彩色多普勒超声检查对乙型肝炎肝硬化患者食管静脉曲张预测价值分析
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摘要
目的探讨使用彩色多普勒超声检查门静脉血流动力学指标预测乙型肝炎肝硬化患者食管静脉曲张的价值。方法我院收治的乙型肝炎肝硬化患者75例和健康体检者25例,接受胃镜和彩色多普勒超声检查。结果经胃镜检查,发现静脉曲张56例和无静脉曲张19例;存在静脉曲张和无静脉曲张患者门静脉血管内径分别为(13.7±3.2)mm和(12.1±3.2)mm,显著大于对照组[(10.9±3.0) mm,P<0.05],门静脉血流速度分别为(9.3±2.1)cm/s和(13.6±2.7) cm/s,显著慢于对照组[(17.7±2.4) cm/s,P<0.05],门静脉血流量分别为(1054.3±336.8)ml/min和(921.6±327.5) ml/min,显著大于对照组[(832.5±234.1) ml/min,P<0.05];食管静脉曲张患者胃左静脉离肝血流发生率为80.4%,显著高于无静脉曲张患者的0.0%(P<0.05);以门静脉血流量等于1000 ml/min为截断点,其判断存在食管静脉曲张的敏感性为78.6%,特异性为79.0%,阳性预测值为91.7%,阴性预测值为55.6%。结论使用彩色多普勒超声检查门静脉血流动力学指标对肝硬化患者存在食管静脉曲张具有一定的预测价值,而发现胃左静脉离肝血流提示肝硬化患者存在食管静脉曲张的风险较大。
Objective The aim of this study was to investigate the diagnostic value of color Doppler ultrasound in predicting esophageal varices(EV) in patients with hepatitis B-induced liver cirrhosis(LC). Methods Seventy-five patients with hepatitis B-induced LC and twenty-five healthy individuals were recruited in this study and all of them underwent gastroscopy and color Doppler ultrasonography to calculate the portal hemodynamic parameters. Results 56 patients with LC were found having and 19 having not EV in our series by gastroscopy;the diameters of portal veins in patients with and without EV were(13.7±3.2) mm and(12.1±3.2) mm,significantly larger than [(10.9±3.0)mm,P<0.05] in the control,the portal vein blood flow velocities were(9.3±2.1) cm/s and(13.6±2.7) cm/s,respectively,significantly slower than [(17.7±2.4) cm/s,P<0.05] in the control,and the portal vein blood flow volume were(1054.3 ±336.8) ml/min and(921.6 ±327.5) ml/min,respectively,significantly higher than[(832.5±234.1) ml/min,P<0.05] in the control;the incidence of reverse hepatic blood flow in left gastric vein in patients with EV was 80.4%,significantly higher than 0.0%(P<0.05) in patients without;the sensitivity was 78.6%,the specificity was 79.0%,the positive predictive value was 91.7% and the negative predictive value was 55.6%when the portal vein blood flow volume equal to 1000 ml/min as the cut-off-value in predicting the existence of EV. Conclusion The check-up of hemodynamics index of portal vein by color Doppler ultrasound might help predict the existence and degrees of EV in patients with hepatitis B-induced LC,which warrants further investigation.
Objective The aim of this study was to investigate the diagnostic value of color Doppler ultrasound in predicting esophageal varices(EV) in patients with hepatitis B-induced liver cirrhosis(LC). Methods Seventy-five patients with hepatitis B-induced LC and twenty-five healthy individuals were recruited in this study and all of them underwent gastroscopy and color Doppler ultrasonography to calculate the portal hemodynamic parameters. Results 56 patients with LC were found having and 19 having not EV in our series by gastroscopy;the diameters of portal veins in patients with and without EV were(13.7±3.2) mm and(12.1±3.2) mm,significantly larger than [(10.9±3.0)mm,P<0.05] in the control,the portal vein blood flow velocities were(9.3±2.1) cm/s and(13.6±2.7) cm/s,respectively,significantly slower than [(17.7±2.4) cm/s,P<0.05] in the control,and the portal vein blood flow volume were(1054.3 ±336.8) ml/min and(921.6 ±327.5) ml/min,respectively,significantly higher than[(832.5±234.1) ml/min,P<0.05] in the control;the incidence of reverse hepatic blood flow in left gastric vein in patients with EV was 80.4%,significantly higher than 0.0%(P<0.05) in patients without;the sensitivity was 78.6%,the specificity was 79.0%,the positive predictive value was 91.7% and the negative predictive value was 55.6%when the portal vein blood flow volume equal to 1000 ml/min as the cut-off-value in predicting the existence of EV. Conclusion The check-up of hemodynamics index of portal vein by color Doppler ultrasound might help predict the existence and degrees of EV in patients with hepatitis B-induced LC,which warrants further investigation.
引文
[1]Bharti P,Mittal D,Ananthasivan R.Preliminary study of chronic liver classification on ultrasound images using an ensemble model.Ultrason Imaging,2018,40(6):357-379.
[2]Grgurevi I,Bokun T,Mustapi S,et al.Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis.Croat Med J,2015,56(5):470-481.
[3]郑盛,唐映梅,尤丽英,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较.中华全科医学,2014,12(7):1127-1128,1187.
[4]Maruyama H,Kobayashi K,Kiyono S,et al.Left gastric veinbased noninvasive test for esophageal varices:a same-day comparison of portal hemodynamic assessment with endoscopic appearance.Clin Transl Gastroenterol,2018,9(5):154.
[5]Mahmoud HS,Mostafa EF,Mohammed MA.Role of portal haemodynamic parameters in predictio n of oesophageal varices in cirrhotic patients.Arab J Gastroenterol,2014,15(3-4):130-134.
[6]中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[7]刘保池.肝硬化的手术与细胞治疗.中华消化病与影像杂志(电子版),2018,8(5):193-196.
[8]Rowe,Ian A.Lessons from epidemiology:The burden of liver disease.Dig Dis,2017,35(4):304-309.
[9]Asrani SK,Devarbhavi H,Eaton J,et al.Burden of liver diseases in the world.J Hepatol,2018,70(1):151-171.
[10]周光文,关蛟.对门静脉高压症规范治疗的认识-如何理解共识与指南.中华普通外科杂志,2018,33(7):537-539.
[11]徐小元,丁惠国,贾继东,等.肝硬化门静脉高压食管胃静脉曲张出血防治指南(2015).中华胃肠内镜电子杂志,2015,2(4):1-21.
[12]Tseng Y,Ma L,Luo T,et al.Patient response to endoscopic therapy for gastroesophageal varices based on endoscopic ultrasound findings.Gut Liver,2018,12(5):562-570.
[13]Tseng Y,Li F,Wang J,et al.Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices.J Clin Ultrasound,2018,46(7):442-449.
[14]Kibrit J,Khan R,Jung BH,et al.Clinical assessment and management of portal hypertension.Semin Intervent Radiol,2018,35(3):153-159.
[15]Antil N,Sureka B,Mittal MK,et al.Hepatic venous waveform,splenoportal and damping index in liver cirrhosis:correlation with Child Pugh's score and oesophageal varices.J Clin Diagn Res,2016,10(2):1-5.
[16]Bintintan A,Chira RI,Bintintan VV,et al.Value of hepatic elasto graphy and Doppler indexes for predictions of esophageal varices in liver cirrhosis.Med Ultrason,2015,17(1):5-11.
[17]Kondo T,Maruyama H,Sekimoto T,et al.Impact of portal hemodynamics on Doppler ultrasonography for predicting decompensation and long-term outcomes in patients with cirrhosis.Scand J Gastroenterol,016,51(2):236-244.
[18]Sangma MA,Biswas N,Ahmed MU,et al.Doppler assessment of hepatic venous waves for evaluation of large varices in cirrhotic patient.Mymensingh Med J,2016,25(4):641-646.
[19]Shastri M,Kulkarni S,Patell R,et al.Portal vein Doppler:a tool for non-invasive prediction of esophageal varices in cirrhosis.J Clin Diagn Res,2014,8(7):12-15.
[20]Bin in an A,Chira RI,Mircea PA.Non-invasive ultrasoundbased diagnosis and staging of esophageal varices in liver cirrhosis.A systematic review of the literature published in the third millenium.Med Ultrason,2013,15(2):116-124.
[2]Grgurevi I,Bokun T,Mustapi S,et al.Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis.Croat Med J,2015,56(5):470-481.
[3]郑盛,唐映梅,尤丽英,等.MSCTP与内镜检查诊断肝硬化合并食管胃静脉曲张的比较.中华全科医学,2014,12(7):1127-1128,1187.
[4]Maruyama H,Kobayashi K,Kiyono S,et al.Left gastric veinbased noninvasive test for esophageal varices:a same-day comparison of portal hemodynamic assessment with endoscopic appearance.Clin Transl Gastroenterol,2018,9(5):154.
[5]Mahmoud HS,Mostafa EF,Mohammed MA.Role of portal haemodynamic parameters in predictio n of oesophageal varices in cirrhotic patients.Arab J Gastroenterol,2014,15(3-4):130-134.
[6]中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南.实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[7]刘保池.肝硬化的手术与细胞治疗.中华消化病与影像杂志(电子版),2018,8(5):193-196.
[8]Rowe,Ian A.Lessons from epidemiology:The burden of liver disease.Dig Dis,2017,35(4):304-309.
[9]Asrani SK,Devarbhavi H,Eaton J,et al.Burden of liver diseases in the world.J Hepatol,2018,70(1):151-171.
[10]周光文,关蛟.对门静脉高压症规范治疗的认识-如何理解共识与指南.中华普通外科杂志,2018,33(7):537-539.
[11]徐小元,丁惠国,贾继东,等.肝硬化门静脉高压食管胃静脉曲张出血防治指南(2015).中华胃肠内镜电子杂志,2015,2(4):1-21.
[12]Tseng Y,Ma L,Luo T,et al.Patient response to endoscopic therapy for gastroesophageal varices based on endoscopic ultrasound findings.Gut Liver,2018,12(5):562-570.
[13]Tseng Y,Li F,Wang J,et al.Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices.J Clin Ultrasound,2018,46(7):442-449.
[14]Kibrit J,Khan R,Jung BH,et al.Clinical assessment and management of portal hypertension.Semin Intervent Radiol,2018,35(3):153-159.
[15]Antil N,Sureka B,Mittal MK,et al.Hepatic venous waveform,splenoportal and damping index in liver cirrhosis:correlation with Child Pugh's score and oesophageal varices.J Clin Diagn Res,2016,10(2):1-5.
[16]Bintintan A,Chira RI,Bintintan VV,et al.Value of hepatic elasto graphy and Doppler indexes for predictions of esophageal varices in liver cirrhosis.Med Ultrason,2015,17(1):5-11.
[17]Kondo T,Maruyama H,Sekimoto T,et al.Impact of portal hemodynamics on Doppler ultrasonography for predicting decompensation and long-term outcomes in patients with cirrhosis.Scand J Gastroenterol,016,51(2):236-244.
[18]Sangma MA,Biswas N,Ahmed MU,et al.Doppler assessment of hepatic venous waves for evaluation of large varices in cirrhotic patient.Mymensingh Med J,2016,25(4):641-646.
[19]Shastri M,Kulkarni S,Patell R,et al.Portal vein Doppler:a tool for non-invasive prediction of esophageal varices in cirrhosis.J Clin Diagn Res,2014,8(7):12-15.
[20]Bin in an A,Chira RI,Mircea PA.Non-invasive ultrasoundbased diagnosis and staging of esophageal varices in liver cirrhosis.A systematic review of the literature published in the third millenium.Med Ultrason,2013,15(2):116-124.