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声辐射力脉冲成像技术定量预测肝硬化食管静脉曲张程度的临床价值
Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis
文章发布日期:2017年12月09日  来源:  作者:陈敏,张大鹍,皋月娟,等  点击次数:396次  下载次数:96次

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【摘要】:目的 探讨声辐射力脉冲成像(ARFI)技术定量分析预测肝硬化门静脉高压食管静脉曲张程度的临床价值。方法 选取2014年10月-2016年2月解放军第三〇二医院收治的肝硬化患者116例,应用ARFI技术分别对肝脏、脾脏的实时超声弹性进行测量,以胃镜为食管静脉曲张程度的诊断金标准,将患者分为无曲张组(EV0,n=16)、轻度曲张组(EV1,n=39)、中度曲张组(EV2,n=26)和重度曲张组(EV3,n=35)。采用受试者工作特征曲线分析肝脏、脾脏ARFI技术预测食管静脉曲张程度的临床诊断价值。计量资料多组间比较采用方差分析或Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验;计数资料多组间比较采用χ2检验。ARFI弹性测值与食管静脉曲张程度的相关性采用Spearman相关分析。结果 肝硬化患者食管静脉曲张程度从EV0至EV3级的脾脏ARFI测值分别为(2.54±0.34)、(3.05±0.34)、(3.48±0.50)、(3.69±0.33)m/s,组间比较差异有统计学意义(χ2=60.121,P<0.001)。脾脏ARFI测值与食管静脉曲张分级呈正相关(r=0.713,P<0.001)。脾脏ARFI测值诊断不同食管静脉曲张程度≥EV1、≥EV2、EV3的受试者工作特征曲线下面积分别为0.93、0.88、0.83。肝脏ARFI测值在不同食管静脉曲张程度组间差异无统计学意义(P=0.085),其与肝硬化食管静脉曲张程度亦无相关性(P=0.245)。结论 脾脏ARFI弹性测值可较准确地无创定量预测肝硬化门静脉高压食管静脉曲张程度,具有潜在的临床应用前景。
【Abstract】:Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) in quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension. Methods A total of 116 patients with liver cirrhosis who were admitted to 302 Hospital of PLA from October 2014 to February 2016 were enrolled. ARFI was used to measure real-time liver and spleen stiffness for all patients. With the degree of esophageal varices determined by gastroscopy as the gold standard for diagnosis, these patients were divided into non-varices group (EV0, 16 patients), mild varices group (EV1, 39 patients), moderate varices group (EV2, 26 patients), and severe varices group (EV3, 35 patients). The receiver operating characteristic (ROC) curve was used to analyze the clinical value of liver/spleen ARFI in predicting the degree of esophageal varices. An analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, and the least significant difference Mann-Whitney U test was used for further comparison between any two groups; the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was used to investigate the correlation between the stiffness measured by ARFI and the degree of esophageal varices. Results The ARFI value of the spleen was 2.54±0.34 m/s for EV0 patients, 3.05±0.34 m/s for EV1 patients, 3.48±0.50 m/s for EV2 patients, and 3.69±0.33 m/s for EV3 patients (χ2=60.121,P<0.001). The ARFI value of the spleen was positively correlated with the grade of esophageal varices (r=0.713, P<0.001). The areas under the ROC curve for the ARFI value of the spleen in the diagnosis of ≥EV1, ≥EV2, or EV3 esophageal varices were 0.93, 0.88, and 0.83, respectively. There was no significant difference in the ARFI value of the liver between groups (P=0.085), and the ARFI value of the liver was not correlated with the degree of esophageal varices (P=0.245). Conclusion The ARFI value of the spleen helps to achieve accurate quantitative prediction of the degree of esophageal varices in patients with cirrhotic portal hypertension and holds promise for clinical application.
【关键字】:肝硬化;食管和胃静脉曲张;弹性成像技术;诊断
【Key words】:liver cirrhosis; esophageal and gastric varices; elasticity imaging techniques; diagnosis
【引证本文】:CHEN M, ZHANG DK, GAO YJ, et al. Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol, 2018, 34(1): 80-83. (in Chinese)
陈敏, 张大鹍, 皋月娟, 等. 声辐射力脉冲成像技术定量预测肝硬化食管静脉曲张程度的临床价值[J]. 临床肝胆病杂志, 2018, 34(1): 80-83.

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