中国肝脏病杂志(电子版)

位置：首页 >> 期刊文章

磁共振弹性成像测定的肝硬度值和脾硬度值对门静脉高压的诊断价值

作者： style="font-size: 12px ">王民张冠华冯丽娟何福亮王宇

单位：首都医科大学附属北京友谊医院（消化健康全国重点实验室国家消化系统疾病临床医学研究中心）肝病中心北京 100050

分类号：

出版年,卷(期):页码：2026,18(2):52-59

摘要：

摘要：目的探讨磁共振弹性成像（magnetic resonance elastography，MRE）测量的肝硬度值（liver stif fness measurement，LSM）及脾硬度值（spleen stif fness measurement，SSM）对肝硬化严重门静脉高压（severe portal hypertension，SPH）及高风险静脉曲张（high-risk varices，HRV）的诊断价值。方法前瞻性纳入 2019 年 12 月至 2023 年 4 月在首都医科大学附属北京友谊医院肝病中心就诊并接受肝静脉压力梯度（hepatic venous pressure gradient，HVPG）测定的肝硬化门静脉高压患者。所有患者在完成 HVPG 测定后 1 周内接受电子胃镜及 MRE 检查，获取 MRE-LSM 与 MRE-SSM。采用 Spearman相关分析变量间的相关性。采用受试者工作特征（receiver operating characteristic，ROC）曲线评估并比较 MRE-LSM 和 MRE-SSM 对 SPH 和 HRV 的诊断效能，通过约登指数确定最佳诊断界值。采用一元和多元线性回归分析 MRE-SSM 的影响因素。结果研究共纳入 101 例患者，平均 HVPG 为（17.9 ± 6.13）mmHg。Spearman 相关性分析显示，MRE-SSM 和 MRE-LSM 均与 HVPG 呈正相关（rs = 0.363，P ＜0.001；rs = 0.203，P = 0.041），且随 HVPG 升高，MRE-LSM 与 MRE-SSM 均有升高趋势。MRESSM 和 MRE-LSM 诊断 SPH 的 ROC 曲线下面积分别为 0.851、0.789，差异无统计学意义（Z = 0.622，P = 0.534），对应的诊断界值分别为 10.0 kPa 和 4.5 kPa。MRE-SSM与 HRV 呈正相关（r = 0.471，P ＜ 0.001），而 MRE-LSM 与 HRV 无相关性（r = - 0.031，P = 0.758）。MRE-SSM 诊断 HRV 的效能显著优于 MRE-LSM（ROC 曲线下面积：0.808比 0.522；Z = 2.915，P = 0.004）。多元线性回归分析表明，血小板计数是 MRE-SSM 的独立影响因素（β = - 0.021，95%CI：- 0.030～- 0.011，P ＜ 0.001）。结论 MRE-SSM与 HVPG、HRV 密切相关，对 SPH 和 HRV 均显示出较高的诊断效能。相较于 MRELSM，MRE-SSM 在识别 HRV 方面更为突出，有望成为评估门静脉高压及其并发症的重要无创手段。

Abstract: Objective To evaluate the diagnostic value of liver stif fness measurement (LSM) and spleen stif fness measurement (SSM) measured by magnetic resonance elastography (MRE) for severe portal hypertension (SPH) and high-risk varices (HRV) in patients with liver cirrhosis. Methods Patients with cirrhotic portal hypertension who underwent hepatic venous pressure gradient (HVPG) measurement at Liver Research Center, Beijing Friendship Hospital, Capital Medical University from December 2019 and April 2023 were enrolled in this prospective study. All patients underwent electronic gastroscopy and MRE examination within one week after HVPG measurement to obtain MRE-LSM and MRE-SSM value. Spearman correlation analysis was used to assess the correlations between variables. The diagnostic value of MRE-LSM and MRE-SSM for SPH and HRV were evaluated by receiver operating characteristic (ROC) curve, and the optimal cut-of f values were determined by the Youden index. Univariate and multiple linear regression were used to analyze the infl uencing factors of MRE-SSM. Results Total of 101 patients were enrolled, and the level of HVPG was (17.9 ± 6.13) mmHg. Spearman correlation analysis showed that both MRE-SSM and MRELSM were positively correlated with HVPG （rs = 0.363, P ＜ 0.001; rs = 0.203, P = 0.041), and as HVPG increased, both MRE-LSM and MRE-SSM showed an increasing trend. The area under the ROC curve of MRE-SSM and MRE-LSM for diagnosing SPH was 0.851 and 0.789, respectively, with no statistically signif icant dif ference (Z = 0.622, P = 0.534). The corresponding diagnostic cut-of f values were 10.0 kPa and 4.5 kPa, respectively. MRE-SSM was positively correlated with HRV (r = 0.471, P ＜ 0.001), whereas MRE-LSM showed no correlation with HRV (r = - 0.031, P = 0.758). The diagnostic performance of MRE-SSM for HRV was signif icantly superior to that of MRE-LSM (area under the ROC curve: 0.808 vs. 0.522; Z = 2.915, P = 0.004). Multiple linear regression analysis showed that platelet count was an independent infl uencing factor of MRE-SSM (β = - 0.021, 95%CI: - 0.030～- 0.011, P ＜ 0.001). Conclusions MRE-SSM was closely associated with both HVPG and HRV, and demonstrated good diagnostic performance for SPH and HRV. Compared to MRE-LSM, MRE-SSM showed a superior capability in identifying HRV, suggesting its potential as an ef fective non-invasive tool for assessing portal hypertension and its complications.

基金项目：

作者简介：

参考文献：

服务与反馈：

【文章下载】【加入收藏】