肝脾硬度联合门静脉宽度预测酒精性肝硬化食管胃底静脉曲张破裂出血的临床观察

The Clinical Value of Liver-spleen Stiffness Combined with Portal Vein Width in Predicting the Risk of Rupture and Bleeding of Esophagogastric Varices in Alcoholic Cirrhosis

目的探讨肝脾硬度联合门静脉宽度预测酒精性肝硬化(AC)患者食管胃底静脉曲张破裂出血风险的临床价值。方法回顾性分析2020—2022年赣州市第五人民医院收治的200例AC患者的临床资料,依据内镜下食管静脉曲张分级标准将其分为无曲张组(n=41)、轻度曲张组(n=43)、中度曲张组(n=61)、重度曲张组(n=55),均行电子胃镜、肝脾硬度和腹部彩超检查,比较其肝脏硬度值(LSM)、脾脏硬度值(SSM)、脾厚度及门静脉宽度水平。对患者进行为期18个月的随访,根据随访期间有无食管胃底静脉曲张破裂出血将其分为出血组(n=116)和无出血组(n=84),比较2组的LSM、SSM值和门静脉宽度水平,建立ROC风险评估模型,评估肝脾硬度、门静脉宽度以及二者联合的诊断效能。结果重度组LSM、SSM、脾厚度、门静脉宽度水平均高于轻度和中度曲张组(P<0.05);与无出血组比较,出血组LSM、SSM、门静脉宽度水平均明显增加(P<0.001);ROC曲线分析结果显示,肝脾硬度联合门静脉宽度风险评估模型的AUC值最高,为0.983,灵敏度和特异度分别为98.27%和83.62%。结论随着AC患者食管胃底静脉曲张程度的加重,LSM、SSM、脾厚度、门静脉宽度水平也逐渐增高,肝脾硬度联合门静脉宽度预测AC患者食管胃底静脉曲张破裂出血风险具有较高的临床价值,效能优于单独采用LSM、SSM或门静脉宽度。

Objective To investigate the clinical value of measuring liver-spleen stiffnessin conjunction with portal vein width in predicting the risk of rupture and bleeding of esophagogastric varices in patients with alcoholic cirrhosis(AC).Methods The clinical records of 200 AC patients admitted to the Fifth People’s Hospital of Ganzhou City between January 2020 and December 2022 were retrospectively analyzed.Based on the Endoscopic Classification Criteria for Esophageal Varices,patients were categorized into four groups:non-varicose group(n=41),mild varicose group(n=43),moderate varicose group(n=61),and severe varicose group(n=55),and they were all subjected to e-gastroscopy,liver and spleen hardness and abdominal ultrasound to compare their liver stiffness measurement(LSM),spleen stiffness measurement(SSM),spleen thickness and portal vein width levels.The patients were followed up for a period of 18 months and divided into the bleeding group(n=116)and the non-bleeding group(n=84)according to the presence or absence of ruptured esophagogastric variceal hemorrhage during the follow-up period.The levels of LSM,SSM values,and portal vein width of the 2 groups were compared,anda ROC risk assessment model was established to evaluate the diagnostic efficacy of liver-spleen stiffness,portal vein width,and the combination of the two.Results The levels of LSM,SSM,spleen thickness,and portal vein width in the severe varicose group were higher than those in the mild and moderate varicose groups(P<0.05);the levels of LSM,SSM,and portal vein width in the bleeding group were significantly increased compared with those in the non-bleeding group(P<0.001);and the results of the ROC curve analysis showed that the risk assessment model of liver-spleen stiffness combined with portal vein width had the highest AUC value of 0.983,and the sensitivity and specificity were 98.27%and 83.62%,respectively.Conclusion LSM,SSM,spleen thickness,and portal vein width can all gradually increase with the aggravation of esophagogastric varices in patients with AC.The combination of liver and spleen stiffness and portal vein width may have a higher clinical valuein predicting the risk of rupture and bleeding of esophageal varices than the use of LSM,SSM,or portal vein width alone in AC patients.