聲觸診組織量化技術(shù)在預(yù)測肝硬化食管靜脈曲張發(fā)生風(fēng)險中的價值
發(fā)布時間：2018-08-09 15:19
【摘要】：研究背景食管靜脈曲張(Esophageal varices,EV)是肝硬化門脈高壓引起的重要并發(fā)癥,也是臨床上最常見的消化道靜脈曲張。臨床上常因出現(xiàn)急性消化道靜脈曲張破裂出血才得以確診。內(nèi)鏡檢查仍是目前診斷上消化道靜脈曲張及其出血的金標(biāo)準(zhǔn)。2007年美國肝病學(xué)會“肝硬化胃食管靜脈曲張及出血診治指南”及2009年中華醫(yī)學(xué)會消化內(nèi)鏡學(xué)分會“消化道靜脈曲張及出血的內(nèi)鏡診斷和治療規(guī)范試行方案”中均提出:對于所有來診肝硬化患者需盡早進(jìn)行消化道內(nèi)鏡檢查,以便篩查和確認(rèn)需要預(yù)防性治療的患者。然而,其中高風(fēng)險食管靜脈曲張患者只占15-25%,大多數(shù)患者未見靜脈曲張或只有輕度靜脈曲張但無需預(yù)防性治療。因此,能夠應(yīng)用非侵入性方法早期診斷和評估肝硬化患者的EV及其程度,可使大部分患者有效地避免不必要的侵入性上消化道內(nèi)鏡檢查,特別是針對于低風(fēng)險的肝硬化患者群。此領(lǐng)域研究是目前國內(nèi)外的研究熱點。聲脈沖輻射力成像(Acoustic Radiation Force Impulse,ARFI)是無創(chuàng)評估組織硬度的超聲彈性成像技術(shù),其借助聲觸診組織量化(Virtual touch tissue quantification,VTQ)功能,測量聲速經(jīng)過組織的剪切波速度(Shear wave velocity,SWV),進(jìn)而定量評估組織彈性及硬度變化。近年來,VTQ技術(shù)作為評估肝纖維化的無創(chuàng)性超聲彈性成像方法備受國內(nèi)外關(guān)注,2016年的美國肝病學(xué)會“肝硬化門脈高壓出血的風(fēng)險分層、診斷和管理實踐指導(dǎo)”上把肝硬度(liver stiffness,LS)作為無創(chuàng)性監(jiān)測臨床顯著性門靜脈高壓(clinically significant portal hypertension,CSPH)的重要指標(biāo)之一。另一方面,國內(nèi)外學(xué)者通過分別測定LS、脾硬度(spleen stiffness,SS)及脾臟長徑等參數(shù)研究VTQ技術(shù)在預(yù)測和評估EV及出血(Esophageal variceal bleeding,EVB)的診斷價值,具有一定的臨床應(yīng)用前景,但大多數(shù)研究結(jié)果不能同時獲得滿意的靈敏度和特異度。本研究利用VTQ等多種超聲診斷新技術(shù),通過多種客觀參數(shù)的系統(tǒng)檢測試圖探尋影響肝硬化EV發(fā)生的獨立危險因素,并評估經(jīng)ROC曲線分析獲得的最佳臨界值在預(yù)測肝硬化EV中的臨床診斷價值,目前國內(nèi)未見系統(tǒng)的研究報道。目的本研究應(yīng)用二維超聲及VTQ技術(shù)無創(chuàng)檢測肝硬化患者的肝臟和脾臟的SWV值、肝門靜脈及脾靜脈的內(nèi)徑和血流速度,分析影響肝硬化EV發(fā)生的獨立危險因素;探討兩種超聲技術(shù)手段在肝硬化EV發(fā)生風(fēng)險中的診斷效能及臨床價值;并利用受試者工作特征曲線(Receiver operator characteristic curve,ROC)曲線為臨床提供無創(chuàng)監(jiān)測肝硬化EV的最佳臨界值。方法本研究中的患者均符合《慢性乙型肝炎防治指南》(2015版)中肝硬化的診斷標(biāo)準(zhǔn),共154例,男95例,女59例,年齡29-80歲,平均年齡55±10歲。所有入選患者均行上消化道內(nèi)鏡檢查,并根據(jù)其結(jié)果進(jìn)行分組:其中52例未發(fā)生EV歸為無靜脈曲張組(No esophageal varices,NEV組,n=52),102例存在EV歸為靜脈曲張組(EV組,n=102)。記錄每位被檢者的性別、年齡、身高及體重,并計算BMI。所有被檢者嚴(yán)格空腹8小時以上,取靜脈血用于檢測肝功能及凝血常規(guī)。采用Siemens Acuson S2000型超聲診斷儀(配備VTQ軟件)行超聲檢查。所有被檢者嚴(yán)格空腹8小時以上,平臥于檢查床上,充分暴露腹部。首先對每一個被檢者行常規(guī)超聲檢查,觀察肝臟和脾臟的輪廓及實質(zhì)回聲,測量右肝斜徑、脾臟厚徑、脾臟長徑、肝門靜脈和脾靜脈的內(nèi)徑及血流速度。然后,啟動ARFI技術(shù)中VTQ模式,測量所有實驗對象的肝臟和脾臟的SWV值。采用SPSS22.0統(tǒng)計學(xué)軟件對實驗數(shù)據(jù)進(jìn)行獨立樣本t檢驗或卡方檢驗;應(yīng)用Logistic回歸分析篩選影響EV發(fā)生的獨立危險因素;繪制ROC曲線并計算最佳臨界值。采用Med Calc醫(yī)學(xué)統(tǒng)計軟件中的De Long檢驗進(jìn)行曲線下面積(Area under the curve,AUC)之間的比較。結(jié)果1、EV組與NEV組各參數(shù)的比較(1)臨床資料及肝功能分級的比較EV組的肝功能Child Pugh分級明顯高于NEV組,具有統(tǒng)計學(xué)差異(P0.05);兩組患者的年齡、性別和BMI未見明顯統(tǒng)計學(xué)差異(P0.05)。(2)二維及頻譜多普勒超聲參數(shù)的比較EV組的肝門靜脈和脾靜脈內(nèi)徑明顯大于NEV組,具有統(tǒng)計學(xué)差異(P0.05);EV組的肝門靜脈及脾靜脈的血流速度明顯低于NEV組,具有統(tǒng)計學(xué)差異(P0.05)。(3)SWV值的比較EV組的肝臟和脾臟的SWV值明顯高于NEV組,具有統(tǒng)計學(xué)差異(P0.05)。2、Logistic回歸分析篩查影響EV的獨立危險因素Logistic回歸分析結(jié)果顯示肝門靜脈內(nèi)徑、肝臟及脾臟SWV值為預(yù)測EV發(fā)生的獨立危險因素,其OR值分別為2.396、1.007和1.005(P0.05)。3、二維超聲和VTQ技術(shù)在無創(chuàng)評估肝硬化EV發(fā)生風(fēng)險中的診斷效能及臨床價值繪制影響肝硬化EV的獨立危險因素即肝門靜脈內(nèi)徑、肝臟及脾臟SWV值的ROC曲線,其AUC分別為0.88(95%CI:0.824-0.936)、0.911(95%CI:0.866-0.957)和0.908(95%CI:0.863-0.953);采用Youden指數(shù)最大切點為臨界點確定其最佳臨界值,分別為14.05mm、2.013m/s和2.937m/s;靈敏度分別為73.6%、82.4%和79.6%;特異度分別為87.1%、90.3%和87.6%;陽性預(yù)測值分別為75%、80.8%和75%;陰性預(yù)測值分別為86.3%、91.2%和90.2%;準(zhǔn)確度分別為82.5%、87.7%和85.1%。結(jié)論1、肝功能分級、肝門靜脈和脾靜脈的內(nèi)徑及血流速度以及肝臟和脾臟的SWV值在判斷EV是否發(fā)生中起到一定的輔助作用。2、肝門靜脈內(nèi)徑、肝臟和脾臟SWV值為預(yù)測EV發(fā)生的獨立危險因素。3、經(jīng)ROC曲線分析,肝門靜脈內(nèi)徑、肝臟和脾臟SWV值在評估肝硬化EV發(fā)生風(fēng)險中具有較好的診斷效能,尤其是肝臟SWV值具有一定的優(yōu)勢。提示二維超聲和VTQ技術(shù)有望成為無創(chuàng)、簡便、動態(tài)、客觀評價肝硬化EV發(fā)生風(fēng)險的有效指標(biāo)。
[Abstract]:Background Esophageal varices (EV) is an important complication caused by portal hypertension in liver cirrhosis and the most common digestive tract varicose in the clinic. The diagnosis of acute gastrointestinal variceal bleeding is often found. Endoscopy is still the gold diagnosis of upper gastrointestinal varicosity and bleeding. Standard.2007 guidelines for the diagnosis and treatment of gastroesophageal varices and bleeding in cirrhosis of the liver disease society of the United States of America and the "trial plan for endoscopic diagnosis and treatment of digestive tract varices and bleeding" at the Chinese Medical Association's digestive endoscopy branch, 2009, all require early gastrointestinal endoscopy for all patients with cirrhosis of the liver, Screening and identifying patients requiring prophylactic treatment. However, only 15-25% of patients with high risk esophageal varices, most patients have no varicose or only mild varicosity but no preventive treatment. Therefore, the early diagnosis and evaluation of EV and its degree in patients with liver cirrhosis can be made by non invasive methods. Patients can effectively avoid unnecessary invasive upper gastrointestinal endoscopy, especially for patients with low risk of cirrhosis. Research in this field is a hot spot at home and abroad. Acoustic Radiation Force Impulse (ARFI) is a noninvasive ultrasonic elastic imaging technique for evaluating the hardness of the group fabric with the aid of sound contact. Virtual touch tissue quantification (VTQ) function, measuring sound velocity through tissue shear wave velocity (Shear wave velocity, SWV), and then quantifying the changes of tissue elasticity and hardness. In recent years, VTQ technology as a noninvasive hyper elastic imaging method for evaluating liver fibrosis has attracted much attention at home and abroad, in 2016, American Liver Liver stiffness (LS) is regarded as one of the important indicators of clinically significant portal hypertension (CSPH) for noninvasive monitoring of clinical significant portal hypertension (CSPH). On the other hand, domestic and foreign scholars have measured LS and splenic hard, on the other hand. Spleen stiffness (SS) and spleen length diameter and other parameters study VTQ technology to predict and evaluate the value of EV and hemorrhage (Esophageal variceal bleeding, EVB), and has a certain clinical application prospects, but most of the results can not obtain satisfactory sensitivity and specificity at the same time. This study uses a variety of new ultrasonic diagnostic techniques such as VTQ, etc., In order to explore the independent risk factors affecting the occurrence of cirrhosis EV by systematic detection of various objective parameters, and evaluate the clinical diagnostic value of the best critical value obtained by ROC curve analysis in predicting the EV of liver cirrhosis, there is no systematic study in China at present. The purpose of this study should be non-invasive detection of cirrhosis by two-dimensional ultrasound and VTQ technique. The SWV value of the liver and spleen, the internal diameter of the hepatic portal vein and the splenic vein, the internal diameter and blood flow velocity of the hepatic portal and splenic vein, analyzed the independent risk factors affecting the occurrence of EV in the liver cirrhosis, and discussed the diagnostic efficiency and clinical value of the two kinds of ultrasonic techniques in the risk of EV in the liver cirrhosis; and the Receiver operator characteristic curve was used. The ROC) curve provides the best critical value for non invasive monitoring of liver cirrhosis for clinical EV. Methods the patients in this study were in accordance with the diagnostic criteria for cirrhosis in the 2015 edition of the guide to chronic hepatitis B prevention and control. A total of 154 cases, 95 men, 59 women, 29-80 years of age, and the average age of 55 + 10 years. All the selected patients underwent upper gastrointestinal endoscopy and were based on them The results were divided into groups: 52 cases without EV were classified as no varicose group (No esophageal varices, NEV group, n=52), and 102 cases were classified as varicose vein group (EV group, n=102). The sex, age, height and weight of each person were recorded, and BMI. all subjects were strictly fasting for more than 8 hours, and venous blood was used to detect liver function and coagulation. Blood routine. The Siemens Acuson S2000 ultrasonic diagnostic instrument (with VTQ software) was used for ultrasound examination. All the subjects were strictly empty stomach for more than 8 hours, lying on the check bed, exposing the abdomen fully. First of all, the routine ultrasound examination of each person was performed to observe the liver and spleen profile and the essence echo, the right liver oblique diameter, splenic thickness, spleen were measured. The internal diameter and blood velocity of the hepatic portal vein and the splenic vein. Then, the VTQ model of the ARFI technique was started to measure the SWV value of the liver and spleen of all the subjects. The independent sample t test or chi square test of the experimental data was carried out by the SPSS22.0 statistics software, and the independent risk factors affecting the occurrence of EV were screened by the Logistic regression analysis. Draw the ROC curve and calculate the best critical value. Using the De Long test in the Med Calc medical statistics software, the comparison between the area under the curve (Area under the curve, AUC). Results 1, the comparison of the parameters between the EV group and the NEV group (1) the comparison of the clinical data and the classification of liver function is significantly higher than that of the group. The age, sex and BMI of the two groups were not significantly different (P0.05). (2) the comparison of the two dimensional and spectral Doppler ultrasound parameters in the EV group was significantly greater than that in the NEV group (P0.05), and the blood flow velocity of the hepatic portal vein and the splenic vein in the EV group was significantly lower than that of the NEV group, and the blood flow rate of the hepatic portal and splenic veins in the EV group was significantly lower than that of the NEV group. Study difference (P0.05). (3) SWV values compared with the EV group, the SWV value of the liver and spleen was significantly higher than that of the NEV group, with statistical difference (P0.05).2, Logistic regression analysis was used to screen the independent risk factors of EV. Logistic regression analysis showed the internal diameter of the hepatic portal vein, the liver and spleen SWV were the independent risk factors to predict the occurrence of EV. The diagnostic efficacy and clinical value of 2.396,1.007 and 1.005 (P0.05).3, two-dimensional ultrasound and VTQ in the noninvasive assessment of the risk of EV in liver cirrhosis, and to draw independent risk factors affecting the EV of liver cirrhosis, namely the hepatic portal diameter, the ROC curve of the liver and spleen SWV values of 0.88 (95%CI:0.824-0.936), 0.911 (95%CI:0.866-0.957) and 0.9, respectively. 08 (95%CI:0.863-0.953); the best critical points of the Youden index are determined as the critical point, 14.05mm, 2.013m/s and 2.937m/s respectively; the sensitivity is 73.6%, 82.4% and 79.6%, the specificity is 87.1%, 90.3% and 87.6%, respectively, and the positive predictive values are 75%, 80.8% and 75%, respectively, and the negative predictive values are respectively, 91.2% and 90.2%; accuracy points respectively. Do not be 82.5%, 87.7%, and 85.1%. conclusion 1, liver function classification, the internal diameter of the hepatic portal vein and the splenic vein and the SWV value of the liver and spleen play a certain auxiliary role in judging the occurrence of EV, the internal diameter of the hepatic portal vein, the liver and spleen SWV value as an independent risk factor for predicting the occurrence of EV, the ROC curve analysis, the hepatic portal vein. The SWV value of the liver and spleen has a good diagnostic efficiency in assessing the risk of EV in liver cirrhosis, especially the liver SWV value. It is suggested that two-dimensional ultrasound and VTQ may be an effective indicator of non invasive, simple, dynamic and objective evaluation of the risk of EV in liver cirrhosis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2
本文編號：2174502
[Abstract]:Background Esophageal varices (EV) is an important complication caused by portal hypertension in liver cirrhosis and the most common digestive tract varicose in the clinic. The diagnosis of acute gastrointestinal variceal bleeding is often found. Endoscopy is still the gold diagnosis of upper gastrointestinal varicosity and bleeding. Standard.2007 guidelines for the diagnosis and treatment of gastroesophageal varices and bleeding in cirrhosis of the liver disease society of the United States of America and the "trial plan for endoscopic diagnosis and treatment of digestive tract varices and bleeding" at the Chinese Medical Association's digestive endoscopy branch, 2009, all require early gastrointestinal endoscopy for all patients with cirrhosis of the liver, Screening and identifying patients requiring prophylactic treatment. However, only 15-25% of patients with high risk esophageal varices, most patients have no varicose or only mild varicosity but no preventive treatment. Therefore, the early diagnosis and evaluation of EV and its degree in patients with liver cirrhosis can be made by non invasive methods. Patients can effectively avoid unnecessary invasive upper gastrointestinal endoscopy, especially for patients with low risk of cirrhosis. Research in this field is a hot spot at home and abroad. Acoustic Radiation Force Impulse (ARFI) is a noninvasive ultrasonic elastic imaging technique for evaluating the hardness of the group fabric with the aid of sound contact. Virtual touch tissue quantification (VTQ) function, measuring sound velocity through tissue shear wave velocity (Shear wave velocity, SWV), and then quantifying the changes of tissue elasticity and hardness. In recent years, VTQ technology as a noninvasive hyper elastic imaging method for evaluating liver fibrosis has attracted much attention at home and abroad, in 2016, American Liver Liver stiffness (LS) is regarded as one of the important indicators of clinically significant portal hypertension (CSPH) for noninvasive monitoring of clinical significant portal hypertension (CSPH). On the other hand, domestic and foreign scholars have measured LS and splenic hard, on the other hand. Spleen stiffness (SS) and spleen length diameter and other parameters study VTQ technology to predict and evaluate the value of EV and hemorrhage (Esophageal variceal bleeding, EVB), and has a certain clinical application prospects, but most of the results can not obtain satisfactory sensitivity and specificity at the same time. This study uses a variety of new ultrasonic diagnostic techniques such as VTQ, etc., In order to explore the independent risk factors affecting the occurrence of cirrhosis EV by systematic detection of various objective parameters, and evaluate the clinical diagnostic value of the best critical value obtained by ROC curve analysis in predicting the EV of liver cirrhosis, there is no systematic study in China at present. The purpose of this study should be non-invasive detection of cirrhosis by two-dimensional ultrasound and VTQ technique. The SWV value of the liver and spleen, the internal diameter of the hepatic portal vein and the splenic vein, the internal diameter and blood flow velocity of the hepatic portal and splenic vein, analyzed the independent risk factors affecting the occurrence of EV in the liver cirrhosis, and discussed the diagnostic efficiency and clinical value of the two kinds of ultrasonic techniques in the risk of EV in the liver cirrhosis; and the Receiver operator characteristic curve was used. The ROC) curve provides the best critical value for non invasive monitoring of liver cirrhosis for clinical EV. Methods the patients in this study were in accordance with the diagnostic criteria for cirrhosis in the 2015 edition of the guide to chronic hepatitis B prevention and control. A total of 154 cases, 95 men, 59 women, 29-80 years of age, and the average age of 55 + 10 years. All the selected patients underwent upper gastrointestinal endoscopy and were based on them The results were divided into groups: 52 cases without EV were classified as no varicose group (No esophageal varices, NEV group, n=52), and 102 cases were classified as varicose vein group (EV group, n=102). The sex, age, height and weight of each person were recorded, and BMI. all subjects were strictly fasting for more than 8 hours, and venous blood was used to detect liver function and coagulation. Blood routine. The Siemens Acuson S2000 ultrasonic diagnostic instrument (with VTQ software) was used for ultrasound examination. All the subjects were strictly empty stomach for more than 8 hours, lying on the check bed, exposing the abdomen fully. First of all, the routine ultrasound examination of each person was performed to observe the liver and spleen profile and the essence echo, the right liver oblique diameter, splenic thickness, spleen were measured. The internal diameter and blood velocity of the hepatic portal vein and the splenic vein. Then, the VTQ model of the ARFI technique was started to measure the SWV value of the liver and spleen of all the subjects. The independent sample t test or chi square test of the experimental data was carried out by the SPSS22.0 statistics software, and the independent risk factors affecting the occurrence of EV were screened by the Logistic regression analysis. Draw the ROC curve and calculate the best critical value. Using the De Long test in the Med Calc medical statistics software, the comparison between the area under the curve (Area under the curve, AUC). Results 1, the comparison of the parameters between the EV group and the NEV group (1) the comparison of the clinical data and the classification of liver function is significantly higher than that of the group. The age, sex and BMI of the two groups were not significantly different (P0.05). (2) the comparison of the two dimensional and spectral Doppler ultrasound parameters in the EV group was significantly greater than that in the NEV group (P0.05), and the blood flow velocity of the hepatic portal vein and the splenic vein in the EV group was significantly lower than that of the NEV group, and the blood flow rate of the hepatic portal and splenic veins in the EV group was significantly lower than that of the NEV group. Study difference (P0.05). (3) SWV values compared with the EV group, the SWV value of the liver and spleen was significantly higher than that of the NEV group, with statistical difference (P0.05).2, Logistic regression analysis was used to screen the independent risk factors of EV. Logistic regression analysis showed the internal diameter of the hepatic portal vein, the liver and spleen SWV were the independent risk factors to predict the occurrence of EV. The diagnostic efficacy and clinical value of 2.396,1.007 and 1.005 (P0.05).3, two-dimensional ultrasound and VTQ in the noninvasive assessment of the risk of EV in liver cirrhosis, and to draw independent risk factors affecting the EV of liver cirrhosis, namely the hepatic portal diameter, the ROC curve of the liver and spleen SWV values of 0.88 (95%CI:0.824-0.936), 0.911 (95%CI:0.866-0.957) and 0.9, respectively. 08 (95%CI:0.863-0.953); the best critical points of the Youden index are determined as the critical point, 14.05mm, 2.013m/s and 2.937m/s respectively; the sensitivity is 73.6%, 82.4% and 79.6%, the specificity is 87.1%, 90.3% and 87.6%, respectively, and the positive predictive values are 75%, 80.8% and 75%, respectively, and the negative predictive values are respectively, 91.2% and 90.2%; accuracy points respectively. Do not be 82.5%, 87.7%, and 85.1%. conclusion 1, liver function classification, the internal diameter of the hepatic portal vein and the splenic vein and the SWV value of the liver and spleen play a certain auxiliary role in judging the occurrence of EV, the internal diameter of the hepatic portal vein, the liver and spleen SWV value as an independent risk factor for predicting the occurrence of EV, the ROC curve analysis, the hepatic portal vein. The SWV value of the liver and spleen has a good diagnostic efficiency in assessing the risk of EV in liver cirrhosis, especially the liver SWV value. It is suggested that two-dimensional ultrasound and VTQ may be an effective indicator of non invasive, simple, dynamic and objective evaluation of the risk of EV in liver cirrhosis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2
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7 謝賢桂,樸雯雯;二維超聲波彩色多普勒能量圖在腎腫瘤中的應(yīng)用評價[J];中國臨床醫(yī)學(xué)影像雜志;1999年03期
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