超声图预测肝硬化患者食管静脉曲张程度  

Ultrasonographic prediction of esophageal varices in patients with liver cirrhosis

作　　者：张晓红[1] 张宇锋[1] 宁方芹[2] 杨绍基[1] 

机构地区：[1]中山大学第三附属医院传染病科,广东省广州市510630 [2]中山大学第三附属医院科研科,广东省广州市510630

出　　处：《世界华人消化杂志》2004年第4期911-913,共3页World Chinese Journal of Digestology

摘　　要：目的:筛选有意义的超声检查指标,结合Child-Pugh分级对中度以上食管静脉曲张的肝硬化患者进行预测,探讨超声检查预测肝硬化患者食管静脉曲张程度的价值. 方法:将所有病例按Child-Pugh评分分级,进行超声及胃镜检查,用Spearman等级相关分析筛选出与食管静脉曲张程度相关并且对其判断贡献较大的指标,建立Logistic 回归方程. 结果:食管静脉曲张程度与Child-Pugh分级呈正相关(r=0.39, P<0.01),Child-Pugh C级患者中度以上食管静脉曲张占93.3%.对Child-Pugh A级患者,判断食管静脉曲张程度贡献较大的指标是PUV,Logistic回归方程:P(A)=1/[1+e-(- 0.405+1.686PUV],其判断准确率为68.0%,敏感性为60.0%, 特异性为78.3%.对Child-Pugh B级患者判断食管静脉曲张程度贡献较大的指标有PVD,PUV,GBBL和AS,Logistic 回归方程:P(B)=1/[1+e-(-19.554+9.295AS-2.757PUV-4.278GBBL+1.288PVD)], 其判断准确率为92.7%,敏感性为96.8%,特异性为80.0%. 结论:Child-Pugh c级肝硬化患者绝大部分有中度以上的食管静脉曲张;以超声检查指标建立的回归方程对Child- Pugh A,B级患者中度以上的食管静脉曲张判断符合率较高,可以用于肝硬化患者食管静脉曲张程度的预测.AIM: To study the value of ultrasonographic prediction of the esophageal varices in patients with liver cirrhosis. METHODS: All 207 cases were examined by ultrasonography and endoscopy, and classified according to the Child-Pugh score. The valuable ultrasonographic variables were selected to form regression formulae to predict the esophageal varices degrees in patients with liver cirrhosis. RESULTS: The esophageal varices degree was correlated with Child-Pugh classification (r=0.39, P<0.01). In class Child-Pugh C, about 93.3% of patients had over medium degree of esophageal varices. The Logistic formula (P(B)=1/ [1+e-(-19.554+9.295AS-2.757PUV-4.278GBBL+1.288PVD)] might predict child- Pugh B, and the diagnostic accuracy was 92.7%. The Logistic formula (P(A)=1/[1+e-(-0.405+1.686PUV)] might predict Child-Pugh A, and the diagnostic accuracy was 68.0%. CONCLUSION: A majority of patients in class Child-Pugh C has over moderate esophageal varices, therefore all patients in this class should be examined by endoscopy. But patients in classes Child-Pugh B and A should be examined by ultrasonography first, and for high risk patients, endoscopy should be carried out.

关 键 词：超声图 肝硬化 食管静脉曲张 胃镜检查 

分 类 号：R575.2[医药卫生—消化系统] R445.1[医药卫生—内科学]