瞬时弹性成像技术在乙肝肝硬化门静脉高压患者中的应用

Application value of transient elastography in hepatitis B cirrhosis and portal hypertension

目的探讨瞬时弹性成像技术在乙肝肝硬化门静脉高压诊断中的应用效果。方法收集2019年1月至2020年1月广州医科大学附属市八医院收治的各种病因所致的乙肝肝硬化门静脉高压患者共68例,其中男48例,女20例,年龄范围18~70岁。根据患者食管胃静脉曲张程度将其分为正常组(12例)、轻度组(22例)、中度组(18例)和重度组(16例)。采取瞬时弹性成像检测患者肝脏硬度值(liver stiffness measurement,LSM),行腹部彩超观察患者脾脏大小、门静脉内径和腹水等。收集4组患者的LSM、腹水、门静脉内径、脾脏厚度、脾脏长度和食管胃静脉曲张出血情况,并分析LSM与门静脉内径、脾脏厚度、脾脏长度之间的相关性;比较不同食管胃静脉曲张出血患者LSM、门静脉内径和脾脏厚度的差异。结果随着食管胃静脉曲张程度加重,患者LSM、腹水、门静脉内径、脾脏厚度、脾脏长度均显著增加(均P<0.05);LSM与门静脉内径、脾脏厚度、脾脏长度均呈显著正相关(r=0.64、0.55、0.41,均P<0.05)。56例食管胃静脉曲张患者中,未出血患者32例、单次出血患者8例、多次出血患者16例;随着患者出血次数增加,LSM、门静脉内径和脾脏厚度均显著增加(均P<0.05)。结论瞬时弹性成像技术在乙肝肝硬化门静脉高压患者诊断中具有较高的应用价值,可以为临床门静脉高压诊断提供一定的参考依据。

Objective To investigate the application of transient elastography in the diagnosis of hepatitis B cirrhosis and portal hypertension.Methods A total of 68 patients with hepatitis B cirrhosis and portal hypertension caused by various causes admitted to Guangzhou Eighth People's Hospital,Guangzhou Medical University from January 2019 to January 2020 were collected,including 48 males and 20 females,aged from 18 to 70 years.The patients were divided into a normal group(12 cases),a mild group(22 cases),a moderate group(18 cases),and a severe group(16 cases)according to the degree of esophagogastric varices.Transient elastography was used to detect the value of liver stiffness measurement(LSM),and abdominal color ultrasound was performed to observe the spleen size,portal vein diameter,and ascite.LSM,ascite,portal vein diameter,spleen thickness,spleen length,and esophagogastric variceal hemorrhage were collected in the four groups,and the correlations between LSM and portal vein diameter,spleen thickness,and spleen length were analyzed.The differences of LSM,portal vein diameter,and spleen thickness in patients with different esophagogastric variceal hemorrhage were compared.Results With the exacerbation of esophagogastric varices,the LSM,ascite,portal vein diameter,and thickness and length of spleen significantly increased(all P<0.05).LSM was positively correlated with portal vein diameter,spleen thickness,and spleen length(r=0.64,0.55,and 0.41;all P<0.05).Among 56 patients with esophagogastric varices,32 patients had no hemorrhage,8 patients had single hemorrhage,and 16 patients had multiple hemorrhage.LSM,portal vein diameter,and spleen thickness significantly increased with the increase of hemorrhage frequency.Conclusion Transient elastography has a high value in the diagnosis of portal hypertension in patients with hepatitis B cirrhosis,and can provide certain references for the clinical diagnosis of portal hypertension.