声辐射力脉冲弹性成像技术预测肝硬化食管静脉曲张破裂出血的临床价值

张大鹍; 陈敏; 张文辉; 王瑞芳; 史晓娟

doi:10.3969/j.issn.1001-5256.2020.03.018

声辐射力脉冲弹性成像技术预测肝硬化食管静脉曲张破裂出血的临床价值

DOI: 10.3969/j.issn.1001-5256.2020.03.018

1. 中国中医科学院西苑医院超声科
2. 解放军总医院第五医学中心超声科
3. 解放军总医院第五医学中心肝硬化诊疗中心

基金项目:

首都临床特色应用研究专项课题(Z161100000516174)；

详细信息

中图分类号: R575.2
计量
- 文章访问数: 972
- HTML全文浏览量: 23
- PDF下载量: 191
- 被引次数: 0
出版历程
- 收稿日期: 2019-10-23
- 出版日期: 2020-03-20

Clinical value of acoustic radiation force impulse elastography in predicting esophageal variceal bleeding in liver cirrhosis

Department of Ultrasound,Xiyuan Hospital,China Academy of Chinese Medical Sciences

Research funding:

摘要

摘要: 目的探讨声辐射力脉冲弹性成像（ARFI）技术在预测肝硬化食管静脉曲张破裂出血中的临床价值。方法回顾分析2014年10月-2017年5月于解放军总医院第五医学中心就诊的271例肝硬化患者资料,所有患者均应用ARFI技术对肝脏和脾脏的超声弹性进行检测,并根据有无食管静脉曲张破裂出血将患者分为出血组（n=56）和无出血组（n=215）,比较两组间相关指标的差异并结合受试者工作特征曲线（ROC曲线）评估分析ARFI弹性测值对肝硬化食管静脉曲张破裂出血的诊断价值。正态分布的计量资料2组间比较采用t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验。结果肝硬化食管静脉曲张出血组及无出血组脾脏ARFI弹性测值分别为3. 89（3. 49～4. 11） m/s和3. 46（2. 93～3. 80） m/s,出血组显著高于无出血组（Z=-4. 941,P <0. 001）;出血组及无出血组肝脏ARFI弹性值分别为2. 08（1. 57～2. 74） m/s和1. 98（1. 49～2. 70） m/s,两组间差异无统计学意...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 脾 /
- 弹性成像技术
Abstract: Objective To investigate the clinical value of acoustic radiation force impulse( ARFI) elastography in predicting esophageal variceal bleeding in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 271 patients with liver cirrhosis who attended the Fifth Medical Center of Chinese PLA General Hospital from October 2014 to May 2017,and ARFI elastography was performed for all patients to measure the elasticity of the liver and the spleen. According to the presence or absence of esophageal variceal bleeding,the patients were divided into bleeding group and non-bleeding group,and related indices were compared between the two groups. The receiver operating characteristic( ROC) curve was used to evaluate the value of ARFI elasticity in the diagnosis of esophageal variceal bleeding in liver cirrhosis. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Results The bleeding group had a significantly higher ARFI elasticity of the spleen than the non-bleeding group [3. 89( 3. 49-4. 11) m/s vs 3. 46( 2. 93-3. 80) m/s,Z =-4. 941,P < 0. 001],and there was no significant difference in the ARFI elasticity of the liver between the bleeding group and the non-bleeding group [2. 08( 1. 57-2. 74)m/s vs 1. 98( 1. 49-2. 70) m/s,Z =-1. 025,P = 0. 305]. The areas under the ROC curve for ARFI elasticity values of the spleen and the liver were 0. 714 and 0. 544,respectively,in predicting esophageal variceal bleeding in patients with liver cirrhosis( P = 0. 002 5). At the cut-off value of 3. 71 m/s,the ARFI elasticity of the spleen had a sensitivity of 0. 68 and a specificity of 0. 69 in predicting esophageal variceal bleeding. Conclusion The ARFI elasticity value of the spleen has a better value than that of the liver in predicting the risk of esophageal variceal bleeding and thus holds promise for clinical application.
- liver cirrhosis /
- esophageal and gastric varices /
- spleen /
- elasticity imaging technigues

HTML全文

参考文献(17)

[1] Infectious Diseases and Parasitology Branch,Hepatology Branch,Chinese Medical Association. Guideline:Prevention and treatment of viral hepatitis[J]. Chin J Intern Med,2001,40(1):62-68.(in Chinese)中华医学会传染病与寄生虫病学分会、肝病学分会．病毒性肝炎防治方案[J]．中华内科杂志，2001,40(1):62-68.

[2] JANSEN C,MÖLLER P,MEYER C,et al. Increase in liver stiffness after transjugular intrahepatic portosystemic shunt is associated with inflammation and predicts mortality[J]. Hepatology,2018,67(4):1472-1484.

[3] GARCIA-TSAO G. Current management of the complications of cirrhosis and portal hypertension:Variceal hemorrhage,ascites,and spontaneous bacterial peritonitis[J]. Gastroenterology,2001,120(3):726-748.

[4] JENSEN DM. Endoscopic screening for varices in cirrhosis:Findings,implications,and outcomes[J]. Gastroenterology,2002,122(6):1620-1630.

[5] RIZZO L,ATTANASIO M,PINZONE MR,et al. A new sampling method for spleen stiffness measurement based on quantitative acoustic radiation force impulse elastography for noninvasive assessment of esophageal varices in newly diagnosed HCV-related cirrhosis[J]. Biomed Res Int,2014,2014:365982.

[6] ZHANG H,XU YQ. Association between serum ascites albumin gradient and esophagogastric variceal bleeding in patients with liver cirrhosis:A Meta-analysis[J]. J Clin Hepatol,2016,32(2):269-274.(in Chinese)张辉，徐有青．血清-腹水白蛋白梯度与肝硬化食管胃底静脉曲张破裂出血关系的Meta分析[J]．临床肝胆病杂志，2016,32(2):269-274.

[7] YANG WW,YANG JH. Efficiency of platelet count in predicting occurrence risk of esophageal varices in patients with liver cirrhosis[J]. J Clin Med Prac,2018,22(19):101-105.(in Chinese)杨炜炜，杨建华．血小板计数预测肝硬化患者食管静脉曲张发生风险的探讨[J]．实用临床医药杂志，2018,22(19):101-105.

[8] DENG H,QI XS,PENG Y,et al. Diagnostic accuracy of APRI,AAR,FIB-4,FI,and king scores for diagnosis of esophageal varices in liver cirrhosis:A retrospective study[J]. Med Sci Monit,2015,21:3961-3977.

[9] PEAGU R,SARARU R,NECULA A,et al. The role of spleen stiffness using ARFI in predicting esophageal varices in patients with hepatitis B and C virus-related cirrhosis[J]. Rom J Intern Med,2019.[Epub ahead of print]

[10] ZHANF DK,CHEN M,GAO YJ,et al. Clinical value of spleen acoustic radiation force impulse,aspartate aminotransferaseto-platelet ratio index,and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol,2018,34(3):508-512.(in Chinese)张大鹍，陈敏，皋月娟，等．脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值[J]．临床肝胆病杂志，2018,34(3):508-512.

[11] ZHENG LP,WEN W,JIAN Y. The predictive value of transient elastography on upper gastrointestinal bleeding in patients with liver cirrhosis[J]. J Chengdu Med Coll,2018,13(1):85-88.(in Chinese)郑丽萍，文武，蹇贻．瞬时弹性成像技术对肝硬化患者上消化道出血的预测价值[J]．成都医学院学报，2018,13(1):85-88.

[12] GHANY MG,DOO E. Assessment of liver fibrosis:Palpate,poke or pulse[J]. Hepatology,2005,42(4):759-761.

[13] ZHANG Y,DONG L,WANG H,et al. Correlation between liver stiffness and esophageal and gastric varices determined by acoustic radiation force impulse[J]. Chin J Ultrasound Med,2019,35(8):706-708.(in Chinese)张彦，董磊，王惠，等．声脉冲辐射力成像测定肝实质硬度与食管胃底静脉曲张相关性的初步研究[J]．中国超声医学杂志，2019,35(8):706-708.

[14] DIETRICH CF,BAMBER J,BERZIGOTTI A,et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography,update 2017(long version)[J]. Ultraschall Med,2017,38(4):e16-e47.

[15] BOTA S,SPOREA I,SIRLI R,et al. Spleen assessment by Acoustic Radiation Force Impulse Elastography(ARFI)for prediction of liver cirrhosis and portal hypertension[J]. Med Ultrason,2010,12(3):213-217.

[16] KIM HY,JIN EH,KIM W,et al. The role of spleen stiffness in determining the severity and bleeding risk of esophageal varices in cirrhotic patients[J]. Medicine,2015,94(24):e1031.

[17] YANG XS,MENG FK,LYU Y. Feasibility of predicting esophageal varice and bleeding by spleen stiffness[J]. Beijing Med J,2017,39(12):1252-1254.(in Chinese)杨雪松，孟繁坤，吕元．肝硬度预测食管静脉曲张程度及出血风险的可行性研究[J]．北京医学，2017,39(12):1252-1254.

施引文献

资源附件(0)

访问统计