原发性胆汁性胆管炎的肝脏硬度值与脾静动脉血流学参数的相关性分析

Correlation analysis of liver stiffness measurement and hemostatic parameters of splenic artery in primary biliar cholangitis

目的分析原发性胆汁性胆管炎(PBC)患者肝脏硬度值(LSM)与脾静动脉血流学参数的相关性。方法选择PBC患者83例(PBC组),其中男性10例,女性73例;年龄45~75岁,平均年龄51.2岁;病程2.8~12.4年,平均病程7.2年。正常体检者50例(对照组),其中男性11例,女性39例;年龄34~62岁,平均年龄50.3岁。分别做超声脾静动脉检查和LSM检测,统计分析LSM与脾静动脉血流学参数[脾脏厚径、脾脏长径、脾静脉内径、脾静脉最大流速、脾静脉平均流速、脾动脉最大流速、脾动脉最小流速、脾动脉阻力指数(SRI)]的相关性。结果根据Scheuer分期评分系统对标本进行病理分期:Ⅰ期18例,Ⅱ期20例,Ⅲ期9例,Ⅳ期36例。PBC组LSM明显高于对照组[12.4(7.3~20.5)kPa vs 5.1(3.8~6.3)kPa。P<0.01]。脾脏厚径、长径和内径PBC组均大于对照组[(45.4±13.4)mm vs(31.3±5.6)mm、(127.7±36.3)mm vs(90.7±5.6)mm、(8.5±2.8)mm vs(6.5±0.7)mm。P<0.01]。脾动脉最大流速和SRI PBC组高于对照组[(79.7±28.7)cm/s vs(61.9±21.6)cm/s、0.62±0.08 vs 0.59±0.07。P>0.01];在PBC的各肝纤维化分期中,LSM、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI差异均有统计学意义(F=14.555、44.831、32.813、24.693、3.407、11.080,P<0.05)。PBC患者中,Ⅳ期的LSM、脾脏厚径、脾脏长径、脾脏内径、SRI均高于Ⅰ期和Ⅱ期[(25.8±17.3)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa、(56.3±8.2)mm vs(31.5±3.8)mm&(37.0±10.3)mm、(151.3±27.6)mm vs(89.5±10.5)mm&(108.0±21.9)mm、(10.6±2.6)mm vs(6.0±1.0)mm&(6.8±1.4)mm、0.68±0.08 vs 0.58±0.05&0.59±0.07。P<0.05]。Ⅲ期的LSM、脾脏长径、脾静脉内径均高于Ⅰ期和Ⅱ期[(19.7±6.6)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa、(153.0±36.3)mm vs(89.5±10.5)mm&(108.0±21.9)mm、(8.6±1.7)mm vs(6.0±1.0)mm&(6.8±1.4)mm。P<0.05];PBC患者的LSM与病理分期、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI分别呈正相关性(r=0.754、0.695、0.686、0.660、0.243、0.373,P=0.000、0.000、0.000、0.000、0.027、0.001)。结论PBC患者的LSM与病理分期、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI呈正相关,可为临床评估PBC疾病进展提供参考性依据。

Objective To analyze the correlation between liver stiffness measurement(LSM)and splenic arterial hemostatic parameters in patients with primary biliary cholangitis(PBC).MethodsA total of 83 patients with PBC(PBC group)were enrolled,which included 10 males and 73 females,aged 45-75 years old with mean age of 51.2 years old;course of disease was 2.8-12.4 years with mean of 7.2 years.Fifty healthy physical examination subjects were set as control group,which included 11 males and 39 females,aged 34-62 years old with mean age of 50.3 years old.Ultrasound splenic artery examination and LSM examination were performed respectively.The correlation between LSM and splenic artery hemodynamic parameters[spleen thick diameter,spleen long diameter,splenic vein diameter,splenic vein maximum flow velocity,splenic vein average flow velocity,splenic artery maximum flow velocity,splenic artery minimum flow velocity,splenic artery resistance index(SRI)]was statistically analyzed.Results According to the Scheuer staging scoring system,the pathological staging of the spec-imens was 18 cases of stage I,20 of stage II,9 of stage II and 36 of stage IV.LSM in PBC group was significantly higher than that in control group[12.4(7.3-20.5)kPa us 5.1(3.8-6.3)kPa.P<0.01].The thickness,length and inner diameter of spleen in PBC group were larger than those in control group[(45.4±13.4)mm us(31.3±5.6)mm,(127.7±36.3)mm vs(90.7±5.6)mm,(8.5±2.8)mm vs(6.5±0.7)mm.P<0.01].The splenic artery maximum velocity and SRI in PBC group were higher than those in control group[(79.7±28.7)cm/s vs(61.9±21.6)cm/s,0.62±0.08 vs 0.59±0.07.P>0.01].There were significant differ ences of LSM,spleen thickness,spleen length,splenic vein diameter,splenic artery maximum velocity and SRI in different stages of PBC liver fibrosis(F=14.555,44.831,32.813,24.693,3.407,11.080,P<0.05).In PBC patients,the LSM,spleen thick ness,spleen length,spleen diameter and SRI of stage IV were higher than those of stage I and stage II[(25.8±17.3)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa,(56.3±8.2)mm vs(31.5±3.8)mm&(37.0±10.3)mm,(151.3±27.6)mm vs(89.5±10.5)mm&(108.0±21.9)mm,(10.6±2.6)mm vs(6.0±1.0)mm&(6.8±1.4)mm,0.68±0.08 vs 0.58±0.05&0.59±0.07.P<0.05].The LSM,spleen length and splenic vein diameter in stage II were higher than those in stage I and stage II[(19.7±6.6)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa,(153.0±36.3)mm vs(89.5±10.5)mm&(108.0±21.9)mm,(8.6±1.7)mm vs(6.0±1.0)mm&(6.8±1.4)mm.P<0.05].The LSM of PBC patients was positively correlated with pathological stage,spleen thickness diameter,spleen length diameter,spleen vein diameter,spleen artery maximum velocity and SRI(r=0.754,0.695,0.686,0.660,0.243,0.373,P=0.000,0.000,0.000,0.000,0.027,0.001).Conclusion It is demonstrated that the LSM of PBC patients is positively correlated with pathological stage,spleen size,spleen length diameter,splenic vein diameter,splenic artery maximum flow rate and SRI,which may provide reference basis for clinical evaluation of PBC disease progression.