超声预测肝硬化门脉高压食管胃静脉曲张破裂出血的研究

发布时间：2018-05-23 20:43

本文选题：超声 + 助显剂　；参考：《泰山医学院》2014年硕士论文

【摘要】：研究目的:观察肝硬化患者门、脾静脉内径、流速、流量,肝、脾动脉内径、阻力指数、搏动指数、门脉高压指数等参数的变化特点,并经腹胃充盈超声观察肝硬化食管胃壁厚度及曲张静脉的内径,探讨肝硬化门脉高压患者以上各参数与食管胃静脉曲张程度及破裂出血风险的关系,以期找出预测肝硬化门脉高压食管胃静脉曲张破裂出血的简单易行的方法。资料与方法:咸阳市中心医院传染科及消化内科2013年4月至2014年3月住院及门诊的肝硬化病人67例(均为乙肝后肝硬化),其中男性37例,女30例,年龄29~71岁,平均年龄47岁。根据有无食管静脉曲张破裂出血病史分为出血组35例(52.2%),患者有一次或多次食管静脉曲张破裂病史;未出血组32例(47.8%)。根据其食管静脉曲张程度又分为无、轻度、中度和重度四组。随机选择经临床、实验室及影像学检查无任何肝病的健康志愿者20例,其中男性10例,女10例,年龄18~35岁,平均年龄25岁。采用PHILIPS i U22超声诊断仪对所有受检者行腹部超声检查,经右肋缘下纵斜切扫查门静脉主干(PV)及肝右动脉(HA),测量点在主干距左、右分支1~2cm处;右侧卧位在左侧第9~11肋间靠近腋后线上脾门处扫查脾静脉(SV)及脾动脉(SA),测量点在距脾门0.5-1.0cm处测量。在平静呼吸状态下,分别测量门静脉内径(Dpv)、时间平均最大流速(Vpv)、血流量(Qpv),肝动脉内径(Dha)、收缩期流速(HAmax)、舒张期流速(HAmin)、阻力指数(HARI)、搏动指数(HAPI),脾静脉内径(Dsv)、时间平均最大流速(Vsv)、血流量(Qsv),脾动脉内径(Dsa)、收缩期流速(SAmax)、舒张期流速(SAmin)、阻力指数(SARI)、搏动指数(SAPI),以上参数均测量3次,取其平均值,并计算门脉高压指数(PHI)。然后患者饮胃肠造影剂500ml(湖州东亚产胃肠超声助显剂),患者右侧卧位,于腹部正中偏左显示腹主动脉,再显示食管下段及胃底,测量食管胃底壁厚度(Degw)及曲张静脉内径(Degv)。超声检查前了解肝硬化患者的肝功能、血常规及有无肝性脑病等情况。患者行超声检查之前或之后都要进行胃镜检查,按食管胃静脉曲张形态及出血危险程度分轻、中、重3级。应用SPSS13.0软件包进行统计分析,肝硬化组与正常对照组各测量参数的比较采用独立样本t检验,结果以均数±标准差(sx±)表示,各参数与胃镜曲张程度分级的相关性分析采用Spearman等级相关,各参数与超声所测食管胃静脉曲张程度的相关性分析采用Pearson相关,食管胃曲张静脉内径各等级划分的截断值及其敏感性和特异性运用受试者运筹特性曲线(ROC)求得,计数资料食管胃静脉曲张不同程度组的出血率比较采用卡方检验。结果:1.肝硬化患者组的Dpv、Qpv、Dsv、Qsv、Degw、Degv、Dha、HARI、HAPI、Dsa、SARI、SAPI、PHI等参数明显高于正常对照组,Vpv、HAmin明显低于正常对照组,而肝硬化患者组Vsv、HAmax、SAmax、SAmin等参数与正常对照组比较均无明显差异。2.肝硬化患者组Dpv、Dsv与胃镜分级间有弱相关性,Degw、Degv有明显相关性,而Vpv、Qpv、Vsv、Qsv、Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin、SARI、SAPI、Qsv/Qpv、PHI与胃镜分级间均无明显相关性。3.肝硬化患者组Dpv与Degv之间有弱相关性,Dsv、Degw与Degv之间有明显相关性,而Vpv、Qpv、Vsv、Qsv、Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin、SARI、SAPI、Qsv/Qpv、PHI与Degv之间均无明显相关性。4.根据内镜分度标准,将患者分为无、轻、中、重度四组,运用受试者运筹特性曲线(ROC)求出区分轻度与中度、中度与重度曲张静脉内径的截断值,以3.00mm和5.75mm分别作为划分的截断值,其敏感性和特异性分别为87.5%、91.7%和94.9%、89.3%。以超声截断值为标准将所有患者分为无、轻、中、重度四组,结果与内镜分度比较,得出超声诊断食管胃静脉曲张符合率分别为:66.7%、71.4%、78.6%、92.5%。5.肝硬化食管静脉曲张重度组患者出血发生率为72.5%,明显高于轻度及中度组。结论:1.肝硬化患者组的Dpv、Qpv、Dsv、Qsv、Degw、Degv、Dha、HARI、HAPI、Dsa、SARI、SAPI、PHI等参数可明显增大,Vpv、、HAmin两参数可明显降低,而肝硬化患者组Vsv、HAmax、SAmax、SAmin等参数无明显变化。肝硬化患者Degv与胃镜分级有明显相关性,Dpv、Dsv、Degw与Degv及胃镜分级间也有相关性。2.超声造影诊断食管胃静脉曲张时,以3.00mm和5.75mm分别作为划分轻度与中度、中度与重度曲张静脉内径的截断值,其敏感性和特异性分别为87.5%、91.7%和94.9%、89.3%。3.经腹胃充盈超声造影诊断食管胃静脉曲张总体符合率为:85.1%。对于重度食管胃静脉曲张的诊断准确率更是高达92.5%,重度组的出血率明显高于其他两组,达到72.5%,故经腹胃充盈超声造影对预测食管胃静脉曲张破裂出血有一定的临床价值,并可减少上消化道内镜的检查,值得临床推广应用。
[Abstract]:Objective: To observe the changes of the diameter, flow rate, flow rate, internal diameter of the liver, splenic artery, resistance index, pulsatile index and portal hypertension index, and to observe the thickness of the esophageal and gastric wall and the internal diameter of the varicose veins in the liver cirrhosis. The relationship between the degree of varicosity and the risk of rupture and hemorrhage in order to find out the simple and easy way to predict the bleeding of esophageal and gastric varices in the portal hypertension. Data and methods: 67 cases of liver cirrhosis in the hospital of Xianyang Central Hospital and the Department of gastroenterology from April 2013 to March 2014 (all are post hepatitis B cirrhosis). There were 37 males and 30 females, aged 29~71 years, with an average age of 47 years old. According to the history of bleeding bleeding from esophageal varices, the bleeding group was divided into 35 cases (52.2%), the patient had a history of one or more esophageal varices rupture, 32 cases in the non bleeding group (47.8%). According to the degree of esophageal varices, the patients were divided into no, mild, moderate, and severe four groups. 20 healthy volunteers, including 10 males and 10 females, aged 18~35, with an average age of 25 years old, were selected by clinical, laboratory and imaging examination without any liver disease. All the subjects were examined by PHILIPS I U22 ultrasonic diagnostic apparatus, and the measured points were measured in the right rib of the portal vein (PV) and the right hepatic artery (HA) through the right rib margin. The trunk was located at the left and right branches at 1~2cm, and the right lateral position was detected in the splenic vein (SV) and the splenic artery (SA) at the splenic portal near the axillary line at the left 9~11 intercostal intercostal line. The measurement points were measured at the 0.5-1.0cm of the splenic portal. In the quiet breathing state, the portal vein diameter (Dpv), the time average maximum velocity (Vpv), the blood flow (Qpv), the hepatic artery diameter (Dha), and the contraction were measured. Phase flow velocity (HAmax), diastolic velocity (HAmin), resistance index (HARI), pulsatile index (HAPI), spleen vein diameter (Dsv), time average maximum velocity (Vsv), blood flow (Qsv), spleen artery diameter (Dsa), systolic flow velocity (SAmax), diastolic velocity (SAmin), resistance index (SARI), pulsatile index (SAPI)), the above parameters were measured 3 times, and the mean value was taken, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was measured, and the mean value was taken, and the mean value was taken, and the mean value was taken, and the mean value was taken and counted The patient drank the portal hypertension index (PHI). Then the patient drank the gastrointestinal contrast agent 500ml (Huzhou East Asian gastrointestinal ultrasound AIDS), the right lateral position of the patient, the abdominal aorta in the middle of the abdomen, the lower esophagus and the fundus of the stomach, the thickness of the gastric fundus wall (Degw) and the variceal diameter (Degv). The liver function of the patients with liver cirrhosis before ultrasonic examination was understood. The patients had to undergo gastroscopy before or after ultrasound examination. According to the esophageal and gastric varices and the risk of bleeding, the patients were divided into 3 grades. The SPSS13.0 software package was used for statistical analysis. The independent sample t test was used for the comparison of the measured parameters of the liver cirrhosis group and the normal control group. Results the correlation analysis between the parameters and the degree of gastroscope varicosity was related to the correlation analysis between the parameters and the degree of gastroscope varicosity (SX +). The correlation between the parameters and the degree of esophageal gastric varices measured by ultrasound was related to the correlation of Pearson, the truncated values of each grade of the internal diameter of the esophagogastric varicose veins, and the sensitivity and specific use of the esophagogastric varicose veins. The bleeding rate of different degree group of esophageal and gastric varices in counting data was compared with chi square test. Results: the parameters of Dpv, Qpv, Dsv, Qsv, Degw, Degv, Dha, HARI, HAPI, Dsa, SARI, Qpv in the 1. cirrhosis patients were significantly higher than those in the normal control group, and the liver cirrhosis patients were significantly lower than those of the normal control group. The parameters of Vsv, HAmax, SAmax, SAmin were not significantly different from those in the normal control group, and there was no significant correlation between the Dpv in the patients with.2. liver cirrhosis, and there was a weak correlation between the Dsv and the gastroscopy. There is a weak correlation between Dpv and Degv, and there is a significant correlation between Dsv, Degw and Degv, while Vpv, Qpv, Vsv, Qsv, Dha, HAmax, there are no obvious correlations between them. The patients are divided into no, light, medium, and severe groups according to the standard of endoscopy. ROC was used to distinguish between mild and moderate, moderate to severe varicose veins, with 3.00mm and 5.75mm as truncated values respectively. The sensitivity and specificity were 87.5%, 91.7% and 94.9% respectively. 89.3%. was divided into four groups: No, light, medium, severe, and the results were compared with the endoscopy, and the results were compared with the endoscopy. The coincidence rate of ultrasonic diagnosis of esophageal and gastric varices was 66.7%, 71.4%, 78.6%, and the incidence of hemorrhage in the severe esophageal varices of 92.5%.5. cirrhosis was 72.5%, which was significantly higher than that of the mild and moderate groups. Conclusion: 1. liver cirrhosis patients' Dpv, Qpv, Dsv, Qsv, Degw, Degv, Dha, HARI, HAPI, Dsa, SARI, etc. The two parameters could be significantly reduced, while the parameters of Vsv, HAmax, SAmax, and SAmin were not significantly changed in the patients with liver cirrhosis. There was a significant correlation between Degv and gastroscope classification in the patients with liver cirrhosis. Dpv, Dsv, Degw and Degv and gastroscopy were also associated with.2. ultrasonography in the diagnosis of esophageal and gastric varices, and 3.00mm and 5.75mm were used as mild and moderate respectively. The sensitivity and specificity of degrees and severe varicose veins were 87.5%, 91.7% and 94.9% respectively. The total coincidence rate of 89.3%.3. for the diagnosis of esophagogastric varices was as high as 92.5% for severe esophageal varices, and the bleeding rate in severe group was significantly higher than that of the other two groups. It is 72.5%, so it has certain clinical value to predict esophageal and gastric variceal bleeding, and can reduce the examination of upper gastrointestinal endoscopy. It is worthy of clinical application.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R445.1

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