超声与内镜预测食管静脉曲张出血风险的对比研究

Comparison study on the prediction for esophageal varices bleeding risk between ultrasound and endoscopy

目的比较超声与内镜预测食管静脉曲张出血风险的能力。方法选取我院69例乙型肝炎肝硬化患者,其中既往有食管静脉曲张出血史且出血停止1周以上31例(出血组),既往无食管静脉曲张出血史38例(非出血组)。对两组患者食管静脉曲张分级、Child-Pugh分级、门静脉内径和血流速度、脾静脉内径和血流速度、脾厚径和脾长径、胃左静脉内径和血流方向、肝硬度值进行单因素Logistic回归分析。非条件Logistic回归模型筛选出独立危险因素,并计算独立危险因素预测食管静脉曲张出血的曲线下面积、敏感性和特异性。结果单因素Logistic回归分析显示出血组门静脉内径、脾静脉内径和血流速度、脾厚径、胃左静脉内径与非出血组比较,差异均有统计学意义(均P<0.05);非条件Logistic回归模型分析显示胃左静脉内径和食管静脉曲张分级是食管静脉曲张出血独立危险因素(OR分别为1.29和9.27,均P<0.05),二者预测食管静脉曲张出血的曲线下面积分别为0.859和0.896;食管静脉曲张分级为重度时,预测食管静脉曲张出血的敏感性和特异性分别为82.8%和82.5%;当胃左静脉内径≥5.95 mm时,预测食管静脉曲张出血的敏感性和特异性分别为83.9%和71.1%。结论超声测量胃左静脉内径和内镜下食管静脉曲张分级预测食管静脉曲张出血的能力相似,超声可以非侵入性预测食管静脉曲张出血。

Objective To compare the value between the ultrasound and endoscopy in predicting esophageal varices bleeding risk.Methods The data of 69 patients suffering from liver cirrhosis due to hepatitis B were retrospectively analyzed.In this data,31 patients had a history of esophageal varices bleeding and the bleeding had stopped for more than one week（bleeding group）,38 cases had no history of esophageal varices bleeding（non- bleeding group）. The parameters including esophageal varices grading,Child-Pugh grading,portal vein diameter and blood flow velocity,spleen vein diameter and blood flow velocity,thickness and length of spleen,left gastric vein diameter and blood flow direction and liver stiffness,were measured by ultrasound,and were analyzed with single factor logistic regression analysis.Unconditional logistic regression model was performed to screen independent risk factors.The area under the curve,sensitivity and specificity of independent risk factors predict esophageal varices bleeding risk were calculated.Results A single factor logistic regression analysis showed the differences in portal vein diameter,spleen vein diameter,spleen blood flow velocity,spleen thickness,left gastric vein diameter between bleeding group and non-bleeding group were statistically significant（all P0.05）.Unconditional logistic regression model analysis showed that left gastric vein diameter and the esophageal varices grading were independent risk factors（OR were 1.29 and 9.27,respectively,P 0.05）.The area under the curve of left gastric vein diameter and the esophageal varices grading were 0.859 and 0.896,respectively.When esophageal varices grading was severe,the sensitivity and specificity of predicting bleeding were 82.8% and82.5%,respectively.When the left gastric vein diameter was equal or greater than 5.95 mm,the sensitivity and specificity of predicting bleeding were 83.9% and 71.1%,respectively.Conclusion Using left gastric vein diameter measured with ultrasound is similar to that of esophageal varices grading under endoscope in predicting esophageal varices bleeding.Ultrasound may predict esophageal varices bleeding risk non-invasively.