无创检查参数对肝硬化严重食管静脉曲张的诊断价值  

Diagnostic values of noninvasive parameters in liver cirrhosis with severe esophageal varices

作　　者：许晓勇[1] 张超学[1] 时晨[1] 许建明[1] 

机构地区：[1]安徽医科大学第一附属医院消化科,合肥230022

出　　处：《中华消化杂志》2015年第12期825-829,共5页Chinese Journal of Digestion

基　　金：国家自然科学基金面上项目（81070337）

摘　　要：目的分析超声参数和血生物化学因子与食管静脉曲张（EV）程度的关系，探讨其诊断严重EV的价值。方法连续收集各种病因的肝硬化住院患者102例，所有患者均行胃镜检查明确EV的存在和程度，分为中／重度EV组78例，无／轻度EV组24例。采用多普勒超声和超声造影方法检测门静脉充血指数（PV-CI）、肝静脉减振指数（HV-DI）、肝静脉到达时间（HVAT）和肝内循环时间（IHCT），并同时采用ELISA法检测外周血血管性血友病因子（vWF）抗原和可溶性白细胞分化抗原163（sCDl63）水平。采用独立样本t检验或Mann-Whitney秩和检验方法分析比较两组间上述指标的差异，并通过绘制ROC曲线计算相关指标预测EV程度的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确度。结果中／重度EV组PV-CI、HV-DI、外周血vWF抗原和sCD163水平均显著高于无／轻度EV组[0．11（0．05）cm·s比0．07（0．03）cm·s、0．72±0．11比0．52±0．12、1824．00（558．00）U／L比1533．80（311．50）U／L、（72．57±10．94）μg／L比（57．91±10．40）μg／L，Z=-4．949，t=-7．759，Z=-5．420，t=-5．804，P均〈0．05]，而HVAT和IHCT则明显短于无／轻度EV组L17．00（4．25）S比27．78（6．75）S、（6．62±1．85）S比（9．33±2．26）s，Z=-3．822，t=5．820，P均d0．05]。ROC曲线分析显示HV—DI、vWF抗原和sCDl63预测中／重度EV的AUC值均〉0．8，取相应截断值0．64、1693．80U／L和63．98μg／L，敏感度均〉75％，PPV均〉90％，诊断准确度均〉80％。结论HV—DI、外周血vwF抗原和sCDl63作为无创指标能够较好地预测严重EV的存在，有助于尽早发现这类高危患者，及时干预，防止出血。Objective To analyze the correlation between Doppler ultrasound parameters, blood biochemical indexes and the severity of esophageal variees （EV）, and to explore the values of them in the diagnosis of severe EV. Methods A total of 102 hospitalized patients with liver cirrhosis was consecutively collected. All patients underwent endoscopic examination to determine the presence and severity of EV, then they were divided into moderate/severe EV group （n= 78） and non/mild EV group （n=24）. Congestion index of the portal vein （PV-C1）, damping index of hepatic vein（HV-DI）, hepatic vein arrival time（HVAT） and intrahepatic circulatory time （IHCT） were measured by Doppler ultrasound and contrast-enhanced ultrasound. And at same time, the level of yon Willebrand factor antigen （vWF- Ag） and soluble CD163 （sCD163） in peripheral blood were detected by enzyme linked immunosorbent assay （ELISA） method. The differences of these parameters between two groups were compared by independent samples t-test or Mann-Whitney rank sum test. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and diagnostic accuracy （DA） of related parameters in the prediction of EV were calculated according to receiver operating characteristic （ROC） curve. Results Ultrasound parameters PV-CI, HV-DI and peripheral blood vWF-Ag, sCD163 levels of moderate/severe EV group were all significantly higher than those of none/mild EV group 0.11（0.05） cm s vs 0.07（0.03） cm s; 0.72±0.11 vs 0.52±0. 12; 1 824.00（558.00） U/L vs 1 533.80（311. 50） U/L; （72.57±10.94） μg/L vs （57.91±10.40） μg/L; Z=-4. 949, t= -7. 759, Z= -5. 420, t= -5. 804, all P（0.05）. However HVAT and IHCT were significantly shorter than those of non/mild EV group （17.00（4.25） s vs 27.78（6.75） s; （6. 62±1. 85） svs （9.33±2.26） s, Z=-3.822, t=5.820, both P（0.05）. ROC curve analysis showed that the areas under the ROC curve of HV-DI, vWF-Ag and sCD163

关 键 词：超声检查 超声造影 食管和胃静脉曲张 肝硬化 von WILLEBRAND因子 可溶性CD163 

分 类 号：R575.2[医药卫生—消化系统]