超声辐射力成像评估食管静脉曲张程度及出血风险的价值

摘要 目的：探究超声辐射力成像（acoustic radiation force impulse，ARFI）在评估食管静脉曲张（esophageal varices，EV）程度以及出血风险中的应用价值。方法：选择2018年1月至2020年1月于我院接受治疗的82例肝硬化患者，均对其开展ARFI、胃镜与血清学实验室检测，记录患者的肝、脾剪切波速度值（SWV _L 、SWV _S ），参考胃镜检测结果将患者区分为EV组（61例）和无EV组（21例），再根据胃镜结果将EV组区分为轻度（EV-G1，20例）、中度（EV-G2，21例）和重度（EV-G3，20例），比较分析EV组与无EV组、不同EV病变程度组间的SWV _L 、SWV _S 差异；将患者根据食管静脉曲张出血（esophageal variceal bleeding，EVB）风险区分为低风险组（27例）和高风险组（34例），对比低风险和高风险患者SWV _L 、SWV _S 差异；最后探究ARFI在评估EVB中的临床价值。结果：（1）比较显示EV组的SWV _L 、SWV _S 、血清总胆红素、白蛋白、凝血酶原时间等与无EV组差异明显（P<0.05）；（2）组间比较不同EV病变程度患者SWV _S 、血清总胆红素、白蛋白、凝血酶原时间差异明显（P<0.05）；（3）低风险组与高风险组患者间SWV _S 、血清总胆红素、白蛋白、凝血酶原时间差异明显（P<0.05）；（4）相关性分析SWV _S 与EV分级呈正相关（P<0.05），SWV _S 对EVB诊断AUC为0.9622，95 % CI为0.9141-1.000（P<0.001）；结论：超声辐射弹力成像在评估食管静脉曲张程度以及出血风险中应用价值较高，其中SWV _S 诊断出血风险较为敏感，可将其应用于指导患者临床治疗和预后评估中。

The Value of Ultrasonic Radiation Force Imaging in Evaluating Degree of Esophageal Varices and Risk of Bleeding

ABSTRACT Objective: To explore the application value of ultrasound radiation force imaging (ARFI) in the evaluation of esophageal varices (EV) degree and bleeding risk. Methods: A total of 82 patients with liver cirrhosis, who were treated in 942 Hospital of Joint Logistics Support Force of Chinese People''s Liberation Army from January 2018 to January 2020, were selected and were examined by ARFI, gastroscopy and serology laboratory tests, and their shear wave velocity values of liver and spleen (SWV _L , SWV _S ) were recorded. According to the results of gastroscopy, the patients were divided into EV group (61 cases) and non EV group (21 cases), and then EV group was divided into mild group (EV-G1, 20 cases), moderate group (EV-G2, 21 cases) and severe group (EV-G3, 20 cases) according to the results of gastroscopy. The differences of SWV _L and SWV _S between EV group and non EV group and the different EV lesion degree groups were compared and analyzed. Results: (1) The SWV _L , SWV _S , serum total bilirubin, albumin, prothrombin time in EV group were significantly different from those in non EV group (P<0.05). (2) There were significant differences in SWV _S , serum total bilirubin, albumin and prothrombin time among the mild group, moderate group and severe group(P<0.05). (3) There were significant differences in SWV _S , serum total bilirubin, albumin and prothrombin time between low-risk group and high-risk group (P<0.05). (4) Correlation analysis showed that SWV _S was positively correlated with EV grading(P<0.05), and the AUC of SWV _S in EVB diagnosis was 0.9622, 95% CI was 0.9141-1.000 (P<0.001). Conclusion: The application value of acoustic radiation elastography in evaluating the degree of esophageal varices and bleeding risk is higher. Among them, SWV _S is more sensitive in the diagnosis of bleeding risk, which can be used to guide the clinical treatment and prognosis evaluation of patients.