 126 patients, 40 (31.7%) developed SSRS. Compared to the non-shunt group, patients in the shunt group had significantly higher levels of serum total bilirubin[(40.2±5.3) μmol/L vs. (34.6±4.5)μmol/L], larger portal vein diameter [(15.8±3.2) mm vs. (13.2±2.1) mm], larger splenic vein diameter (14.7±3.3 mm vs. 12.5±1.4 mm), and higher incidences of hepatic encephalopathy (45.0% vs. 19.8%) and ascites (52.5% vs. 16.3%), with all differences being statistically significant (P<0.05). Serum albumin levels were significantly lower in the shunt group[(26.2±5.6)g/L]compared to the non-shunt group [(35.3±5.2)g/L, P<0.05]. Ultrasound imaging revealed prominent collateral circulation between the splenic vein and the left renal vein in the form of tubular or serpentine vessels, including: direct type, splenic vein directly draining into the left renal vein (25 cases); indirect type, splenic vein draining into the left renal vein via multiple collateral branches (11 cases); complex type, associated with gastrorenal shunt or esophagogastric varices forming a complex network (4 cases). Significant differences in portal vein diameter, splenic vein diameter, incidence of hepatic encephalopathy, and ascites were observed among the different shunt types (P<0.05). Multivariate logistic regression analysis identified serum total bilirubin, serum albumin level, portal vein diameter, splenic vein diameter, hepatic encephalopathy, and ascites as independent risk factors for the development of SSRS in hepatitis B-related cirrhosis patients (OR=3.442, 3.677, 3.540, 3.710, 3.582, 3.732; P<0.05). Conclusion The incidence of SSRS is relatively high in patients with hepatitis B cirrhosis. Serum total bilirubin, albumin levels, portal and splenic vein diameters, hepatic encephalopathy, and ascites are significant influencing factors. These clinical characteristics may help predict the risk of SSRS and improve patients’ prognosis.

Key words: Hepatitis B cirrhosis, Spontaneous splenorenal shunt, Occurrence, Clinical characteristics

韩敏, 张栋邦, 才新. 乙型肝炎肝硬化患者自发性脾肾分流的发生情况及其临床特点[J]. 肝脏, 2026, 31(4): 499-502.

HAN Min, ZHANG Dong-bang, CAI Xin. The occurrence and clinical characteristics of spontaneous splenorenal shunt in chronic hepatitis B-related liver cirrhotic patients[J]. Chinese Hepatolgy, 2026, 31(4): 499-502.

/ 推荐

参考文献

[1] Yu X, Gong Q, Yu D, et al. Spatial transcriptomics reveals a low extent of transcriptionally active hepatitis B virus integration in patients with HBsAg loss[J]. Gut, 2024, 73(5):797-809.
[2] Yi F, Guo X, Wang L, et al. Impact of spontaneous splenorenal shunt on liver volume and long-term survival of liver cirrhosis[J]. J Gastroenterol Hepatol, 2021, 36(6):1694-1702.
[3] Nickkholgh A, Wang J, Shahbazov R, et al. Intervention on spontaneous splenorenal shunt may decrease the incidence of acute kidney injury after liver transplant[J]. Exp Clin Transplant, 2020, 18(3):320-324.
[4] Chen G, Li Q, Zhang Z, et al. Hemodynamic alterations with large spontaneous splenorenal shunt ligation during adult deceased donor liver transplantation[J]. Front Surg, 2022, 9:916327.
[5] Yi F, Guo X, Zeng Q L, et al. Computed tomography images of spontaneous portosystemic shunt in liver cirrhosis[J]. Can J Gastroenterol Hepatol, 2022, 3231144.
[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]. 实用肝脏病杂志, 2020, 23(1):1-24.
[7] Liu G, Wang X, Luo X. Splenic arteriovenous fistula coexisting with spontaneous splenorenal shunt in a cirrhotic patient[J]. Clin Gastroenterol Hepatol, 2023, 21(10):A33.
[8] Qi X, Qi X, Zhang Y, et al. Prevalence and clinical characteristics of spontaneous splenorenal shunt in liver cirrhosis: A retrospective observational study based on contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scans[J]. Med Sci Monit, 2017, 23:2527-2534.
[9] Kisaoglu A, Dandin O, Demiryilmaz I, et al. A single-center experience in portal flow augmentation in liver transplantation with prior large spontaneous splenorenal shunt[J]. Transplant Proc, 2021, 53(1):54-64.
[10] Durur Karakaya A, Sorkun M, Akyıldız M, et al. Dilation of the left renal vein: an indicator of spontaneous splenorenal shunt in chronic liver disease patients[J]. Br J Radiol, 2025, 98(1169):764-769.
[11] Zheng Y, Hu Q, Zhou J, et al. Evaluation of the presence and severity of spontaneous splenorenal or gastrorenal shunts via four-dimensional flow magnetic resonance imaging: a preliminary study[J]. Quant Imaging Med Surg, 2024, 14(10):7625-7639.
[12] Luo X, Li J, Ma Y, et al. Albumin ratio and liver-to-abdominal area ratio are promising prognostic indicators for patients with post-hepatitis B cirrhosis[J]. Am J Transl Res, 2025, 17(8):5949-5961.
[13] Caraceni P, O′Brien A, Gines P. Long-term albumin treatment in patients with cirrhosis and ascites[J]. J Hepatol, 2022, 76(6):1306-1317.
[14] Garcia-Tsao G, Abraldes J G, Rich N E, et al. AGA clinical practice update on the use of vasoactive drugs and intravenous albumin in cirrhosis: expert review[J]. Gastroenterology, 2024, 166(1):202-210.
[15] Achiwa S, Hirota S, Kako Y, et al. Radiological anatomy of spontaneous splenorenal shunts in patients with chronic liver disease[J]. Jpn J Radiol, 2017, 35(4):206-214.
[16] Liu H, Nguyen H H, Hwang S Y, et al. Oxidative mechanisms and cardiovascular abnormalities of cirrhosis and portal hypertension[J]. Int J Mol Sci, 2023, 24(23):16805.
[17] 薛文豪, 夏磊, 刘仕睿, 等. 肝硬化自发性脾肾分流的治疗与预后分析[J]. 中华普通外科杂志, 2024, 39(5):344-349.
[18] García-Villarreal L, Ortega-Quevedo V, Pérez-Aguado G, et al. Massive spontaneous portosystemic shunt is a solid, easily identifiable prognostic factor in patients with cirrhosis[J]. Eur J Gastroenterol Hepatol, 2023, 35(7): 769-776.
[19] Kothari R, Khanna D, Kar P. To evaluate the prevalence of spontaneous portosystemic shunts in decompensated cirrhosis patients and its prognostic significance[J]. Indian J Gastroenterol, 2023, 42(5): 677-685.