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

陈敏; 张大鹍; 皋月娟; 李猛; 王瑞芳; 张文辉

doi:10.3969/j.issn.1001-5256.2018.01.016

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

DOI: 10.3969/j.issn.1001-5256.2018.01.016

1. 解放军第三〇二医院超声科
2. 解放军第三〇二医院肝硬化诊疗一中心

基金项目:

北京市科技计划课题(Z161100000516174)；解放军第三〇二医院课题(YNKT2014037)；

详细信息

中图分类号: R445.1;R575.2
计量
- 文章访问数: 1571
- HTML全文浏览量: 31
- PDF下载量: 388
- 被引次数: 0
出版历程
- 出版日期: 2018-01-20

Clinical value of acoustic radiation force impulse in quantitative prediction of the degree of esophageal varices in patients with liver cirrhosis

Department of Ultrasound, 302 Hospital of PLA, Beijing 100039, China

Research funding:

摘要

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<0.0...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 弹性成像技术 /
- 诊断
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.
- liver cirrhosis /
- esophageal and gastric varices /
- elasticity imaging techniques /
- diagnosis

HTML全文

参考文献(16)

[1]de FRANCHIS R, BAVENO VI Faculty.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.

[2]CHEN YP, ZHANG Q, DAI L, et al.Is transient elastography valuable for high-risk esophageal varices prediction in patients with hepatitis-B-related cirrhosis?[J].J Gastroenterol Hepatol, 2012, 27 (3) :533-539.

[3]LI Q, WANG LW, GONG ZJ.Analysis of risk factors of gastrointestinal bleeding in cirrhotic patients related hepatitis B[J].Chin J Integr Tradit West Med Liver Dis, 2010, 20 (6) :338-340, 384. (in Chinese) 李卿, 王鲁文, 龚作炯.乙型肝炎肝硬化消化道出血的危险因素分析[J].中西医结合肝病杂志, 2010, 20 (6) :338-340, 384.

[4]NIGHTINGALE K, SOO MS, NIGHTINGALE R, et al.Acoustic radiation force impulse imaging:in vivo demonstration of clinical feasibility[J].Ultrasound Med Biol, 2002, 28 (2) :227-235.

[5]FAHEY BJ, HSU SJ, WOLF PD, et al.Liver ablation guidance with acoustic radiation force impulse imaging:challenges and opportunities[J].Phys Med Biol, 2006, 51 (15) :3785-3808.

[6] Chinese digestive disease association, Chinese liver disease Association, Chinese endoscopicology association.Consensus for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J].Chin J Dig, 2008, 28 (8) :551-558. (in Chinese) 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治共识 (2008, 杭州) [J].中华消化杂志, 2008, 28 (8) :551-558.

[7]YANG LY.Dilemma and opportunity of surgery for portal hypertension in China[J].Chin J Dig Surg, 2016, 15 (7) :658-660. (in Chinese) 杨连粤.我国门静脉高压症外科的困境与机遇[J].中华消化外科杂志, 2016, 15 (7) :658-660.

[8]SHI KQ, FAN YC, PAN ZZ, et al.Transient elastography:a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease[J].Liver Int, 2013, 33 (1) :62-71.

[9]SPOREA I, RA爩IU I, SIRLI R, et al.Value of transient elastography for the prediction of variceal bleeding[J].World J Gastroenterol, 2011, 17 (17) :2206-2210.

[10]STEFANESCU H, GRIGORESCU M, LUPSOR M, et al.Spleen stiffness measurement using Fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients[J].J Gastroenterol Hepatol, 2011, 26 (1) :164-170.

[11]ZHANG DK, CHEN M, LIU Y, et al.Comparative study of acoustic radiation force impulse imaging and transient elastography on diagnosing liver fibrosis in patients with chronic hepatitis B[J].J Clin Ultrasound in Med, 2016, 18 (1) :21-24. (in Chinese) 张大鹍, 陈敏, 刘阳, 等.声脉冲辐射力成像与瞬时弹性成像诊断慢性乙型肝炎肝纤维化的对比研究[J].临床超声医学杂志, 2016, 18 (1) :21-24.

[12]FRIEDRICH-RUST M, NIERHOFF J, LUPSOR M, et al.Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis:a pooled meta-analysis[J].J Viral Hepat, 2012, 19 (2) :e212-e219.

[13]SALZL P, REIBERGER T, FERLITSCH M, et al.Evaluation of portal hypertension and varices by acoustic radiation force impulse imaging of the liver compared to transient elastography and AST to platelet ratio index[J].Ultraschall Med, 2014, 35 (6) :528-533.

[14]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.

[15]HONG W, HAN EH, LYU ZH, et al.Feasibility study of predicting esophageal varices in cirrhosis patients with spleen shear wave[J].J Clin Ultrasound in Med, 2013, 15 (12) :827-830. (in Chinese) 洪玮, 韩鄂辉, 吕志红, 等.脾脏剪切波速预测肝硬化患者食管静脉曲张的可行性研究[J].临床超声医学杂志, 2013, 15 (12) :827-830.

[16]BAO MW, LI HY, DONG CF, et al.Value of shear wave velocity of spleen in predicting esophageal varices of cirrhosis[J].J Clin Ultrasound in Med, 2015, 17 (3) :181-184. (in Chinese) 包明稳, 李汉英, 董常峰, 等.脾脏剪切波速预测肝硬化合并食管胃底静脉曲张的价值[J].临床超声医学杂志, 2015, 17 (3) :181-184.

施引文献

资源附件(0)

访问统计