超声造影联合血清学指标评估失代偿期肝硬化患者门静脉高压的临床价值

Clinical value of contrast-enhanced ultrasonography and serum markers in assessing portal hypertension in patients with decompensated liver cirrhosis

目的探讨超声造影联合常规血清学标志物评估失代偿期肝硬化患者门静脉高压的可行性。方法根据肝静脉压力梯度(hepatic venous pressure gradient,HVPG)将54例失代偿期肝硬化门静脉高压患者分为HVPG<12 mmHg(1 mmHg=0.133 kPa)和HVPG≥12 mmHg两组。对血常规、肝功能、出凝血功能、Childpugh评分(Child-pugh score,CPS)及肝脏超声造影定量参数,包括肝动脉到达时间(hepatic artery arrival time,HAAT)、肝静脉到达时间(hepatic vein arrival time,HVAT)、门静脉到达时间(portal vein arrival time,PVAT)、肝动脉-肝静脉渡越时间(hepatic artery to hepatic vein arrive transmit time,HA-HVTT)、门静脉-肝静脉渡越时间(portal vein to hepatic vein arrive transmit time,PV-HVTT),进行单因素分析和Logistic回归分析,筛选出可以诊断门静脉高压的无创指标,并在此基础上构建诊断模型。通过ROC曲线评价模型的诊断价值并确定界值。结果建立诊断模型Y=-0.217×PV-HVTT+1.526×CPS-7.097。当模型的预测概率值≥0.631时,其判断HVPG≥12 mmHg的敏感性为87.5%,特异性为78.6%,ROC曲线下面积为0.857。结论由PV-HVTT和CPS建立的无创诊断模型对评估门静脉高压有一定的临床价值。

Objective To analyze the possibility of assessing portal hypertension in patients with decompensated liver cirrhosis via contrast-enhanced ultrasonography and common serum markers. Methods Fifty-four patients with decompensated liver cirrhosis were divided into two groups according to hepatic venous pressure gradient （HVPG）： HVPG〈12 mmHg （1 mmHg=0.133 kPa） and HVPG≥12 mmHg. The non-invasive index of routine blood test, liver function, coagulation function, Child-pugh score （CPS） and the results of contrast-enhanced ultrasound such as hepatic artery arrival time （HAAT）, hepatic vein arrival time （HVAT）, portal vein arrival time （PVAT）, hepatic artery to hepatic vein arrive transmit time （HA-HVTT） and portal vein to hepatic vein arrive transmit time （PV-HVTT） were assessed by univariate analysis and multivariate Logistic regression analysis, and then were used to generate a diagnostic model. The receiver operating characteristic curve was also used for analysis. Results The non-invasive model is Y=-0.217×PV-HVTT＋1.526×CPS-7.097. When the area under ROC curve （AUROC） was≥0.857 and the best cutoff value was≥0.631, and the sensitivity and specificity in judging HVPG≥12 mmHg were 87.5% and 78.6%, respectively. Conclusions The model composed of PV-HVTT and CPS could be used to assess portal hypertension.