经腹胃充盈超声造影对食管-胃底静脉曲张分度的探讨

Cutoff values for the classification of esophago-gastric varices on transabdominal gastric-filling ultrasonography

目的探讨经腹胃充盈超声造影对食管-胃底静脉曲张程度分级的诊断界值。方法应用经腹胃充盈超声造影检查118例肝硬化门脉高压症食管-胃底静脉曲张患者,测量曲张静脉内径,并与内镜结果比较。结果 118例内镜诊断有食管-胃底静脉曲张的患者,经腹胃充盈超声的检出率为97.5%(115/118)。用ROC曲线求出轻度/中度、中度/重度的诊断界值分别为2.85和5.80 mm,敏感性和特异性分别为92.7%、96.4%和93.9%、92.7%。以上述超声诊断界值为标准将超声检出的115例患者分为轻、中、重度三组,经Kappa检验,超声与内镜诊断食管-胃底静脉曲张结果具有高度一致性,诊断轻、中、重度的准确率分别为88.9%、89.7%、93.9%,总体诊断准确率为91.3%(105/115)。结论经腹胃充盈超声造影不仅可显示食管-胃底静脉曲张及范围,而且能区分轻中重度曲张,与内镜结果高度一致。

Objective To determine the cutoff values for the classification of esophago-gastric varices on transabdominal gastric-filling ultrasonography（US）. Methods US was performed on 118 patients with portal hypertension and esophago-gastric varices related to liver cirrhosis. The inner diameter of the varices were measured and compared with endoscopy. Results The detection rate of varices on US was 97.5%（115 / 118）. Using ROC curve analysis, the cutoff venous diameter of mild / moderate varices was 2.85 mm with 92.7% sensitivity and 96.4% specificity, 5.80 mm for moderate / severe varices with 93.9% sensitivity and 92.7% specificity. The diagnostic accuracy of US for mild, moderate and severe varices was 88.9%, 89.7%, 93.9%,respectively with 91.3%（105 / 115） overall accuracy compared to endoscopy. Conclusion US shows the extent and distinguishes between mild, moderate and severe esophago-gastric varices.