肝血流超声参数联合外周血vWF-Ag对肝硬化患者食管静脉曲张出血的预测价值

摘要/Abstract

摘要： 目的探究肝血流超声参数联合外周血中血管性血友病因子抗原(vWF-Ag)对肝硬化患者食管静脉曲张出血(EVH)的预测价值。方法选择2015年12月至2018年12月重庆市东南医院收治的80例肝硬化患者为肝硬化组,同期收治的80例肝硬化合并EVH患者为肝硬化合并EVH组,健康体检者80名为对照组,比较3组肝血流超声参数门静脉内径(PVD)、门静脉充血指数(PV-CI)、门静脉到达时间(PVAT)、门静脉流速(PVV)、肝静脉到达时间(HVAT)、肝内循环时间(IHCT)、肝静脉减振指数(HV-DI)及血清vWF-Ag水平,以及EVH严重程度不同的肝硬化患者PVD、PV-CI、PVAT、PVV、HVAT、IHCT、HV-DI及血清vWF-Ag水平;分析肝硬化合并EVH患者血清vWF-Ag水平与肝血流超声参数的相关性,以及超声参数联合外周血vWF-Ag对肝硬化患者食管静脉曲张出血的的诊断效能。结果肝硬化组、肝硬化合并EVH组、对照组PVD分别为(1.25±0.20)、(1.52±0.25)、(0.78±0.15)cm,PV-CI分别为(0.08±0.03)、(0.13±0.03)、(0.05±0.01)cm/s,PVAT分别为(19.88±4.59)、(23.34±3.68)、(13.19±3.02)s,PVV分别为(18.13±4.38)、(15.88±4.23)、(20.20±4.16)cm/s,HVAT分别为(20.35±5.19)、(16.77±2.66)、(23.96±5.56)s,IHCT分别为(9.53±2.55)、(6.48±1.90)、(11.12±2.93)s,HV-DI分别为(0.62±0.12)、(0.75±0.13)、(0.51±0.11)及血清vWF-Ag水平分别为(150.15±19.61)、(211.09±50.83)、(90.33±10.28)有显著差异(P<0.05) ;肝硬化患者轻度、中度、重度EVH的PVD分别为(1.38±0.08)、(1.50±0.16)、(1.61±0.23)s,PV-CI分别为(0.12±0.04)、(0.14±0.03)、(0.16±0.05)cm/s,HV-DI分别为(0.72±0.09)、(0.78±0.12)、(0.84±0.15),PVAT分别为(21.11±3.01)、(23.45±4.23)、(25.67±4.92)s及血清vWF-Ag分别为(206.45±35.43)、(225.32±50.67)、(256.30±59.62)水平随EVH严重程度的增加而增加(P<0.05),肝硬化患者轻度、中度、重度EVH的PVV分别为(16.88±3.48)、(14.33±2.12)、(12.56±1.87)cm/s、HVAT分别为(18.45±2.68)、(16.34±2.22)、(13.26±1.08)s,IHCT分别为(6.29±1.76)、(6.01±1.46)、(5.91±1.03)s,随EVH严重程度的增加而减少(P<0.05);肝硬化合并EVH患者血清vWF-Ag水平与PVD (r=0.752)、PV-CI (r=0.750)、HV-DI (r=0.761)、PVAT (r=0.738)呈正相关(P<0.05,与PVV (r=-0.438)、HVAT (r=-0.441)、IHCT (r=-0.435)呈负相关(P<0.05);PVD、PV-CI、PVAT、PVV、HVAT、IHCT、HV-DI联合vWF-Ag对肝硬化患者食管静脉曲张出血的的诊断效能明显优于各指标单项检测(P<0.05)。结论肝血流超声参数PVD、PV-CI、PVAT、PVV、HVAT、IHCT、HV-DI联合外周血vWF-Ag对肝硬化患者食管静脉曲张出血一定预测价值,可作为肝硬化前期预防食管静脉曲张出血的检测指标。

关键词: 肝血流超声参数, vWF-Ag, 肝硬化, 食管静脉曲张出血, 预测价值

Abstract: Objective To investigate predictive value of hepatic hemodynamics ultrasonic parameters combined with peripheral blood von Willebrand factor antigen (vWF-Ag) for esophageal varices hemorrhage (EVH) in patients with liver cirrhosis.Methods From December 2015 to December 2018, 80 cases of cirrhosis, 80 cases of cirrhosis combined with EVH patients and 80 healthy individuals in our hospital were enrolled, and set as cirrhosis group, cirrhosis & EVH group, and control group, respectively. Various indexes were compared between groups, including hepatic hemodynamics ultrasonic parameters, as well as the serum vWF-Ag levels. The correlation of hemodynamics ultrasonic parameters and peripheral blood vWF-Ag level in cirrhosis combined with EVH patients was analyzed. Results Significant differences were found in the levels of PVD[(1.25±0.20), (1.52±0.25), (0.78±0.15)], PV-CI[(0.08±0.03), (0.13±0.03), (0.05±0.01)], PVAT[(19.88±4.59), (23.34±3.68), (13.19±3.02)], PVV[(18.13±4.38), (15.88±4.23), (20.20±4.16)], HVAT[(20.35±5.19), (16.77±2.66), (23.96±5.56)], IHCT[(9.53±2.55), (6.48±1.90), (11.12±2.93)], HV-DI[(0.62±0.12), (0.75±0.13), (0.51±0.11)] and serum vWF-Ag [(150.15±19.61), (211.09±50.83), (90.33±10.28)]in the 3 groups cirrhosis group, cirrhosis & EVH group, and control group (P<0.05). With the increase of the EVH severity (mild, moderate, severe), the levels of PVD[(1.38±0.08), (1.50±0.16), (1.61±0.23)], PV-CI[(0.12±0.04), (0.14±0.03), (0.16±0.05)], HV-DI[(0.72±0.09), (0.78±0.12), (0.84±0.15)], PVAT[(21.11±3.01), (23.45±4.23), (25.67±4.92)]and serum vWF-Ag[(206.45±35.43), (225.32±50.67), (256.30±59.62)]in patients with cirrhosis were increased, meanwhile, the PVV[(16.88±3.48), (14.33±2.12), (12.56±1.87)], HVAT[(18.45±2.68), (16.34±2.22), (13.26±1.08)]and IHCT[(6.29±1.76), (6.01±1.46), (5.91±1.03)]were decreased (P<0.05). Serum vWF-Ag levels in patients with cirrhosis and EVH were positively correlated with PVD, PV-CI, HV-DI and PVAT (P<0.05), and negatively correlated with PVV, HVAT and IHCT (P<0.05). The diagnostic efficacy of hepatic hemodynamics ultrasonic parameters combined with vWF-Ag in patients with cirrhosis with EVH was significantly better than single detection (P<0.05).Conclusion Predictive value of hepatic hemodynamics ultrasonic parameters combined with peripheral blood vWF-Ag is certain for cirrhosis combined with EVH patients, which is worthy of clinical promotion.

Key words: Hepatic hemodynamics ultrasonic parameters, vWF-Ag, Cirrhosis of the liver, Esophageal variceal hemorrhage, Predictive value

程静, 徐路, 彭素琼. 肝血流超声参数联合外周血vWF-Ag对肝硬化患者食管静脉曲张出血的预测价值[J]. 肝脏, 2020, 25(3): 260-263.

CHENG Jing, XU Lu, PENG Su-qiong.. Predictive value of hepatic hemodynamics ultrasonic parameters combined with peripheral blood vWF-Ag in esophageal varices hemorrhage in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2020, 25(3): 260-263.

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