肝血流超声参数对肝硬化食管静脉曲张程度评估价值

Evaluation value of hepatic blood flow ultrasound parameters on the degree of esophageal varices in cirrhosis

目的探讨不同肝硬化食管静脉曲张程度患者的肝血流超声参数及评估价值。方法选择2020-01-01-2022-12-31商丘市立医院收治的80例肝硬化食管静脉曲张患者为研究对象,根据胃镜诊断结果,分为轻度组(40例,无红色征)和中重度组(40例,有红色征)。均接受肝血流超声检查,比较2组患者肝血流超声参数[门静脉流速(PVV)、门静脉内径(PVD)、肝静脉减振指数(HV-DI)、肝内循环时间(IHCT)]、肝动脉搏动指数(PI)、动态扫描参数[到达肝动脉时间(HAAT)、到达肝静脉时间(HVAT)、肝内循环时间(HV-HA)、到达门静脉时间(PVAT)],绘制受试者工作特征(ROC)曲线分析肝血流超声参数在静脉曲张诊断中的应用效能。结果轻度组的PVV为(16.87±3.76)cm/s,高于重度组的(13.46±3.14)cm/s,t=4.403,P<0.001;IHCT为(6.31±1.02)s,长于重度组的(5.77±0.97)s,t=2.426,P=0.018;HAAT为(11.23±2.75)s,长于重度组的(10.16±1.46)s,t=2.174,P=0.033;HVAT为(18.46±2.16)s,长于重度组的(14.06±1.44)s,t=10.720,P<0.001;HV-HA为(9.79±2.12)s,长于重度组的(6.43±1.64)s,t=7.928,P<0.001。轻度组的PVD为(1.39±0.08)cm,低于重度组的(1.58±0.13)cm,t=7.872,P<0.001;HV-DI为0.71±0.11,低于重度组的0.82±0.15,t=3.740,P<0.001;PI为1.31±0.11,低于重度组的1.58±0.18,t=8.095,P<0.001;PVAT为(21.04±3.01)s,短于重度组的(24.97±4.16)s,t=4.841,P<0.001。肝血流超声参数指标联合诊断肝硬化食管静脉曲张中重度的曲线下面积(AUC)为0.886(95%CI为0.785~0.987),高于单一指标(均P<0.05),灵敏度、特异度分别为92.50%和95.00%。结论在肝硬化食管静脉曲张中采取肝血流超声检查,不同病情者的肝血流超声参数有差异,能反映肝脏病变及食管静脉曲张程度。

Objective To investigate the parameters and evaluation value of hepatic blood flow ultrasound in different degree of esophageal varices in cirrhosis.Methods Eighty patients with esophageal varices with cirrhosis admitted to Shangqiu Municipal Hospital from January 1,2020 to December 31,2022 were selected as the study objects.According to the diagnosis results of gastroscopy.they were divided into mild group(40 cases without red sign)and moderate and severe group(40 cases with red sign).Two groups of patients were compared for liver blood flow ultrasound parameters[portal vein velocity(PVV),portal vein dilation(PVD),hepatic vein-damping index(HV-DI),intrahepatic circulation time(IHCT)],hepatic artery pulsatility index(PI),and dynamic scanning parameters[hepatic artery arrival time(HAAT),hepatic vein arrival time(HVAT),hepatic vein-hepatic artery transit time(HV-HA)and portal vein arrival time(PVAT)].Receiver operating characteristic(ROC)curves were drawn to analyze the application efficiency of liver blood flow ultrasound parameters in the diagnosis of varicose veins.Results The PVV of the mild group was(16.87±3.76)cm/s,higher than that in the moderate and severe group(13.46±3.14)cm/s,t=4.403,P<0.001;IHCT was(6.31±1.02)s,longer than that in the moderate and severe group(5.77±0.97)s,t=2.426,P=0.018;HAAT was(11.23±2.75)s,longer than that in the moderate and severe group(10.16±1.46)s,t=2.174,P=0.033;HVAT was(18.46±2.16)s,longer than that in the moderate and severe group(14.06±1.44)s,t=10.720,P<0.001;HV-HA was(9.79±2.12)s,longer than that in the moderate and severe group(6.43±1.64)s,t=7.928,P<0.001.The PVD of the mild group was(0.39±0.08)cm,lower than that of the moderate and severe group(1.58±0.13)cm,t=7.872,P<0.001;HV-DI was 0.71±0.11,lower than that of the moderate and severe group(0.82±0.15),t=3.740,P<0.001;PI was 1.31±0.11,lower than that of the moderate and severe group(1.58±0.18),t=8.095,P<0.001;PVAT was(21.04±3.01)s,shorter than that of the moderate and severe group(24.97±4.16)s,t=4.841,P<0.001.The area under the curve(AUC)for the combined diagnosis of moderate to severe esophageal varices in cirrhosis using liver blood flow ultrasound parameters was 0.886(95%CI was 0.785-0.987),which was higher than that of a single indicator(all P<0.05).The sensitivity and specificity were 92.50%and 95.00%,respectively.Conclusion Hepatic blood flow ultrasound examination in patients with esophageal varices due to liver cirrhosis shows differences in ultrasound parameters among patients with different conditions,which can reflect the degree of liver lesions and esophageal varices.