脾体积对肝硬化门静脉高压性胃病及其严重程度的预测价值

张志强; 陈伟; 刘波

doi:10.3969/j.issn.1001-5256.2023.04.013

脾体积对肝硬化门静脉高压性胃病及其严重程度的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.04.013

湖北医药学院附属襄阳市第一人民医院消化内科，湖北襄阳 441000

基金项目:

湖北省自然科学基金 (2018CFB619)

伦理学声明：本研究方案于2022年9月8日经由湖北医药学院附属襄阳市第一人民医院伦理委员会批准，批号：XYYYE20220087。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：张志强负责课题设计，资料分析，撰写论文；陈伟、刘波参与修改文章关键内容并最后定稿。

详细信息

通信作者:
陈伟，chenweiyf@163.com (ORCID: 0000-0002-6985-4595)

计量
- 文章访问数: 249
- HTML全文浏览量: 55
- PDF下载量: 44
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-17
- 录用日期: 2022-10-20
- 出版日期: 2023-04-20

Value of spleen volume in predicting portal hypertensive gastropathy and its severity in patients with liver cirrhosis

Department of Gastroenterology, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, Hubei 441000, China

Research funding:

Hubei Provincial Natural Science Foundation Project (2018CFB619)

More Information

Corresponding author: CHEN Wei, chenweiyf@163.com (ORCID: 0000-0002-6985-4595)

摘要

摘要: 目的探讨脾体积(SV)对肝硬化患者门静脉高压性胃病(PHG)及重度PHG的预测价值。方法回顾性分析2018年1月—2022年8月湖北医药学院附属襄阳市第一人民医院收治的168例肝硬化患者临床资料，以胃镜检查结果为“金标准”，将患者分为无PHG组(n=115)和PHG组(n=53)，轻度PHG组(n=26)和重度PHG组(n=27)，所有患者均行电子胃镜、腹部磁共振及相关血清学检查，获取相关指标及参数。正态分布的计量资料两组间比较采用成组t检验；非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。通过多因素Logistic回归分析筛选出PHG、重度PHG的独立危险因素，利用受试者工作特征曲线(ROC曲线)比较相关指标或参数的预测价值。ROC曲线下面积的比较采用Delong检验。结果单因素分析显示：PHG组和非PHG组性别、有无腹水、Hb、PLT、AST、TBil、Alb、PT、INR、Child-Pugh分级、FIB-4评分、King评分、Lok评分、脾长径(SD)、SV、血小板/脾长径(PSDR)、血小板/脾体积(PSVR)比较，差异均有统计学意义(P值均＜0.05)；轻度PHG组和重度PHG组Hb、PLT、Alb、SD、SV、PSDR、PSVR比较，差异均有统计学意义(P值均＜0.05)。多因素Logistic回归分析显示：FIB-4评分(OR=1.280，95%CI：1.009~1.625)和SV(OR=1.007，95%CI：1.001~1.013)是PHG发生的独立危险因素(P值均＜0.05)；SV(OR=0.990，95%CI：0.980~1.000)是重度PHG发生的独立影响因素(P＜0.05)。ROC曲线分析结果显示：在预测PHG发生时，SV的曲线下面积为0.884, 高于FIB-4评分的0.825(P＜0.05)，其最佳临界值为406.82，敏感度为0.774，特异度为0.870；在预测重度PHG发生时，SV的曲线下面积为0.782，最佳临界值为714.63，敏感度为0.593，特异度为0.962。结论 SV对PHG和重度PHG的发生均具有较好的预测价值。
- 肝硬化 /
- 门静脉高压性胃病 /
- 预测
Abstract: Objective To investigate the value of spleen volume (SV) in predicting portal hypertensive gastropathy (PHG) and severe PHG in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 168 patients with liver cirrhosis who were admitted to Xiangyang No.1 People's Hospistal Affiliated to Hubei University of Medicine from January 2018 to August 2022, and with the results of gastroscopy as the gold standard, these patients were divided into non-PHG group with 115 patients and PHG group with 53 patients; the PHG group was further divided into mild PHG group with 26 patients and severe PHG group with 27 patients. All patients underwent electronic gastroscopy, abdominal magnetic resonance imaging, and serological examination to obtain related indices and parameters. The group t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate Logistic regression analysis was used to screen out the independent risk factors for PHG and severe PHG, and the receiver operating characteristic (ROC) curve was used to compare the predictive value of related indices or parameters. The area under the Roccurve is compared using Delong test. Results The univariate analysis showed that there were significant differences between the PHG group and the non-PHG group in sex, presence or absence of ascites, hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase, total bilirubin, albumin (Alb), prothrombin time, international normalized ratio, Child-Pugh class, FIB-4 score, King score, Lok score, spleen diameter (SD), SV, platelet count/spleen diameter ratio (PSDR), and platelet count/spleen volume ratio (PSVR) (all P < 0.05), and there were significant differences in Hb, PLT, Alb, SD, SV, PSDR, and PSVR between the mild PHG group and the severe PHG group (all P < 0.05). The multivariate Logistic regression analysis showed that FIB-4 score (odds ratio [OR]=1.280, 95% confidence interval [CI]: 1.009-1.625, P < 0.05) and SV (OR=1.007, 95% CI: 1.001-1.013, P < 0.05) were independent risk factors for PHG, and SV (OR=0.990, 95% CI: 0.980-1.000, P < 0.05) was an independent influencing factor for severe PHG. The ROC curve analysis showed that in predicting PHG, SV had a larger area under the ROC curve (AUC) than FIB-4 score (0.884 vs 0.825, P < 0.05), with a sensitivity of 0.774 and a specificity of 0.870 at the optimal cut-off value of 406.82; in predicting the onset of severe PHG, SV had an AUC of 0.782, with a sensitivity of 0.593 and a specificity of 0.962 at the optimal cut-off value of 714.63. Conclusion SV has a good value in predicting the onset of PHG and severe PHG.
- Liver Cirrhosis /
- Portal Hypertensive Gastropathy /
- Forecasting

HTML全文

图 1 SV和FIB-4评分预测PHG的ROC曲线

Figure 1. ROC curve of SV and FIB-4 score in predicting PHG

下载: 全尺寸图片幻灯片

图 2 SV预测重度PHG的ROC曲线

Figure 2. ROC curve of SV in predicting severe PHG

下载: 全尺寸图片幻灯片

表 1 无PHG组与PHG组一般资料比较

Table 1. General information of patients in No-PHG group and PHG group

变量	无PHG组(n=115)	PHG组(n=53)	统计值	P值
性别(男/女，例)	65/50	41/12	χ²=6.765	0.009
年龄(岁)	54.79±10.74	51.65±11.38	t=-1.709	0.089
吸烟史(有/无，例)	35/80	21/32	χ²=1.378	0.240
饮酒史(有/无，例)	34/81	23/30	χ²=3.096	0.078
高血压史(有/无，例)	28/87	6/47	χ²=3.814	0.051
病因(例)			χ²=3.767	0.052
乙型肝炎	74	42
其他	41	11
腹水(有/无，例)	31/84	34/19	χ²=21.159	＜0.001
Hb(g/L)	137.10±19.81	119.64±25.59	t=-4.395	＜0.001
PLT(×10⁹/L)	148.00(109.00~192.00)	65.00(53.50~101.00)	Z=-7.951	＜0.001
ALT(U/L)	27.70(17.70~60.00)	27.40(21.55~52.45)	Z=-0.486	0.627
AST(U/L)	33.40(26.10~54.90)	45.20(33.40~61.35)	Z=-2.483	0.013
TBil(μmol/L)	18.24(15.20~28.30)	25.79(18.64~39.16)	Z=-3.301	0.001
Alb(g/L)	42.47±5.74	37.87±6.43	t=-4.644	＜0.001
PT(s)	11.00(10.50~11.60)	12.10(11.65~13.35)	Z=-5.864	＜0.001
INR	0.94(0.91~1.00)	1.06(1.02~1.16)	Z=-5.982	＜0.001
Child-Pugh分级(例)			χ²=12.546	0.002
A级	95	30
B级	17	20
C级	3	3
FIB-4评分	2.54(1.75~3.77)	6.09(3.94~8.63)	Z=-6.763	＜0.001
King评分	13.41(8.08~30.67)	37.48(22.69~53.98)	Z=-5.497	＜0.001
Lok评分	-0.16(-0.96~0.39)	1.30(0.51~2.13)	Z=-6.900	＜0.001
SD(mm)	111.63±22.43	152.07±29.12	t=8.959	＜0.001
SV(cm³)	240.79±138.25	597.30±275.86	t=8.907	＜0.001
PSDR(n·cm^-3·mm^-1)	1 304.43(978.24~1 875.26)	452.46(319.40~675.63)	Z=-8.330	＜0.001
PSVR(n·cm^-3·cm^-3)	749.88(438.72~1 185.13)	132.26(69.53~215.77)	Z= -8.477	＜0.001

下载: 导出CSV

表 2 轻度PHG组与重度PHG组一般资料比较

Table 2. General information of patients in Mild PHG group and Severe PHG group

变量	轻度PHG组(n=26)	重度PHG组(n=27)	统计值	P值
性别(男/女，例)	18/8	23/4	χ²=1.925	0.165
年龄(岁)	52.12±12.31	51.33±9.90	t=-0.255	0.800
吸烟史(有/无，例)	12/14	9/18	χ²=0.910	0.340
饮酒史(有/无，例)	14/12	10/17	χ²=1.510	0.219
高血压病史(有/无，例)	2/24	4/23	χ²=0.148	0.701
病因(例)
乙型肝炎	19	23	χ²=1.181	0.277
其他	7	4
腹水(有/无，例)	15/11	19/8	χ²=0.926	0.336
Hb(g/L)	111.62±26.92	127.37±22.06	t=2.334	0.024
PLT(×10⁹/L)	83.50(62.00~114.25)	56.00(51.00~71.00)	Z=-3.194	0.001
ALT(U/L)	23.65(19.63~46.85)	35.10(25.00~53.10)	Z=-1.406	0.160
AST(U/L)	47.16(32.28~89.48)	41.60(37.80~49.30)	Z=-1.076	0.282
TBil(μmol/L)	23.15(17.70~32.90)	30.20(21.98~46.20)	Z=-1.779	0.075
Alb(g/L)	35.99±6.27	39.67±6.17	t=2.156	0.036
PT(s)	11.95(11.30~12.33)	12.60(11.80~13.40)	Z=-0.962	0.336
INR	1.05(1.02~1.16)	1.09(1.02~1.17)	Z=-0.695	0.487
Child-Pugh分级(例)			χ²=0.555	0.912
A级	14	16
B级	10	10
C级	2	1
FIB-4评分	5.48(3.14~10.39)	6.12(4.70~7.57)	Z=-0.071	0.943
King评分	29.68(18.03~97.45)	47.01(31.97~52.17)	Z=-1.050	0.294
Lok评分	1.42(0.53~2.31)	1.14(0.35~2.08)	Z=-0.587	0.557
SD(mm)	142.49±27.14	161.29±28.43	t=2.461	0.017
SV(cm³)	459.92±178.33	729.59±290.82	t=4.086	＜0.001
PSDR(n·cm^-3·mm^-1)	536.46(447.82~897.43)	350.29(269.36~529.85)	Z=-3.256	0.001
PSVR(n·cm^-3·cm^-3)	161.74(131.83~282.81)	73.63(55.82~136.00)	Z=-3.683	＜0.001

下载: 导出CSV

表 3 肝硬化PHG无创指标的Logistic回归分析

Table 3. Logistic regression analysis of non-invasive indexes of PHG in liver cirrhosis

变量	B值	SE	Wald	P值	OR	95%CI
性别(女=0, 男=1)	0.894	0.647	1.911	0.167	2.445	0.688~8.684
腹水(无=0，有=1)	0.600	0.670	0.802	0.370	1.832	0.490~6.781
Alb	-0.101	0.062	2.614	0.106	0.904	0.800~1.022
Child-Pugh分级	0.074	0.819	0.008	0.928	1.077	0.216~5.361
(A=0，B=1，C=2)
FIB-4评分	0.247	0.122	4.123	0.042	1.280	1.009~1.625
King评分	-0.016	0.009	2.754	0.097	0.984	0.966~1.003
SD	-0.006	0.022	0.077	0.781	0.994	0.953~1.037
SV	0.007	0.003	5.675	0.017	1.007	1.001~1.013
PSDR	0.000	0.001	0.000	0.990	1.000	0.998~1.002
PSVR	-0.001	0.002	0.179	0.672	0.999	0.995~1.003

下载: 导出CSV

表 4 肝硬化重度PHG无创指标的Logistic回归分析

Table 4. Logistic regression analysis of non-invasive indexes of severe PHG in liver cirrhosis

变量	B值	SE	Wald	P值	OR	95%CI
PLT	0.017	0.068	0.066	0.797	1.018	0.891~1.162
Alb	-0.023	0.077	0.087	0.768	0.977	0.840~1.138
SD	0.054	0.053	1.033	0.310	1.055	0.951~1.171
SV	-0.010	0.005	4.073	0.044	0.990	0.980~1.000
PSDR	0.004	0.011	0.125	0.724	1.004	0.983~1.025
PSVR	-0.007	0.008	0.751	0.386	0.993	0.978~1.008

下载: 导出CSV

表 5 SV和FIB-4评分诊断PHG，SV诊断重度PHG效能分析

Table 5. Efficiency analysis of SV and FIB-4 in diagnosing PHG, SV in diagnosing severe PHG

变量	AUC	95%CI	P值	最佳临界值	敏感度	特异度	约登指数
SV和FIB-4评分诊断PHG
SV	0.884	0.829~0.940	＜0.001	406.82	0.774	0.870	0.644
FIB-4评分	0.825	0.756~0.894	＜0.001	4.05	0.755	0.809	0.563
SV诊断重度PHG	0.782	0.656~0.909	＜0.001	714.63	0.593	0.962	0.554

下载: 导出CSV

参考文献(22)

[1]	LIU XJ, CHEN MK. Research advances in portal hypertensive gastropathy[J]. Chin J Dig Endosc, 2020, 37(10): 762-765. DOI: 10.3760/cma.j.cn321463-20191014-00688. 刘小娇, 陈明锴. 门脉高压性胃病研究进展[J]. 中华消化内镜杂志, 2020, 37(10): 762-765. DOI: 10.3760/cma.j.cn321463-20191014-00688.
[2]	ROCKEY DC. An update: Portal hypertensive gastropathy and colopathy[J]. Clin Liver Dis, 2019, 23(4): 643-658. DOI: 10.1016/j.cld.2019.07.002.
[3]	LYLES T, ELLIOTT A, ROCKEY DC. A risk scoring system to predict in-hospital mortality in patients with cirrhosis presenting with upper gastrointestinal bleeding[J]. J Clin Gastroenterol, 2014, 48(8): 712-720. DOI: 10.1097/MCG.0000000000000014.
[4]	WANG WS, CHEN DF, WEN LZ. Highlights in portal hypertensive gastropathy[J]. J Prac Hepatol, 2019, 22(4): 601-604. DOI: 10.3969/j.issn.1672-5069.2019.04.038. 王文生, 陈东风, 文良志. 门脉高压性胃病临床研究进展[J]. 实用肝脏病杂志, 2019, 22(4): 601-604. DOI: 10.3969/j.issn.1672-5069.2019.04.038.
[5]	AMER IF, EL SHENNAWY EM, EL BATEA H, et al. Accuracy of noninvasive tests in the prediction of portal hypertensive gastropathy in Egyptian patients with cirrhosis[J]. JGH Open, 2021, 5(2): 286-293. DOI: 10.1002/jgh3.12486.
[6]	EL-KALLA F, MANSOUR L, KOBTAN A, et al. Blood ammonia level correlates with severity of cirrhotic portal hypertensive gastropathy[J]. Gastroenterol Res Pract, 2018, 2018: 9067583. DOI: 10.1155/2018/9067583.
[7]	NISHINO K, KAWANAKA M, MANABE N, et al. Portal hypertensive gastropathy in liver cirrhosis: Prevalence, natural history, and risk factors[J]. Intern Med, 2022, 61(5): 605-613. DOI: 10.2169/internalmedicine.7943-21.
[8]	MIN YW, BAE SY, GWAK GY, et al. A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease[J]. Clin Mol Hepatol, 2012, 18(2): 178-184. DOI: 10.3350/cmh.2012.18.2.178.
[9]	YU S, CHEN W, JIANG Z. Platelet count/spleen volume ratio has a good predictive value for esophageal varices in patients with hepatitis B liver cirrhosis[J]. PLoS One, 2021, 16(12): e0260774. DOI: 10.1371/journal.pone.0260774.
[10]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
[11]	DE FRANCHIS R. Updating consensus in portal hypertension: report of the Baveno Ⅲ Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension[J]. J Hepatol, 2000, 33(5): 846-852. DOI: 10.1016/s0168-8278(00)80320-7.
[12]	BADRAN DH, KALBOUNEH HM, AL-HADIDI MT, et al. Ultrasonographic assessment of splenic volume and its correlation with body parameters in a Jordanian population[J]. Saudi Med J, 2015, 36(8): 967-972. DOI: 10.15537/smj.2015.8.11809.
[13]	MOROZOV SV, IZRANOV VA. Methods of ultrasound spleen morphometry[J]. J Ultrasound Med, 2022, 41(9): 2123-2133. DOI: 10.1002/jum.15901.
[14]	LI Y, WANG ZH, LI PP, et al. 3D visualization technology for measuring the spleen volume of normal Chinese adult[J]. J Hepatobiliary Surg, 2018, 26(5): 340-343. DOI: 10.3969/j.issn.1006-4761.2018.05.007. 李曜, 王志恒, 李鹏鹏, 等. 三维可视化技术测定中国正常成人脾脏体积的研究[J]. 肝胆外科杂志, 2018, 26(5): 340-343. DOI: 10.3969/j.issn.1006-4761.2018.05.007.
[15]	DE FRANCHIS R. Evolving consensus in portal hypertension. Report of the Baveno Ⅳ consensus workshop on methodology of diagnosis and therapy in portal hypertension[J]. J Hepatol, 2005, 43(1): 167-176. DOI: 10.1016/j.jhep.2005.05.009.
[16]	CHEN SY, LIN QY, HUANG XQ. Studies on diagnosis and pathogenesis of portal hypertensive gastropathy[J]. J Diagn Concepts Pract, 2016, 15(5): 451-454. DOI: 10.16150/j.1671-2870.2016.05.003. 陈世耀, 林秋燕, 黄晓铨. 门静脉高压性胃病的诊断及发病机制研究[J]. 诊断学理论与实践, 2016, 15(5): 451-454. DOI: 10.16150/j.1671-2870.2016.05.003.
[17]	DE FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno Ⅶ-Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
[18]	SALEEM K, BAIG FA, NIDA M, et al. Correlation between severity of portal hypertensive gastropathy and size of oesophageal varices in cirrhotic hepatitis-C patients[J]. J Ayub Med Coll Abbottabad, 2018, 30(1): 54-57.
[19]	SIMBRUNNER B, BEER A, WÖRAN K, et al. Portal hypertensive gastropathy is associated with iron deficiency anemia[J]. Wien Klin Wochenschr, 2020, 132(1-2): 1-11. DOI: 10.1007/s00508-019-01593-w.
[20]	SUN DY. Prediction of FIB-4、Lok and King score measurement for esophageal varices in cirrhosis[D]. Hefei: Anhui Medical University, 2021. 孙迪一. FIB-4、Lok和King评分对肝硬化食管静脉曲张的预测价值[D]. 合肥: 安徽医科大学, 2021.
[21]	MANDHWANI R, HANIF FM, UL HAQUE MM, et al. Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis[J]. J Transl Int Med, 2017, 5(3): 169-173. DOI: 10.1515/jtim-2017-0025.
[22]	JIANG A, LI ZF. Common causes and treatment strategies of hyperslenism[J/OL]. Chin J Hepat Surg (Electronic Edition), 2018, 7(2): 97-99. DOI: 10.3877/cma.j.issn.2095-3232.2018.02.003. 蒋安, 李宗芳. 脾功能亢进常见原因及治疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2018, 7(2): 97-99. DOI: 10.3877/cma.j.issn.2095-3232.2018.02.003.