脾脏动静脉血流参数预测食管胃底静脉曲张及出血风险的研究

Study on spleen arterial and venous blood flow parameters for predicting risk of esophageal and gastric varices and bleeding

目的运用超声造影技术探讨脾脏动静脉血流参数在评估乙肝后肝硬化患者胃底静脉曲张(EGV)破裂出血的临床价值。方法对60例确诊为乙肝后肝硬化患者行胃镜检查,并对EGV程度分级;患者接受脾脏超声造影后绘制时间-强度曲线后确认3个时间点,分别是脾动脉、脾静脉显影时间点及脾静脉达到最大强度的时间点,然后计算脾脏动静脉最小循环时间(MCT)、峰值增强时间(PET)。绘制ROC曲线,比较MTC、PET对诊断EGV及评估静脉破裂出血风险的临床价值。结果有无EGV患者间脾动脉阻力指数(RI)、搏动指数(PI)值及脾静脉直径、平均流速的差异无统计学意义(均P>0.05)。有EGV乙肝后肝硬化患者的MTC、PET均高于无EGV乙肝后肝硬化患者(均P<0.01)。以胃镜结果为金标准,MTC和PET诊断EGV的ROC曲线下面积(AUC),分别为0.865(95%CI:0.761～0.969)和0.843(95%CI:0.740～0.946),最佳临界值分别为4.8s和13.5s,灵敏度为93.88%和93.88%,特异度为63.64%和72.73%;其预测静脉曲张破裂出血高分险的AUC分别为0.857(95%CI:0.748～0.966)和0.820(95%CI:0.709～0.931),最佳临界值分别为5.6s和14.8s,灵敏度为86.36%和88.64%,特异度为75.00%和68.75%。结论脾脏动静脉MCT和PET有助于诊断乙肝后肝硬化患者EGV及预测静脉曲张破裂出血分险。

Objective To investigate the clinical value of spleen arterial and venous blood flow parameters for predicting esophageal and gastric varices(EGV)rupture bleeding in the patients with hepatitis B related cirrhosis.Methods Sixty patients with definitely diagnosed hepatitis B related cirrhosis conducted the gastroscopic examination.The EGV degree was graded.After receiving the spleen ultrasound examination,the time-intensity curve(TIC)was drawn for confirming the 3 time points,which were splenic artery developing time,splenic vein developing time and time point for spleen vein reaching maximal intensity.Then minimal circulation time(MCT)of the spleen artery and vein and the peak enhancement time(PET).The ROC curve was drawn to compare the clinical value of MTC and PET in diagnosing EGV and assessing the risk of varices rupture bleeding.Results The spleen arterial resistance index(RI),pulse index(PI),splenic vein diameter and mean flow velocity had no statistical difference between the patients with and without EGV(all P>0.05).MTC and PET in the patients with hepatitis B related cirrhosis complicating EGV were higher than those in the patients without complicating EGV(all P<0.01).With the gastroscopic examination results as the gold standard,the areas under the ROC curve(AUC)of MTC and PET for diagnosing EGV was 0.865(95%CI:0.761-0.969)and 0.843(95%CI:0.740-0.946)respectively.The best cutoff values were 4.8 s and 13.5 s,the sensitivities were 93.88%and 93.88%,and the specificities were 63.64%and 72.73%,respectively.Their AUC for predicting the high risk of variceal rupture bleeding were 0.857(95%CI:0.748-0.966)and 0.820(95%CI:0.709-0.931)respectively.The best cutoff values were 5.6 s and 14.8 s,the sensitivities were 86.36%and 88.64%,and the specificities were 75.00%and 68.75%,respectively.Conclusion Spleen arterial and venous MCT and PET are helpful in diagnosing EGV and predicting the risk of varices bleeding in the patients with hepatitis B related cirrhosis.