肝脏硬度能够区分肝脾型曼氏血吸虫病与肝硬化，而脾脏硬度可能是肝脾型血吸虫病患者静脉曲张出血的一个预测指标。

Liver stiffness is able to differentiate hepatosplenic Schistosomiasis mansoni from liver cirrhosis and spleen stiffness may be a predictor of variceal bleeding in hepatosplenic schistosomiasis.

作者信息

Silva Catherine F, Nardelli Mateus J, Barbosa Fernanda A, Galizzi Humberto O, Cal Tereza C M F, Ferrari Teresa C A, Faria Luciana C, Couto Claudia A

机构信息

Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, 30130-100, Belo Horizonte, Brazil.

Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, 31270-901, Belo Horizonte, Brazil.

出版信息

Trans R Soc Trop Med Hyg. 2022 Jan 19;116(1):26-33. doi: 10.1093/trstmh/trab041.

DOI:10.1093/trstmh/trab041

PMID:33728472

Abstract

BACKGROUND

Ultrasonography is limited for differentiating portal hypertension due to liver cirrhosis from that secondary to hepatosplenic schistosomiasis (HSS). We aimed to investigate the role of transient elastography (TE) in differentiating HSS mansoni from cirrhosis and the factors associated with liver and spleen stiffness (LS and SS) in HSS.

METHOD

A cross-sectional study was conducted including patients with HSS mansoni (n=29) and liver cirrhosis due to non-alcoholic steatohepatitis (n=23). All patients underwent TE and those with HSS were assessed by the Niamey protocol.

RESULTS

HSS subjects presented lower median LS (9.6 vs 21.3 Kpa, p<0.001) and liver controlled attenuation parameter (229 vs 274 dB/m, p=0.010) than cirrhosis subjects, in addition to higher SS (73.5 vs 42.2 Kpa, p=0.002). The area under the receiver operating characteristic curve for detecting cirrhosis by LS was 0.947 (95% CI 0.89 to 1.00, p<0.001), with an optimal cut-off of 11.75 Kpa. In HSS subjects, higher SS was associated with the presence of the following: diabetes mellitus (p=0.036), metabolic syndrome (p=0.043), esophageal varices (p=0.001), portal vein thrombosis (p=0.047) and previous variceal bleeding (p=0.011). In HSS patients without portal vein thrombosis, variceal bleeding was associated with higher SS (p=0.018). Niamey categories were not associated with LS (p=0.676) or SS (p=0.504).

CONCLUSION

TE can play a role in differentiating HSS from cirrhosis, especially by LS. SS may be further investigated for predicting complications in HSS.

摘要

背景

超声检查在鉴别肝硬化所致门静脉高压与肝脾血吸虫病（HSS）继发的门静脉高压方面存在局限性。我们旨在研究瞬时弹性成像（TE）在鉴别曼氏血吸虫病所致HSS与肝硬化中的作用，以及与HSS中肝脏和脾脏硬度（LS和SS）相关的因素。

方法

进行了一项横断面研究，纳入曼氏血吸虫病所致HSS患者（n = 29）和非酒精性脂肪性肝炎所致肝硬化患者（n = 23）。所有患者均接受了TE检查，对HSS患者采用尼亚美方案进行评估。

结果

与肝硬化患者相比，HSS患者的中位LS较低（9.6对21.3 Kpa，p<0.001），肝脏控制衰减参数较低（229对274 dB/m，p = 0.010），而SS较高（73.5对42.2 Kpa，p = 0.002）。通过LS检测肝硬化的受试者工作特征曲线下面积为0.947（95%CI 0.89至1.00，p<0.001），最佳截断值为11.75 Kpa。在HSS患者中，较高的SS与以下情况相关：糖尿病（p = 0.036）、代谢综合征（p = 0.043）、食管静脉曲张（p = 0.001）、门静脉血栓形成（p = 0.047）和既往静脉曲张出血（p = 0.011）。在没有门静脉血栓形成的HSS患者中，静脉曲张出血与较高的SS相关（p = 0.018）。尼亚美分类与LS（p = 0.676）或SS（p = 0.504）无关。