Spleen Vein Diameter Research Articles

Construction and validation of a nomogram for predicting the risk of portal vein thrombosis after splenectomy in patients with hepatitis B cirrhosis

To construct and validate an individualized nomogram to predict the probability of occurrence of portal vein thrombosis (PVT) after splenectomy in patients with hepatitis B cirrhosis. We retrospectively collected the clinical data from 180 patients with hepatitis B cirrhosis undergoing splenectomy with postoperative anticoagulation therapy during the period from January, 2014 to January, 2020 in our hospital. The patients were randomized into modeling group (n= 120) and validation group (n=60), and the former group was further divided into PVT group (n=49) and non-PVT group (n=71) according to the occurrence of PVT occurred within 1 month after splenectomy. The independent risk factors of PVT after splenectomy were screened in the modeling group using univariate and multivariate binary logistic regression analyses and were used for construction of the nomogram prediction model. The area under the receiver-operating characteristic (AUROC) curve (C-index), GiViTI calibration belt and Hosmer-Lemeshow test, and the DCA curve were used to estimate the discrimination power, calibration and clinical efficiency of the prediction model in both the model construction group and validation group. Univariate and multivariate logistic regression analyses showed that a history of hemorrhage, portal vein diameter, spleen vein diameter, spleen volume, varicose, postoperative platelet change, and postoperative D-dimer differed significantly between PVT group and non-PVT group (P < 0.05), and portal vein diameter, spleen vein diameter, and postoperative platelet change were independent risk factors of PVT after splenectomy (P < 0.05). The prediction model had a good discrimination power with AUROC (C-index) of 0.880 (95% CI: 0.818-0.942) in the modeling group and 0.873 (95% CI: 0.785-0.960) in the validation group. The 80% and 95%CI region of GiViTI calibration belt did not cover the 45-degree diagonal bisector line (P=0.965 and 0.632, respectively), and the P-values of the Hosmer-Lemeshow test were 0.624 and 0.911, respectively, suggesting a high reliability of the predicted probability by the model. DCA curve analysis showed a threshold probability of 30.5%, with a net benefit of 30% in the modeling group and 34% in the validation group, indicating a good clinical efficiency of the model. The model for predicting the risk of PVT after splenectomy in patients with hepatitis B cirrhosis can help in early identification of patients having high risks of PVT.

FibroBox: a novel noninvasive tool for predicting significant liver fibrosis and cirrhosis in HBV infected patients

BackgroundChina is a highly endemic area of chronic hepatitis B (CHB). The accuracy of existed noninvasive biomarkers including TE, APRI and FIB-4 for staging fibrosis is not high enough in Chinese cohort.MethodsUsing liver biopsy as a gold standard, a novel noninvasive indicator was developed using laboratory tests, ultrasound measurements and liver stiffness measurements with machine learning techniques to predict significant fibrosis and cirrhosis in CHB patients in north and east part of China. We retrospectively evaluated the diagnostic performance of the novel indicator named FibroBox, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) in CHB patients from Jilin and Huai’an (training sets) and also in Anhui and Beijing cohorts (validation sets).ResultsOf 1289 eligible HBV patients who had liver histological data, 63.2% had significant fibrosis and 22.5% had cirrhosis. In LASSO logistic regression and filter methods, fibroscan results, platelet count, alanine transaminase (ALT), prothrombin time (PT), type III procollagen aminoterminal peptide (PIIINP), type IV collagen, laminin, hyaluronic acid (HA) and diameter of spleen vein were finally selected as input variables in FibroBox. Consequently, FibroBox was developed of which the area under the receiver operating characteristic curve (AUROC) was significantly higher than that of TE, APRI and FIB-4 to predicting significant fibrosis and cirrhosis. In the Anhui and Beijing cohort, the AUROC of FibroBox was 0.88 (95% CI, 0.72–0.82) and 0.87 (95% CI, 0.83–0.91) for significant fibrosis and 0.87 (95% CI, 0.82–0.92) and 0.90 (95% CI, 0.85–0.94) for cirrhosis. In the validation cohorts, FibroBox accurately diagnosed 81% of significant fibrosis and 84% of cirrhosis.ConclusionsFibroBox has a better performance in predicting liver fibrosis in Chinese cohorts with CHB, which may serve as a feasible alternative to liver biopsy.

Effects of endoscope combined with drug therapy on the hemorrhage of esophageal varicose veins in cirrhosis

Objective To observe the clinical effect of endoscope combined with drug therapy in the treatment of hemorrhage of esophageal and gastric varices in patients with cirrhosis, thus to provide reference for clinical diagnosis and treatment. Methods From January 2017 to January 2018, 58 liver cirrhosis patients with ruptured esophageal gastric varices bleeding in Tongji Huangzhou Hospital of Huazhong University of Science and Technology were selected and divided into two groups by random number table method, with 29 cases in each group.The control group was treated with somatostatin alone.The observation group was treated with somatostatin combined with endoscopic therapy.The clinical efficacy of the two groups was compared, and the clinical indicators and the changes of indices of TCM syndromes before and after treatment were compared between the two groups. Results The total effective rate of the observation group was 89.8%, which was higher than 79.3% of the control group, and the difference was statistically significant(χ2=9.75, P<0.01). After treatment, the pain, abdominal distention, poor appetite, nausea, weakness of the body tired, depression, boredom, loose stool and other syndromes index scores of two groups were improved obviously, the improvements in the observation group was better than those in the control group, and the differences were statistically significant(t=8.847, 9.470, 7.833, 8.120, 9.029, 8.120, 9.029, all P<0.05). After treatment, the white blood cells, platelets of the two groups were increased, the spleen length to diameter, thickness of spleen, portal venous trunk, spleen vein diameter of the two groups were reduced, the improvements in the observation group was better than those in the control group, and the differences were statistically significant(t=8.934, 8.923, 8.933, 9.463, 9.478, 9.463, all P<0.05). Conclusion Endoscope combined with drugs in the treatment of cirrhotic esophageal variceal hemorrhage has significant clinical efficacy, and can effectively improve the patients' TCM syndrome score and clinical indicators. Key words: Endoscopy; Somatostatin; Liver cirrhosis; Esophageal and gastric varices; Hemorrhage

Predict esophageal varices via routine trans-abdominal ultrasound: A design of classification analysis model.

Upper gastrointestinal endoscopy remains the gold standard for diagnosis of esophageal varices. Trans-abdominal ultrasound, as a noninvasive routine examination for the follow-up of cirrhosis patient, is safe, cheap, easy to perform, and plays an important role. In this study, we attempt to design a practical classification analysis model to predict esophageal varices via ultrasound. Compared with endoscopy, the ultrasound qualitative signs (lower esophageal Doppler signals, left gastric vein hepatofugal flow, and paraumbilical vein recanalization) and quantitative parameters (spleen diameter, spleen vein diameter, portal vein diameter, and portal vein velocity) have been evaluated in 286 cirrhosis patients. The classification analysis model is designed as that: the patients are defined with esophageal varices high risk, who with any ultrasound qualitative signs or who with spleen diameter greater than 162 mm without qualitative parameters. The sensitivity for detecting esophageal varices is 97.5% and the specificity is 82.6%, while the positive predictive value is 96.7%, negative predictive value is 83.4%, and the omission diagnostic rate is 2.5%. This classification analysis model design includes ultrasound qualitative signs and spleen diameter, which can be detected easily via routine ultrasound without other auxiliary. The classification analysis model is useful in detecting esophageal varices, which may be a supplement for predicting of esophageal varices, and reducing the frequency of endoscopy in the follow-up of cirrhosis patients.

Correlation studies between real-time shear wave elastography measuring liver stiffness and the degree of esophageal varices

Application of real-time shear wave elastography (SWE) measurement of patients with Chronic severe hepatitis B and liver cirrhosis of the liver stiffness, aimed to explore SWE can evaluate the existence of liver cirrhosis patients with esophageal varices (EV) and its severity. According to the results of gastroscope, 256 cases of patients with chronic liver disease and cirrhosis of the liver can be divided into no EV group,mild EV group,moderate to severe EV group,analysis between groups in patients with liver stiffness, portal vein,spleen vein diameter, the correlation of liver fibrosis indexes and the degree of esophageal varices.Using receives operating characteristic curve (ROC) and area under curve of ROC to evaluate each index prediction ability. Compare the liver stiffiness, portal vein,spleen vein diameter had statistically significant difference in the no EV group, mild EV group,moderate to severe EV group, (F values are respectively 137.86,44.77,73.88, P < 0.05), Patients age, type IV collagen, larninin, hyaluronic acid had no statistically significant difference in the no EV group and mild EV group (P > 0.05) and had statistically significant difference in the other two groups (P < 0.05). Patients with gender, pro-collagen type III N-terminal peptide (PC III NP) had no statistically significant difference in the three groups (P > 0.05). Correlation analysis showed that portal vein, spleen vein diameter, type IV collagen, laminin, hyaluronic acid showed significant positive correlation (P < 0.05),highest correlation was liver stiffness and the degree of esophageal varices, correlation coefficient of 0.689 (P < 0.01). PC III NP and the degree of esophageal varices, liver stiffness showed no correlation (P > 0.05). Liver stiffness area under the ROC curve is 0.923, with a strong ability to predict than the portal vein and splenic vein diameter, LN, IV-C, HA, PCIII NP. Liver stiffness more than 7.55 kPa, diagnose mild EV sensitivity 90.5%, specificity 60%.Liver stiffness more than 18.85 kPa,the sensitivity of the diagnosis of severe EV 82.4%, specificity of 90.5%. SWE liver stiffness measurement was predicted the existence of the EV and the severity of liver disease patients and effective inspection method, can be used as evaluation of liver disease patients with esophageal varices non-invasive indicator of the initial screening.

Esophageal Varix Predictive Performance of Lower Esophageal Doppler Signals During the Swallowing Process

The objective of this study was to assess whether the swallowing action can improve the display of lower esophageal Doppler signals (LEDS) during transabdominal ultrasound (TUS). Eighty-four patients with cirrhosis underwent both TUS and endoscopic examination for esophageal varices (EVs). LEDS were assessed under the esophageal resting state and during the swallowing process. Univariate analysis indicated that spleen diameter, spleen vein diameter, portal vein diameter, LEDS and left gastric vein hepatofugal flow were significantly associated with the presence of EVs. No LEDS were detected in patients without EVs at rest or during swallowing. Of the 69 patients with EVs, LEDS could be detected in 21 cases (30.4%) in the esophageal resting state and in 58 cases (84.1%) during the swallowing process. Compared with the esophageal resting state, the swallowing action can significantly improve display of LEDS during TUS (p = 0.000), which may be beneficial for TUS detection of EVs.

The causes and prevention of portal vein thrombosis after splenectomy in patients with hepatitis and cirrhosis

Objective To analyze the relevant factors and explore methods for prevention of portal vein thrombosis in patients after spleuectomy of portal hypertension due to cirrhosis resulted from hepatitis.Methods Clinical data of 143 patients with splenectomy weft analyze,and the relationship of portal system thrombosis with gender,age,temperature,diameter of spleen vein,average diameter of main portal vein,size of spleen,thickness of spleen and number of thrombocytes after operation were compared.Results The results showed that the rate of portal hypertension was 9.79％.The thrombosis of portal vein was related to the average diameter of main portal vein,size of spleen,thickness of spleen and number of thrombocytes after operation (P ＜ 0.05),other than related to the gender,age,temperature and the diameter of spleen vein (P ＞ 0.05).Conclusion The portal vein thrombosis in patients after splenectomy is related to portal vein,diameter of spleen vein and size of the spleen.Anticoagulation therapy given in the early stage can prevent the occurrence of the portal system thrombosis in patients with liver cirrhosis and portal hypertension after splenectomy. Key words: Cirrhosis; Splenectomy; Portal vein; Thrombus

Portalsystemic hemodynamic changes in chronic severe hepatitis B: An ultrasonographic study

To evaluate portalsystemic hemodynamic changes in chronic severe hepatitis B. Hemodynamic parameters included portal vein diameter (PVD), portal vein peak velocity (PVPV), portal vein volume (PVV), spleen length (SPL), spleen vein diameter (SPVD), spleen vein volume (SPVV) and umbilical vein recanalization. They were measured by Color Doppler ultrasonography in 36 patients with chronic severe hepatitis B, compared with 51 normal controls, 61 patients with chronic hepatitis B, 46 patients with compensable cirrhosis, and 36 patients with decompensable cirrhosis. In the group of chronic severe hepatitis B, PVD (12.38 +/- 1.23 mm) was significantly different from the normal control, compensable cirrhosis and decompensable cirrhosis groups (P = 0.000-0.026), but not significantly different from the chronic hepatitis group. PVPV (16.15 +/- 3.82 cm/s) dropped more significantly in the chronic severe hepatitis B group than the normal control, chronic hepatitis B and compensable cirrhosis groups (P = 0.000-0.011). PVV (667.53 +/- 192.83 mL/min) dropped significantly as compared with the four comparison groups (P = 0.000-0.004). SPL (120.42 +/- 18.36 mm) and SPVD (7.52 +/- 1.52 mm) were longer in the normal control and chronic hepatitis B groups (P = 0.000-0.009), yet they were significantly shorter than those in the decompensable cirrhosis group (P = 0.000). SPVV (242.51 +/- 137.70 mL/min) was also lower than the decompensable cirrhosis group (P = 0.000). The umbilical vein recanalization rate (75%) was higher than the chronic hepatitis B and compensable cirrhosis groups. In the course of progression from chronic hepatitis to decompensable cirrhosis, PVD, SPL and SPVD gradually increased and showed significant differences between every two groups (P = 0.000-0.002). Patients with chronic severe hepatitis B have a tendency to develop acute portal hypertension, resulting in significantly reduced portal vein perfusion. Observation of the portalsystemic hemodynamic changes may be contributed to the disease progression of chronic liver disease.

Relevant factors and prevention of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis

目的 析肝炎肝硬化门静脉高压症脾切除术后门静脉系统形成血栓的相关因素,寻找预防门静脉高压症脾切除术后门静脉系统形成血栓的方法.方法 回顾性分析我院1999年3月至2005年6月收治的肝炎肝硬化门静脉高压症行单纯脾切除、脾切除加EVL或脾切除加贲门周围血管断流术的病人132人,用Logistic回归分析分析术前肝功能Child-Pugh分级、门静脉和脾静脉直径、脾脏的大小以及术后血小板的数量与门静脉系统血栓形成的关系;将其中符合要求的112人分为三组,A组56人:术后未用抗凝、祛凝药;B组33人:术后在血小板＞300×109/L时用抗凝、祛凝药;C组23人:术后早期应用抗凝、祛凝药.比较三组门静脉系统血栓的发生率.结果 Logistic单因素分析提示门静脉系统的血栓形成与门静脉直径、脾脏的大小、脾脏的厚度、血清总胆红素以及术后血小板的数量有关;多因素回归分析发现门静脉系统的血栓形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;A组、B组和C组门静脉系统发生血栓的人数分别为19人、9人和1人,发生率分别为33.9%、27.3%和4.3%,门静脉血栓发生率的比较A组和B组的差异无显著性(χ2=0.427,P=0.514),A组和C组的差异有显著性(χ2=7.545.082,P=0.006),B组和C组的差异有显著性(χ2=4.856,P=0.028).结论 肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成与门静脉和脾静脉直径、脾脏的大小和是否行抗凝祛凝治疗有关;早期、全身应用抗凝、祛凝药能有效的预防肝炎肝硬化门静脉高压症脾切除术后门静脉系统血栓的形成。

Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis

To evaluate the validity of ultrasonographic and pathologic diagnosis of liver fibrosis in patients with chronic viral hepatitis. The liver fibrosis status in 324 patients was evaluated by both needle biopsy and ultrasonography. Liver fibrosis was divided into S0-S4 stages. S4 stage was designated as definite cirrhosis. The ultrasonographic examination included qualitative variables, description of liver surface and parenchyma, and quantitative parameters, such as diameter of vessels, blood flow velocity and spleen size. Ultrasonographic qualitative description of liver surface and parenchyma was related with the severity of fibrosis. Among the quantitative ultrasonographic parameters, cut-off value of spleen length (12.1 cm) had a sensitivity of 0.600 and a specificity of 0.753 for diagnosis of liver cirrhosis. The diameters of spleen (8 mm) and portal vein (12 mm) had a diagnostic sensitivity of 0.600 and 0.767, and a diagnostic specificity of 0.781 and 0.446, respectively. The diagnostic accuracy for liver cirrhosis was moderately satisfactory, and the negative predictive values of these parameters reached near 0.95. Ultrasonography can predict the degree of liver fibrosis or cirrhosis. A single ultrasonographic parameter is limited in sensitivity and specificity for the diagnosis of early cirrhosis. The presence or absence of liver cirrhosis in patients with chronic virus hepatitis can be detected using 2 or 3 quantitative and qualitative parameters, especially the length of spleen, the diameter of spleen vein and echo pattern of liver surface.