关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 超声参数, 血浆白蛋白

Abstract:

Objective　To investigate the value of ultrasound parameters combined with plasma albumin (ALB) in the evaluation of esophagogastric variceal bleeding in patients with liver cirrhosis. Methods　A total of 126 patients with liver cirrhosis and esophagogastric varices treated at Xi'an International Medical Center Hospital from March 2021 to March 2024 were included in the study. The patients were divided into a bleeding group (54 cases) and a non-bleeding group (72 cases) based on whether they had variceal bleeding. The bleeding group included 29 males and 25 females, with an age of (61.12±6.21) years. The non-bleeding group included 41 males and 31 females, with an age of (59.77±6.15) years. The general clinical data were compared between the two groups. All the patients underwent ultrasound examination to measure the ultrasound parameters. The logistic regression analysis was used to identify the influencing factors of esophagogastric variceal bleeding in the patients and construct a nomogram. The receiver operating characteristic curves (ROC) were constructed to analyze the value of ultrasound parameters combined with ALB in the evaluation of esophagogastric variceal bleeding in the patients. t and χ² tests were used for the statistical analysis. Results　The bleeding group had higher Child-Pugh liver function grade and degree of esophagogastric varices, longer prothrombin time, and lower platelet count (PLT) and ALB than the non-bleeding group (all P<0.05). The hepatic vein diameter and splenic vein flow velocity in the bleeding group were lower than those in the non-bleeding group [(5.65±0.85) mm vs. (6.07±0.92) mm and (11.55±1.66) cm/s vs. (18.15±2.21) cm/s], and the splenic vein diameter, spleen area, and mean spleen elasticity value were higher [(11.28±1.67) mm vs. (8.47±1.25) mm, (53.74±2.84) cm² vs. (51.32±2.08) cm², and (16.46±1.30) kPa vs. (12.24±1.15) kPa] (t=2.649, 19.143, 10.376, 5.288, and 18.936; all P<0.001). The logistic regression analysis revealed that the degree of esophagogastric varices, PLT, PT, ALB, splenic vein diameter, and mean spleen elasticity value were influencing factors for esophagogastric variceal bleeding (all P<0.05). The ROC results showed that the combination of ALB, splenic vein diameter, and mean spleen elasticity value had an area under the curve (AUC) of 0.977, a sensitivity of 94.4%, and a specificity of 93.1%, which were significantly higher than those of ALB (AUC=0.748, sensitivity=57.4%, and specificity=79.2%), splenic vein diameter (AUC=0.892, sensitivity=81.5%, and specificity=88.9%), and mean spleen elasticity value (AUC=0.936, sensitivity=92.6%, and specificity=93.1%). Conclusion　The combination of ultrasound parameters and ALB is valuable for predicting esophagogastric variceal bleeding in patients with liver cirrhosis.

Key words: Liver cirrhosis,  , Esophagogastric variceal bleeding,  , Ultrasound parameters,  , Plasma albumin