内镜超声检查术对食管静脉曲张出血风险的预测价值  

Value of endoscopic ultrasonography for risk assessment in esophageal varices bleeding

作　　者：李爽[1] 张德发[2] 陆伟[1] 胡东胜[2] 李嘉[2] 文君[2] 郭小苓[2] 岳晓粉[2] 姬向军 周国强[2] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第二人民医院内镜诊疗科

出　　处：《中华消化内镜杂志》2017年第12期887-891,共5页Chinese Journal of Digestive Endoscopy

基　　金：天津市卫计委科技基金（2015KR18）

摘　　要：目的通过研究食管静脉曲张（EV）患者内镜超声检查术（EUS）下食管侧枝静脉（ECV）、门静脉（PV）主干及主要属支的表现与EV出血的关系，评估EUS对EV出血的预测价值。方法采用回顾性队列研究，以114例中、重度EV患者为研究对象，通过EUS测量并描述ECV等级，同时测量PV、奇静脉（AIV）及脾静脉（SV）直径，以首次内镜超声检查时间为起点，随访期1年，以发生EV出血或随访结束为终点，评价ECV曲张程度等级及PV、AIV、SV对EV出血的预测价值。结果单因素Cox回归分析显示重度食管周围侧枝静脉（peri-ECV）曲张比轻度更易发生出血（HR=4．081，95％CI：1．833～9．086，P=0．001）；重度食管旁侧枝静脉（para—ECV）曲张比轻度更易发生出血（HR=4．042，95％CI：1．814～9．005，P=0．001）。多因素Cox回顾分析显示ECV等级是EV出血的有效预测因素，当peri-ECV和para—ECV呈重度曲张表现时，EV出血风险分别是轻度的3．8313倍（P=0．0043）和3．493倍（P=0．0031）。PV、AIV、SV的直径对EV出血有预测价值，PV直径ROC曲线下面积：0．959（P〈0．001）；AIV直径ROC曲线下面积=0．958（P〈0．001）；SV直径ROC曲线下面积0．830（P〈0．001）。此外，当PV直径〉13．65mm（灵敏度=0．94，特异度=0．84）、AIV直径〉8．65mm（灵敏度=0．94，特异度=0．89）、SV直径〉9．45mm（灵敏度=0．90，特异度=0.67）时EV出血风险显著增加。结论EUS有助于预测中、重度食管静脉曲张出血的风险，而重度ECV、Pv、AIV、SV曲张可作为预测EV出血风险的指标。Objective To assess the predictive value of endoscopic uhrasonography （EUS） for esophageal variees （EV） bleeding by studying the relationship between esophageal collateral veins （ECV）, portal vein （PV） trunk with its main branches and EV bleeding. Methods A retrospective cohort study of 114 cases of moderate and severe EV was conducted. The ECV level was determined through EUS. At the same time, diameters of PV, azygos vein （AIV） and spleen vein （SV） were measured through EUS. The predictive value of ECV level and diameters of PV, AIV, SV for EV bleeding were assessed during the 1- year follow-up, which started from the first EUS examination to EV bleeding or the end of follow-up. Results Single factor Cox regression analysis showed severe peri-ECV varices had higher risk than mild in EV bleeding（ HR = 4.081,95% CI：I. 833-9. 086, P = 0. 001 ） ; severe para-ECV varices had higher risk than mild in EV bleeding （ HR = 4. 042, 95% CI： 1. 814-9. 005, P = 0. 001 ）. Muhivariable Cox retrospective analysis showed ECV level was an effective predictor for EV bleeding, when the peri-ECV and para-ECV were severe varices, EV bleeding risk increased to 3. 831 3 （P = 0. 004 3 ） and 3.493 3 （P = 0. 003 1 ） times compared with mild respectively. Diameters of PV, AIV and SV could predict EV bleeding（ PV AUC = 0. 959,P〈0. 001 ;AIV AUC=0. 958,P〈0. 001 ;SV AUC = 0. 830,P〈0. 001 ） .In addition, when diameter of PV〉 13.65 mm （ sensitivity = 0. 94, specificity = 0. 84）, AIV 〉 8.65 mm（ sensitivity = 0. 94, specificity = 0. 89）, SV〉 9. 45 mm （ sensitivity = 0. 90, specificity = 0. 67）, EV bleeding risk increased significantly. Conclusion EUS is helpful to predict the risk of moderate and severe EV bleeding, and severe varices of ECV, PV, AIV, and SV can be used as indicators to predict risk of EV bleeding.

关 键 词：超声检查 食管和胃静脉曲张 出血 门脉高压 

分 类 号：R575.2[医药卫生—消化系统]