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

Risk value analysis of real-time two-dimensional shear wave elastography in predicting variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension

摘要:

目的 探讨实时二维剪切波弹性成像技术预测乙型肝炎（乙肝）肝硬化门静脉高压患者曲张静脉出血风险的价值。方法 选取2020年1月—2022年1月武汉市中西医结合医院收治的92例乙肝肝硬化门静脉高压患者作为研究组，行实时二维剪切波弹性成像技术检查，另选取84例肝脏正常者作为对照组，比较两组肝弹性值和脾弹性值。所有乙肝肝硬化门静脉高压患者均行电子胃镜检查，并根据食管静脉曲张程度分为正常、轻度、中度和重度，比较不同程度患者的肝弹性值和脾弹性值。采用单因素分析影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的因素，采用一般多因素Logistic回归分析影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的危险因素；绘制受试者工作特征（ROC）曲线分析肝弹性值和脾弹性值对乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的预测价值。结果 研究组肝弹性值和脾弹性值均高于对照组（P <0.05）；不同程度食管静脉曲张患者的肝弹性值和脾弹性值比较，差异有统计学意义（P <0.05），随着食管静脉曲张程度增加，患者肝弹性值和脾弹性值逐渐升高；92例乙肝肝硬化门静脉高压患者中，共有24例发生食管静脉曲张破裂出血，发生率为26.09%（24/92）。单因素分析显示，发生食管静脉曲张破裂出血患者重度食管静脉曲张程度构成比高于未发生患者，门静脉宽度大于未发生患者，凝血酶原时间长于未发生患者，肝弹性值、脾弹性值高于未发生患者（P <0.05）；一般多因素Logistic回归分析结果显示食管静脉曲张程度［O^R=3.180（95%CI：1.037，9.757）］、肝弹性值［O^R=3.873（95%CI：1.262，11.881）］、脾弹性值［O^R=3.647（95%CI：1.189，11.189）］均是影响乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的危险因素（P <0.05）；ROC分析显示，肝弹性值和脾弹性值预测乙肝肝硬化门静脉高压患者发生食管静脉曲张破裂出血的最佳截断点分别为15.39 kPa和30.01 kPa，敏感性分别为83.33%（95%CI：0.626，0.953）和79.17%（95%CI：0.577，0.929），特异性分别为86.76%（95%CI：0.764，0.938）和89.71%（95%CI：0.798，0.957）（P <0.05）。结论 肝弹性值和脾弹性值对乙肝肝硬化门静脉高压患者曲张静脉出血风险具有预测价值。

Abstract:

Objective To explore the value of real-time two-dimensional shear wave elastography in predicting the risk of variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension.Methods From January 2020 to January 2022, 92 patients with portal hypertension and hepatitis B cirrhosis who were admitted to the hospital were selected as the research group, and underwent real-time two-dimensional shear wave elastography. Another 84 patients with normal livers were selected as the control group. Liver elasticity values and spleen elasticity values were compared between the two groups. All patients with hepatitis B cirrhosis and portal hypertension underwent electronic gastroscopy were divided into no, mild, moderate, and severe varices according to the degree of esophageal varices. The liver and spleen elasticity values were compared among the four groups. The incidence of esophageal variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension was counted. Univariate analysis was used to analyze the influencing factors of esophageal varices bleeding in patients with hepatitis B cirrhosis and portal hypertension. Logistic regression analysis was performed on the influencing factors. Receiver operating curve (ROC) was used to analyze the value of liver elasticity value and spleen elasticity value in predicting esophageal varices bleeding in patients with hepatitis B cirrhosis and portal hypertension.Results The liver elasticity value and spleen elasticity value of the study group were higher than those of the control group (P < 0.05). There were significant differences in liver elasticity value and spleen elasticity value in patients with different degrees of esophageal varices, and any two comparisons were statistically significant (P < 0.05). That is, with the increase in the degree of esophageal varices, the patient's liver elasticity value and spleen elasticity value gradually increased. Among 92 patients with hepatitis B cirrhosis and portal hypertension, a total of 24 had esophageal variceal bleeding, and the incidence rate was 26.09% (24/92). Univariate analysis showed that there were significant differences in the degree of esophageal varices, portal vein width, prothrombin time, liver elasticity, and spleen elasticity between patients with esophageal variceal bleeding and those without (P < 0.05). The composition ratio of severe esophageal varices, portal vein width, prothrombin time, liver elasticity, and spleen elasticity in patients with esophageal variceal bleeding were higher than those in patients without. Logistic multivariate regression analysis showed that the degree of esophageal varices [ O^R = 3.180 (95% CI: 1.037, 9.757) ], liver elasticity value [O^R = 3.873 (95% CI: 1.262, 11.881) ], and spleen elasticity value [ O^R = 3.647 (95% CI: 1.189, 11.189) ] were risk factors for esophageal variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension (P < 0.05). ROC analysis showed that the optimal cut-off points of liver elasticity value and spleen elasticity value for predicting esophageal variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension were 15.39 kPa and 30.01 kPa, the sensitivity was 83.33% (95% CI: 0.626, 0.953) and 79.17% (95% CI: 0.577, 0.929), the specificity was 86.76% (95% CI: 0.764, 0.938) and 89.71% (95% CI: 0.798, 0.957), and any two comparisons were statistically significant (P < 0.05).Conclusion Liver elasticity value and spleen elasticity value are of great value in predicting the risk of variceal bleeding in patients with hepatitis B cirrhosis and portal hypertension.