超声造影评估脾脏动静脉血流对乙型肝炎肝硬化患者EGV破裂出血的诊断价值  

The value of contrast-enhanced ultrasonography evaluating splenic blood flow status in the diagnosis of EGVB in patients with hepatitis B related cirrhosis

作　　者：居峰 王栋 史玉民 朱艳红 黎美琳 王晓伟 姚上志 JU Feng;WANG Dong;SHI Yu-min;ZHU Yan-hong;LI Mei-lin;WANG Xiao-wei;YAO Shang-zhi(Department of Gastroenterology,Wuxi Fifth People′s Hospital,Jiangsu 214000,China)

机构地区：[1]无锡市第五人民医院消化科,江苏无锡214000

出　　处：《肝脏》2021年第11期1253-1256,共4页Chinese Hepatology

基　　金：无锡市科技发展项目(N2020X001)。

摘　　要：目的探讨超声造影评估脾脏动静脉血流对乙肝后肝硬化患者食管胃底静脉曲张(EGV)破裂出血的诊断价值。方法选取无锡市第五人民医院2019年4月至2020年4月收治的69例乙肝肝硬化EGV患者为研究对象,依据患者是否发生EGV破裂出血分为出血组(n=26)与非出血组(n=43)。两组患者入院后均在治疗前行超声造影检查,统计两组患者脾动脉阻力指数、脾动脉搏动指数、脾静脉直径、脾静脉平均流量、最小循环时间(MCT)、峰值增强时间(PET)。对比两组脾脏动静脉血流信息差异,并借助ROC分析MCT及PET诊断乙肝肝硬化EGV破裂出血的价值。结果两组脾动脉阻力指数、脾动脉搏动指数、脾静脉直径及脾静脉平均流量对比均有P>0.05;出血组MCT、PET显著高于非出血组,均有P<0.05。经ROC分析MCT、PET均可用于乙肝肝硬化患者EGV破裂出血的诊断,曲线下面积分别为0.775、0.866,且均有P<0.05。结论超声造影能够用于乙肝肝硬化患者EGV破裂出血的诊断,其中MCT>5.950 s、PET>12.270 s为诊断此类患者EGV破裂出血的最佳截断值,可为临床诊疗工作的开展提供帮助。Objective To investigate the value of splenic blood flow in diagnosing esophagogastric variceal bleeding(EGVB)in patients with hepatitis B virus(HBV)-related cirrhosis by contrast-enhanced ultrasonography(CEUS).Methods A total of 69 patients with HBV-related cirrhosis complicated by EGVB admitted to our hospital from April 2019 to April 2020 were included in the study.According to the occurrence of EGVB,the patients were divided into bleeding group(n=26)and non-bleeding group(n=43).After admission,CEUS was performed before treatment in both groups.Splenic artery resistance index,splenic artery pulsatility index,splenic vein diameter,mean splenic vein flow,minimum circulation time(MCT),and peak enhancement time(PET)were recorded.The difference of splenic blood flow between the 2 groups was compared,and the values of MCT and PET in the diagnosis of HBV-related cirrhosis complicated by EGVB were analyzed based on receiver operating characteristic(ROC)analysis.Results There was no significant difference in splenic artery resistance index,splenic artery pulsatility index,splenic vein diameter and splenic vein mean flow between the 2 groups(P>0.05).MCT and PET in the bleeding group were significantly higher than those in the non-bleeding group(P<0.05).Both MCT and PET could be used for the diagnosis of EGVB in patients with HBV-related cirrhosis based on ROC analysis.The areas under the curves were 0.775 and 0.866,respectively(P<0.05).Conclusion CEUS can be used in the diagnosis of EGVB in patients with HBV-related cirrhosis.MCT>5.950 s and PET>12.270 s are the best cutoff values for diagnosing EGVB in such patients,which is helpful to the clinical treatment.

关 键 词：乙型肝炎肝硬化 食管胃底静脉曲张破裂出血 超声造影 脾静脉 脾动脉 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]