基于彩色多普勒超声在定量评估乙型肝炎肝纤维化患者脾静脉内径和门静脉内径中的价值

doi:10.7517/issn.1674-0475.230602

摘要/Abstract

摘要： 探究彩色多普勒超声检测脾静脉内径(SVD)、门静脉内径(PVD)及半定量评分与乙型肝炎肝纤维化的关系。选取202例乙型肝炎患者行超声引导下肝穿刺活检,根据肝穿刺活检结果将其分为肝纤维化组(n=112)和无肝纤维化组(n=90)。多因素Logistic回归分析各指标水平与乙型肝炎患者肝纤维化之间的关系,构建乙型肝炎患者肝纤维化的预测模型和乙型肝炎患者肝纤维化风险评分系统及划分风险等级。结果显示,SVD升高、PVD升高、脾门厚度升高、脾脏面积升高、胆囊壁厚度升高、肝表面被膜升高、肝固有动脉峰值血流速度(HAV_max)升高、肝脏硬度测量(LSM)升高、丙氨酸转氨酶(ALT)升高是乙型肝炎患者肝纤维化的独立危险因素,脾脏长度降低、肝实质回声降低、肝静脉清晰度降低、门静脉峰值血流最大速度(PVV_max)升高、脾静脉峰值血流速度(SVV_max)升高是其保护因素(P<0.05);SVD和PVD与乙型肝炎肝纤维化呈明显非线性关系(P＜0.05);对各影响因素进行风险评分,总分在0.5~24分,根据百分位数进行评分分级,低危组(n=84)<9分,中危组(n=67)9~17分,高危组(n=51)>17分,高危组患者肝纤维化发生率显著高于低危组和中危组(P＜0.05)。乙型肝炎纤维化患者的SVD和PVD明显高于无纤维化患者,与不同程度的肝纤维化密切相关。

关键词: 乙型肝炎, 肝纤维化分期, 门静脉内径, 脾静脉内径, 多普勒超声

Abstract: To investigate the relationship between splenic vein diameter (SVD), portal vein diameter (PVD), and semi-quantitative scoring and liver fibrosis in patients with hepatitis B. A total of 202 patients with hepatitis B who underwent ultrasound-guided liver biops. Based on the results of liver biopsy, the patients were divided into the liver fibrosis group (n=112) and the non-fibrosis group (n=90). Logistic regression analysis was used to explore the relationship between various indicators and liver fibrosis in patients with hepatitis B. A predictive model for liver fibrosis and a risk scoring system were constructed, and risk levels were 238 determined. The results showed that Elevated SVD, elevated PVD, increased splenic thickness, increased spleen area, increased gallbladder wall thickness, increased liver surface membrane height, increased peak blood flow velocity of the hepatic artery (HAV_max), increased liver stiffness measurement (LSM), and elevated alanine aminotransferase (ALT) were independent risk factors for liver fibrosis in patients with hepatitis B. Decreased spleen length, decreased liver parenchymal echo, decreased clarity of liver veins, increased peak blood flow velocity of the portal vein (PVV_max), and increased peak blood flow velocity of the splenic vein (SVV_max) were protective factors (P<0.05). SVD and PVD had a significant nonlinear relationship with liver fibrosis in hepatitis B patients (P<0.05). Risk scoring was performed for each influencing factor, with a total score ranging from 0.5 to 24. Based on the percentiles, the scores were classified into low-risk group (n=84) with a score <9, moderate-risk group (n=67) with a score of 9~17, and high-risk group (n=51) with a score >17. The incidence of liver fibrosis in the high-risk group was significantly higher than that in the low-risk and moderate-risk groups (P<0.05). SVD and PVD are significantly higher in patients with hepatitis B-related fibrosis compared to those without fibrosis and are closely related to the degree of liver fibrosis.

Key words: hepatitis B, staging of hepatic fibrosis, internal diameter of portal vein, internal diameter of splenic vein, Doppler ultrasound

曾晓蓉, 李丹, 牟荥, 喻英. 基于彩色多普勒超声在定量评估乙型肝炎肝纤维化患者脾静脉内径和门静脉内径中的价值[J]. 影像科学与光化学, 2023, 41(5): 238-246.

ZENG Xiaorong, LI Dan, MOU Ying, YU Ying. Value of Color Doppler Ultrasonography in Quantitative Evaluation of Splenic Vein Diameter and Portal Vein Diameter in Patients with Hepatitis B Hepatic Fibrosis[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(5): 238-246.

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