剪切波速度评估TIPS术疗效及预测食管静脉曲张出血风险的临床研究

发布时间：2018-05-10 10:43

本文选题：经颈静脉肝内门-体分流术 + 门静脉高压　；参考：《重庆医科大学》2014年硕士论文

【摘要】：第一部分剪切波速度无创评估TIPS分流术疗效的临床研究目的应用声触诊组织量化(virtual touch tissue quantification，VTQ)技术测量肝脏剪切波速度(liver shear wave speed，LSWS)值和脾脏剪切波速度(spleen shear wave speed，SSWS)值，探讨该技术无创评估经颈静脉肝内门-体（Transjugular Intrahepatic Portosystemic Shunt，TIPS）分流术术后疗效的可行性。方法应用VTQ技术对20例健康志愿者和24例肝硬化门静脉高压预行TIPS分流术患者进行LSWS值和SSWS值的测量；并于手术同时测量门静脉压力（Portal vein pressure Gradient，PPG）；比较手术前、后LSWS值和SSWS值的变化以及变化趋势，并分析两者与门静脉压力的相关性；同时对14例患者进行术后1个月的随访。结果PPG在TIPS分流术前、后的差异有统计学意义（P 0.001）；LSWS值和SSWS值在正常对照组与TIPS分流术组间的差异均有统计学意义（P均0.001）；TIPS分流术前、后的LSWS值比较差异没有统计学意义（P=0.130），但是SSWS值比较差异有显著的统计学意义（P0.001）。14例随访患者的LSWS值在术前、术后1w、术后1m中两两比较差异均无统计学意义（P均0.05）；而SSWS值两两比较差异均有统计学意义（P均0.05）。Spearman秩相关分析显示，LSWS值与PPG无相关性（r=0.154，P=0.296），而SSWS值与PPG呈高度正相关（r=0.602，P0.001）。结论VTQ技术测量的SSWS值可作为无创评估门静脉压力的有效指标，定量监测术后门静脉压力的变化，进而评估其手术疗效；但目前还未发现LSWS值可以用于评估其手术疗效。第二部分剪切波速度无创预测肝硬化食管静脉曲张出血风险的临床研究目的应用声触诊组织量化(virtual touch tissue quantification，VTQ)技术测量肝脏剪切波速度(liver shear wave speed，，LSWS)值和脾脏剪切波速度(spleen shear wave speed，SSWS)值，并探讨LSWS值和SSWS值无创预测食管静脉曲张破裂出血(Esophageal Variceal Bleeding，EVB)风险的临床价值。方法应用VTQ技术对99例受试者分别测量LSWS值及SSWS值,包括30例健康志愿者(对照组)、69例临床诊断的乙型肝炎肝硬化患者且经过胃镜证实都患有不同程度的食管静脉曲张(其中有食管静脉曲张破裂出血的36例，无出血的33例)；检查肝生化指标；将各组所得的LSWS值及SSWS值进行比较,并分析LSWS、SSWS值与食管静脉曲张出血风险的关系。结果LSWS值和SSWS值在正常对照组和非出血组间的差异均有统计学意义（P均0.001）。出血组与非出血组间的LSWS值比较差异无统计学意义(P=0.158)，LSWS值与EVB风险无相关性(P=0.164)；但是SSWS值在两组间比较差异有统计学意义(P0.001),且SSWS值与EVB风险呈显著相关，相关系数r=0.73（P0.05）。SSWS值诊断肝硬化食管静脉曲张破裂出血风险的临界值为3.54m/s时，灵敏度、特异度分别为81.3%、84.6%， AUROC (area under receiver operatingcharacteristic curve)为0.894。结论声触诊组织量化技术测量的SSWS值可无创预测肝硬化患者食管静脉曲张破裂出血的风险，但还未发现LSWS值与食管静脉曲张破裂出血的风险有相关性。
[Abstract]:Part one clinical study of the effect of shear wave velocity on noninvasive evaluation of TIPS shunt
Objective to measure the value of the liver shear wave velocity (liver shear wave speed, LSWS) and the splenic shear wave velocity (spleen shear) by virtual touch tissue quantification (VTQ). S) the feasibility of the curative effect after the shunt.
Methods the LSWS and SSWS values of 20 healthy volunteers and 24 patients with cirrhosis of the portal hypertension were measured by VTQ technique, and the portal vein pressure (Portal vein pressure Gradient, PPG) was measured at the same time, and the changes and trends of the value and LSWS value and SSWS value before the operation were compared, and the two were analyzed and analyzed. The correlation of venous pressure was observed, and 14 patients were followed up for 1 months after operation.
Results the difference between PPG and TIPS was statistically significant (P 0.001), and the difference between LSWS and SSWS was statistically significant (P 0.001) between the normal control group and the TIPS shunt group (P all), and there was no statistical significance (P= 0.130) before TIPS shunt (P= 0.130), but there was significant difference between the SSWS value (P). 0.001) the LSWS value of.14 follow-up patients was not statistically significant before operation, 1W after operation and 22 in 1m after operation (P 0.05), while SSWS value 22 was statistically significant (P 0.05).Spearman rank correlation analysis showed that LSWS value was not correlated with PPG (r= 0.154, P=0.296).
Conclusion the SSWS value measured by VTQ can be used as an effective index for noninvasive assessment of portal pressure. The changes of portal vein pressure after the operation are monitored and the effect of the operation is evaluated. However, the LSWS value has not been found to be used to evaluate the effect of the operation.
The second part is a noninvasive prediction of esophageal variceal bleeding risk of cirrhosis with shear wave velocity.
Objective to measure the liver shear wave velocity (liver shear wave speed, LSWS) and splenic shear wave velocity (spleen shear) by virtual touch tissue quantification (VTQ), and to explore the value and non invasive prediction of esophageal variceal bleeding. The clinical value of risk.
Methods VTQ technique was used to measure the value of LSWS and SSWS in 99 subjects, including 30 healthy volunteers (control group), 69 cases of hepatitis B liver cirrhosis, and 69 cases with different degrees of esophageal varices (including 36 cases of esophageal varices bleeding, 33 cases without bleeding). The LSWS value and SSWS value of each group were compared, and the relationship between LSWS and SSWS value and the risk of esophageal varices bleeding was analyzed.
Results there was significant difference between the LSWS value and the SSWS value between the normal control group and the non hemorrhagic group (P 0.001). There was no significant difference in the LSWS value between the bleeding group and the non hemorrhagic group (P=0.158), and the LSWS value was not correlated with the EVB risk (P=0.164), but the SSWS values were statistically significant between the two groups (P0.001), and the SSWS value was compared with E. The risk of VB was significantly correlated. The critical value of the correlation coefficient r=0.73 (P0.05).SSWS value in diagnosing the risk of esophageal variceal bleeding was 3.54m/s, and the sensitivity was 81.3%, 84.6%, AUROC (area under receiver operatingcharacteristic curve) was 0.894..
Conclusion the SSWS value measured by acoustic palpation tissue quantification technique can not predict the risk of esophageal variceal bleeding in patients with cirrhosis, but there is no correlation between the risk of LSWS and the risk of bleeding of esophageal varices.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R654.3

【参考文献】