超声造影无创诊断食管静脉曲张的可行性研究

Study on contrast-enhanced ultrasound for non-invasive prediction of esophageal varices in cirrhotic patients

目的探讨超声造影在肝硬化食管静脉曲张诊断中的应用价值。方法对49例肝硬化伴食管静脉曲张(EV)患者及23例正常对照者进行超声造影(CEUS)观察。根据研究对象的内镜检查结果,将研究对象分为肝硬化食管静脉曲张轻度组(G1)6例,食管静脉曲张中度组(G2)11例,食管静脉曲张重度组(G3)32例及对照组(G0)23例。分别获得食管下段双层黏膜及黏膜下层厚度(Tm)、食管下段最大前后径(De)以及二者比值Tm/De,食管下段超声造影时间-强度曲线(TIC)、腹主动脉TIC参数及其比值。应用单因素方差分析比较四组间各超声造影参数是否有统计学差异;Spearman秩相关分析超声造影各参数与食管静脉曲张程度之间的相关性;受试者工作曲线(ROC)评价造影参数的诊断价值。结果肝硬化食管静脉曲张(EV)组Tm、De、Tm/De、食管下段超声造影剂相对达峰时间(Tep)及食管下段峰值强度与同切面腹主动脉增强峰值强度比值(Iep/Iap)均明显大于正常对照组(P<0.05,P<0.01)。Tm、De、Tm/De、Tep、Iep/Iap诊断G3的灵敏度依次为93.8%、90.6%、78.1%、96.6%、82.8%,特异度依次为95.0%、72.5%、80%、37.8%、67.7%。结论超声造影测得Tm和De可评价重度食管静脉曲张,有望成为一种方便、安全、无创预测重度食管静脉曲张的新方法。

Objective To evaluate the feasibility of evaluating esophageal varices （EV） in cirrhosis patients by contrast - enhanced ultra- sonography. Methods A total of 72 cases （49 patients with esophageal varices and 23 healthy controls without EV） were evaluated by contrast - enhanced uhrasonography （CEUS） for parameters of lower esophagus . According to the result of endoscopy, 49 EV patients were divided into light esophageal varices （LEV） group 1 with 6 patients, moderate esophageal varice （MEV） group 2 with 11 patients and severe esophageal vari- ees （SEV） group 3 with 32 patients. Under CEUS, the following parameters were measured： Tm thickness of double - layer mucosa and submu- cosa in lower esophagus, the maximum anteroposterior diameter of lower esophagus （De） , the ratio of Tm and De （Tm/De）. Time - intensity curves of lower esophagus and aorta can be thoroughly drawn by QLAB software. One factor analysis of variance was used to compare parameters between 4 groups. Spearman rank correlation was used to study the correlation between CEUS and EV grades. The diagnostic value of CEUS was assessed by receiver operating characteristic （ROC） curves. Results Tm, De, Tm/De, Tep and Iep/Iap were greater in patients with esophageal variees （ G1, G2 and G3 ） than those of persons without EV （G0）. The sensitivity and specificity of Tm, De, Tin/De, Tep, Iep/Iap were 93.8 % , 90.6% , 78.1%, 96.6% , 82.8% and 95% , 72.5%, 80% , 37.8% , 67.7% respectively. Conclusion Tm and De attained from CEUS can be new, convenient, noninvasive parameters for diagnosing severe esophageal varices in liver cirrhotic patients.