对于代偿期肝硬化患者，能否通过双功多普勒超声进行食管静脉曲张的无创诊断？
Is non-invasive diagnosis of esophageal varices in patients with compensated hepatic cirrhosis possible by duplex Doppler ultrasonography?
作者信息
Chakrabarti Ritwik, Sen Debraj, Khanna Vikram
机构信息
Military Hospital Tiruvananthapuram, Pangode, Tiruvananthapuram, 695 006, India.
Indian Field Hospital Level II, UN Mission in South Sudan (UNMISS), C/O 56 APO, Malakal, Sudan.
出版信息
Indian J Gastroenterol. 2016 Jan;35(1):60-6. doi: 10.1007/s12664-016-0630-7. Epub 2016 Feb 29.
BACKGROUND AND AIM
Esophageal varices are present in 30% to 40% of patients in compensated cirrhosis (Child-Pugh class A) and in 60% to 85% of patients in decompensated cirrhosis (Child-Pugh classes B and C). It is important to identify patients with compensated cirrhosis at risk for esophageal varix development. We evaluated the accuracy of a duplex Doppler ultrasonographic index for predicting the presence or absence of esophageal varices in patients with compensated hepatic cirrhosis (Child-Pugh class A) by using endoscopy as the reference standard.
METHODS
Fifty-six enrolled patients underwent duplex Doppler ultrasonography followed by screening endoscopy. Mean portal vein velocity (PVV), splenic index (SI), splenoportal index (SPI), hepatic and splenic arterial resistive, and pulsatility indices (hepatic artery resistive index [HARI], hepatic artery pulsatility index [HAPI], splenic artery resistive index [SARI], splenic artery pulsatility index [SAPI]) were recorded. Univariate logistic regression analysis was followed by receiver operating characteristic (ROC) curve construction for the indices that were significant.
RESULTS
The indices HARI, HAPI, SARI, SAPI were not helpful (p > 0.05). Mean PVV, SI, and SPI were all predictive of the presence of esophageal varices (p < 0.05) and SPI was found to be the most accurate parameter. Of the various cut-off levels of SPI evaluated, a cut-off value of SPI at 5.0, offered the highest diagnostic accuracy (88%). For the 28 patients with SPI <5.0, the absence of esophageal varices in 27 of them could be correctly diagnosed using only SPI without invasive screening endoscopy, with high negative predictive value (96%) and sensitivity (96%). Of the remaining 28 patients with SPI ≥5.0, presence of esophageal varices could be similarly correctly diagnosed in 22 of them by using SPI without screening endoscopy, with high positive predictive value (79%) and specificity (82%).
CONCLUSION
The SPI was accurate in predicting the presence or absence of esophageal varices in patients with compensated cirrhosis.
背景与目的
在代偿期肝硬化（Child-Pugh A级）患者中，30%至40%存在食管静脉曲张；在失代偿期肝硬化（Child-Pugh B级和C级）患者中，60%至85%存在食管静脉曲张。识别有食管静脉曲张发生风险的代偿期肝硬化患者很重要。我们以内镜检查作为参考标准，评估了双功多普勒超声指数预测代偿期肝硬化（Child-Pugh A级）患者食管静脉曲张存在与否的准确性。
方法
56例入选患者接受了双功多普勒超声检查，随后进行筛查性内镜检查。记录平均门静脉流速（PVV）、脾脏指数（SI）、脾门静脉指数（SPI）、肝动脉和脾动脉阻力及搏动指数（肝动脉阻力指数[HARI]、肝动脉搏动指数[HAPI]、脾动脉阻力指数[SARI]、脾动脉搏动指数[SAPI]）。对有意义的指数进行单因素逻辑回归分析，随后构建受试者工作特征（ROC）曲线。
结果
HARI、HAPI、SARI、SAPI指数无帮助（p＞0.05）。平均PVV、SI和SPI均能预测食管静脉曲张的存在（p＜0.05），且发现SPI是最准确的参数。在评估的SPI不同截断水平中，SPI截断值为5.0时诊断准确性最高（88%）。对于28例SPI＜5.0的患者，仅使用SPI而不进行侵入性筛查内镜检查，其中27例食管静脉曲张不存在可被正确诊断，具有较高的阴性预测值（96%）和敏感性（96%）。在其余28例SPI≥5.0的患者中，仅使用SPI而不进行筛查内镜检查，其中22例食管静脉曲张存在可被同样正确诊断，具有较高的阳性预测值（79%）和特异性（82%）。
结论
SPI在预测代偿期肝硬化患者食管静脉曲张的存在与否方面准确。
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