超声定量分析技术预测食管胃底静脉曲张出血危险度的应用

doi:10.7517/issn.1674-0475.220304

摘要/Abstract

摘要： 本文探讨超声定量分析技术预测食管胃底静脉曲张（EGV）出血危险度的价值。选取127例肝硬化门静脉高压患者为研究对象，随访3个月，失联2例，根据是否发生EGV出血分为发生组（60例）、未发生组（65例）。比较两组EGV严重程度、Child肝功能分级、肝脏剪切波速度（LSWV）、门静脉内径（PV）、脾脏剪切波速度值（SSWV）、脾脏指数（SI），并对数据进行统计学分析。结果显示，发生组LSWV、PV、SSWV、SI高于未发生组（P<0.05）；LSWV、PV、SSWV、SI与EGV严重程度、Child肝功能分级呈正相关（P<0.05）；以LSWV （X₁）、PV （X₂）、SSWV （X₃）、SI （X₄）作为协变量，得出联合预测因子表达式为：Logit （P）=－3.757+2.003×X₁+1.989×X₂+1.473×X₃+1.981×X₄，其预测EGV出血危险度的曲线下面积（AUC）大于各原始协变量，为0.873，预测敏感度为78.33%，特异度为81.54%。超声定量分析技术检测LSWV、PV、SSWV、SI，可作为预测EGV出血危险度的一个方案，对临床预防性干预及外科手术方式具有一定指导作用。

关键词: 超声, 定量分析技术, 食管胃底静脉曲张出血, 出血危险度

Abstract: This paper investigated the value of ultrasound quantitative analysis technology in predicting the bleeding risk of esophageal gastric varices (EGV). 127 patients with cirrhotic portal hypertension were selected as the research objects. After 3 months of follow-up, 2 patients lost contact. According to the presence or absence of EGV bleeding all patients were divided into the occurrence group (60 cases) and the non-occurrence group (65 cases). The severity of EGV severity, Child liver function classification, liver shear wave velocity (LSWV), portal vein diameter (PV), spleen shear wave velocity (SSWV), and spleen index (SI) were compared between the two groups, and the data were statistically analyzed. The results showed that the LSWV, PV, SSWV, and SI in the occurrence group were higher than those in the non-occurrence group (P<0.05). LSWV, PV, SSWV, and SI were positively correlated with EGV severity and Child liver function grade (P<0.05). The combined predictor expression with LSWV (X₁), PV (X₂), SSWV (X₃), SI (X₄) as covariates was:Logit(P)=-3.757+2.003×X₁+1.989×X₂+1.473×X₃+1.981×X₄, and its AUC for predicting EGV bleeding risk was 0.873 and greater than the original covariates, the predictive sensitivity was 78.33%, and the specificity was 81.54%. It can be seen that the detection of LSWV, PV, SSWV, and SI by ultrasonic quantitative analysis technology could be used as a plan to predict the risk of EGV bleeding, and it can play a certain guiding role in clinical preventive intervention and surgical method.

Key words: ultrasound, quantitative analysis technique, esophagogastric varices bleeding, bleeding risk

刘伟, 王贺, 初晓燕, 徐丽丽, 王爱民. 超声定量分析技术预测食管胃底静脉曲张出血危险度的应用[J]. 影像科学与光化学, 2022, 40(5): 1103-1107.

LIU Wei, WANG He, CHU Xiaoyan, XU Lili, WANG Aimin. Application of Ultrasound Quantitative Analysis Technology in Predicting the Risk of Esophagogastric Varices Bleeding[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(5): 1103-1107.

参考文献

[1] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(12):1087-1093.
[2] Lau L H S, Sung J J Y. Treatment of upper gastrointestinal bleeding in 2020:New techniques and outcomes[J]. Digestive Endoscopy, 2021, 33(1):83-94.
[3] Henry Z, Patel K, Patton H, et al. AGA clinical practice update on management of bleeding gastric varices:Expert review[J]. Clinical Gastroenterology and Hepatology, 2021, 19(6):1098-1107.e1.
[4] 林诗彬, 郑恩海, 杨克丰, 等. 彩色多普勒超声检查对乙型肝炎肝硬化患者食管静脉曲张预测价值分析[J]. 实用肝脏病杂志, 2019, 22(3):409-412.
[5] Shrestha R, Thapa J, Yadav B, et al. Endoscopic detection and management of esophagogastric varices[J]. Cureus, 2021, 13(8):e16825.
[6] 张春雨, 刘作金. 肝硬化门静脉高压外科治疗的现状及进展[J]. 临床肝胆病杂志, 2020, 36(2):417-420.
[7] Sangma M A, Biswas N, Paul P. Relation of hepatic venous doppler sonography and portal flowmetry in determination of severity of esophageal varices in liver cirrhosis[J]. Mymensingh Medical Journal, 2019, 28(4):727-733.
[8] Cannella R, Giambelluca D, Pellegrinelli A, et al. Color doppler ultrasound in portal hypertension:A closer look at left gastric vein hemodynamics[J]. Journal of Ultrasound in Medicine, 2021, 40(1):7-14.
[9] 汪军虎, 曹利利. 超声评估胃短静脉和脾静脉血流动力学对胃底静脉曲张出血的影响[J]. 中国中西医结合消化杂志, 2020, 28(4):304-307.
[10] 岳元元, 张旭. 血小板计数和脾脏厚度在肝硬化食管静脉曲张中的预测价值[J]. 淮海医药, 2020, 38(1):57-59.
[11] 左辉兰, 刘婷, 李田, 等. 脾脏硬度对肝硬化食管静脉曲张的预测价值[J]. 中国医学影像学杂志, 2021, 29(1):51-55.
[12] Zhao W, Liu C, Zhang L, et al. Application of shear wave elastography as a diagnostic method for esophageal varices[J].Annals of Palliative Medicine, 2021, 10(2):1342-1350.
[13] Petrisor A, Stanescu A M A, Papacocea I R, et al. Non-invasive laboratory, imaging and elastography markers in predicting varices with high risk of bleeding in cirrhotic patients[J]. Journal of Internal Medicine=Revue Roumaine De Medecine Interne, 2021, 59(2):194-200.
[14] 徐成川, 钱艺, 龚季陈, 等. 剪切波弹性成像联合多参数模型无创诊断HBV相关性肝细胞癌食管静脉曲张的研究[J]. 临床超声医学杂志, 2019, 21(5):331-335.
[15] Wang X K, Wang P, Zhang Y, et al. A study on spleen transient elastography in predicting the degree of esophageal varices and bleeding[J]. Medicine, 2019, 98(9):e14615.
[16] Stefanescu H, Marasco G, Calès P, et al. A novel spleen-dedicated stiffness measurement by FibroScan^® improves the screening of high-risk oesophageal varices[J]. Liver International, 2020, 40(1):175-185.