超声内镜检查术检查乙型肝炎肝硬化患者食管侧支静脉曲张的价值分析

摘要/Abstract

摘要： 目的研究内镜超声检查术(EUS)在评估食管侧支循环状况中的作用及预测肝硬化食管静脉曲张(EV)中的价值。方法以2018年1月至2020年1月76例肝硬化患者作为研究对象,所有患者均接受EUS检查。记录患者食管旁侧支静脉(para-ECV)和食管周围侧支静脉(peri-ECV)直径和数量。根据是否伴发EV将76例患者分为ECV(肝硬化伴EV)和无ECV(肝硬化未伴EV)。采用Logistic多因素分析法分析影响肝硬化伴发EV的独立影响因素,根据多因素分析结果建立预测模型。利用受试者操作特征曲线(ROC)分析模型对判断EV风险的价值,并验证其价值。结果 76例患者中伴发EV者32例,肝硬化并发EV发生率为42.1%。其中轻度18例,中度10例,重度4例。轻中度肝硬化并发EV占87.5%。ECV患者para-ECV和peri-ECV直径(重度19例、21例),显著多于无ECV(15例、14例,P<0.05),ECV病变支数≥5支者23例,显著高于无ECV(19例,P<0.05)。Logistic多因素分析结果显示抗病毒治疗(β=-0.393,95%CI=0.479~0.951, OR=0.675,P=0.025)、para-ECV直径(β=1.664,95%CI=3.412~8.174,OR=5.281,P=0.000)、peri-ECV直径(β=0.658,95%CI=1.454~2.562,OR=1.930,P=0.000)及病变支数(β=2.082,95%CI=1.167~55.034,OR=8.014,P=0.034)是影响EV的独立因素。ROC分析结果显示无抗病毒治疗(AUC=0.655,95%CI=0.530~0.780,P=0.022)、peri-ECV(AUC=0.693,95%CI=0.572~0.814,P=0.004)、para-ECV(AUC=0.651,95%CI=0.525~0.776,P=0.026)及病变支数(AUC=0.678,95%CI=0.555~0.801,P=0.009)对判断肝硬化并发EV具有一定应用价值。根据Logistic多因素分析结果建立预测模型:Y=0.465-0.393X₁+0.658X₂+1.664X₃+2.082X₄。ROC分析结果显示其判断EV的AUC值为0.802(SE=0.050,95%CI=0.704~0.900,P=0.000),敏感度0.938,特异度0.545。Hosmer-Lemeshow拟合优度检验结果显示EV实际观察结果和预期结果差异无统计学意义(χ²=0.154,P=0.695)。结论 EUS检查有助于评估肝硬化患者食管侧支循环状态,基于EUS检查结果建立的预测模型预测EV风险的准确性较高。

关键词: 内镜超声检查, 食管侧支静脉, 肝硬化食管静脉曲张

Abstract: Objective To study on the value of endoscopic ultrasonography (EUS) in evaluating esophageal collateral circulation and predicting esophageal varices (EV) in patients with liver cirrhosis.Methods 76 patients with liver cirrhosis collected from January 2018 to January 2020 were investigated in the study. All patients had received EUS examination and recorded for the diameters and numbers of para-esophageal collateral veins (para-ECV) and peri-esophageal collateral veins (peri-ECV). The patients were divided into observation group (cirrhosis with EV) and control group (cirrhosis without EV) according to whether they were accompanied by EV. Logistic multivariate analysis was used to analyze the independent influence factors of liver cirrhosis with EV. A predictive model was established based on the results of the multi-factor analysis. Receiver operator characteristic (ROC) and the area under the curve (AUC) were used to analysis and verify the value of this model in predicting EV risk. Results Among the 76 patients, 32 cases (42.1%) were accompanied by EV. Within them, 18 cases were mild, 10 cases were moderate, and 4 were severe in EV. The EVs with mild and moderate cirrhosis accounted for 87.5%. The para-ECV and peri-ECV diameters of patients in the observation group (19 and 21 severe cases, respectively) were significantly larger than those in the control group, which were significantly more than the control group (15 and 14 severe cases, respectively) (P<0.05). There were 23 cases in the observation group who had lesions ≥5, which was significantly more than that in the control group (19 cases) (P<0.05). The Logistic multivariate analysis results showed that the antiviral therapy (β=-0.393, 95%CI=0.479-0.951, OR=0.675, P=0.025), para-ECV diameter (β=1.664, 95%CI=3.412-8.174, OR =5.281, P=0.000), peri-ECV diameter (β=0.658, 95%CI=1.454-2.562, OR=1.930, P=0.000) and the number of lesions (β=2.082, 95%CI=1.167-55.034, OR=8.014, P=0.034) were independent factors affecting EV. The ROC analysis results showed that without antiviral therapy (AUC=0.655, 95%CI=0.530-0.780, P=0.022), peri-ECV (AUC=0.693, 95%CI=0.572-0.814, P=0.004), para-ECV (AUC=0.651, 95%CI=0.525-0.776, P=0.026) and the number of lesions (AUC=0.678, 95%CI=0.555-0.801, P=0.009) had certain application value for predicting EV in liver cirrhotic patients. The prediction model based on the logistic multi-factor analysis was then established as: Y=0.465-0.393X₁+0.658X₂+1.664X₃+2.082X₄. It was shown by ROC analysis that the AUC value of the EV was 0.802 (SE=0.050, 95%CI=0.704-0.900,P=0.000), the sensitivity was 0.938 and the specificity was 0.545. The Hosmer-Lemeshow goodness-of-fit test results showed that there was no statistically significant difference between the actual observation results and the expected results of EV (χ²=0.154, P=0.695).Conclusion EUS examination is helpful in assessing the status of esophageal collateral circulation in patients with liver cirrhosis. The prediction model established on EUS examination has high accuracy for the risk of EV.

Key words: Endoscopic ultrasonography, Esophageal collateral veins, Liver cirrhosis, Esophageal varices

杜居洁, 郑红, 李金. 超声内镜检查术检查乙型肝炎肝硬化患者食管侧支静脉曲张的价值分析[J]. 肝脏, 2021, 26(5): 505-509.

DU Ju-jie, ZHENG Hong, LI Jin. The value of endoscopic ultrasonography in evaluating collateral circulation and predicting esophageal varices in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(5): 505-509.

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