B型超声、胃镜和脾门静脉核素显像对门静脉高压症的量化诊断研究

目的 将B型超声、胃镜和脾门静脉核素显像三种检查方法的结果进行量化，建立判别式，以探讨其在肝硬化门静脉高压症诊断中的临床意义。方法 分别对40例肝硬化门静脉高压症、10例慢性肝病、12例非肝病患者进行B型超声、胃镜和脾门静脉核素显像检查。结果 经逐步回归分析，筛选出诊断肝硬化门静脉高压症的影像学指标是：门体分流指数（X1）、脾静脉宽度（X2）、肝脏回声分级（X3）、食管静脉曲张程度（X4），将其分别建立判别式为：Y1=-36．912＋15．650X1＋67．289X2-0．425X3-1．651X4，Y0=-23．193＋10．697X1＋61．425X2-3．251X3-2．758X4或Y1=-35．828＋15．857X1＋62．390X2＋0．228X3，Y0=-20．167＋11．042X1＋53．241X2-3．581X3，若Y1〉Y0，即为肝硬化门静脉高压症，其诊断肝硬化门静脉高压症的敏感度均为95％，特异度分别为96％、91％，明显优于B超或胃镜定性检查的78％、75％（P〈0．05）。结论 B型超声和脾门静脉核素显像联合定量检测并建立判别式，可以显著提高对肝硬化门静脉高压症的诊断敏感度。

Quantify the results of mode B ultrasonography, gastric endoscopy and per-splenoportal vein scintigraphy in evaluating their clinical diagnostic value in portal hypertension

Objective To quantify the results of mode B ultrasonography, gastric endoscopy and per-splenoportal vein scintigraphy, then define a formula to evaluate its clinical value in the diagnosis of portal hypertension. Methods Forty portal hypertension patients with liver cirrhosis, 10 patients with chronic hepatic disease, and 12 patients with non-hepatic disease were examined by mode B ultrasonography, gastric endoscopy and per-splenoportal vein scintigraphy. Results The indexes of diagnosis of portal hypertension are selected by stepwise (SAS) : portosystemic shunt index ( X1) , splenic vein ( X2 ) , hepatic ultrasono-graphic grading (X3) and esophageal varices (X4) , and define a formula by discrim(SAS) : Y1=-36.912 + 15. 650X1 + 67. 289X2-0. 425X3-1. 651X4; Y0 = -23. 193 + 10. 697X1 + 61. 425X2-3. 251X3-2. 758X4; or Y1 =-35. 828 + 15. 857X1 + 62. 390X2+0. 228X3, Y0 =-20. 167 + 11. 042X1 + 53. 241X2-3. 581X3 ,if Y1 > Y0, then the diagnosis of hypertension with liver cirrhosis obtained. The positive rate of diagnosis is 95% and the specificity is 96% and 91% respectively, much better than those in type B ultrasonography or gastric endoscopy, 78% or 75% respectively (P < 0.05). Conclusion The formula founded by combining per-splenoportal scintigraphy and type B ultrasonography, the positive rate of hypertension with liver cirrhosis is obviously raised.