病毒性肝硬化患者肝脾脏硬度变化及与肝静脉压力梯度的相关性分析

Correlation between liver/spleen stiffness and hepatic venous pressure gradient in patients with viral liver cirrhosis

摘要:

目的 探究病毒性肝硬化患者肝脾脏硬度变化及与肝静脉压力梯度的相关性。方法 将2020年9月至2021年12月在兰州市第二人民医院超声科进行病毒性肝硬化治疗的82例患者作为研究对象，检测患者肝静脉压力梯度（hepatic venous pressure gradient，HVPG）和肝脾硬度。采用Pearson相关性分析评估病毒性肝硬化患者肝脾脏硬度变化与肝静脉压力梯度的相关性；并采用受试者工作特征（receiver operating characteristic，ROC）曲线评估肝脾脏硬度对肝硬化患者HVPG≥12 mmHg的预测价值。结果 病毒性肝硬化Child-pugh B级和Child-pugh C级患者HVPG（F=16.643，P<0.001）、肝脏硬度（F=14.403，P<0.001）、脾脏硬度（F=11.775，P<0.001）明显高于Child-pugh A级患者。患者HVPG与肝脏硬度和脾脏硬度均呈正相关（r=0.591，0.502，P<0.001）。肝脏硬度、脾脏硬度及联合分析预测肝硬化患者HVPG≥12 mmHg的ROC曲线下面积（area under the curve，AUC）分别为0.866、0.821、0.914。结论 病毒性肝硬化患者肝脾脏硬度与HVPG呈正相关，且对门静脉高压的无创诊断有一定预测价值。

Abstract:

Objective To investigate the change in liver/spleen stiffness and the correlation with hepatic venous pressure gradient （HVPG） in patients with viral liver cirrhosis.Methods We included 82 patients with viral liver cirrhosis treated in The Second People's Hospital of Lanzhou from September 2020 to December 2021. HVPG and liver and spleen stiffness were measured. Pearson correlation analysis was used to evaluate the correlation between changes in liver and spleen stiffness and HVPG in these patients. A receiver operating characteristic（ROC） curve was used to evaluate the predictive value of liver and spleen stiffness for HVPG ≥12 mmHg in patients with viral liver cirrhosis.Results HVPG，liver stiffness，and spleen stiffness were significantly higher in the Child-Pugh class B patients and the Child-Pugh class C patients than in the Child-Pugh class A patients（P<0.05）. HVPG was significantly positively correlated with liver stiffness and spleen stiffness（r=0.591，0.502，P<0.001）. The areas under the ROC curves for predicting HVPG ≥12 mmHg using liver stiffness，spleen stiffness，and their combination in patients with liver cirrhosis were 0.866，0.821，and 0.914，respectively.Conclusion Liver and spleen stiffness are significantly positively correlated with HVPG in patients with viral liver cirrhosis， which have certain predictive value for portal hypertension in a noninvasive way.