瞬时弹性成像技术对肝硬化患者上消化道出血的预测价值

目的 探讨瞬时弹性成像技术(transient elastography,TE)对肝硬化患者上消化道出血的预测价值.方法 选择2016年10月至2017年10月在成都市第二人民医院确诊为肝硬化合并上消化道出血并行肝脏弹性测定的50例患者进行回顾性分析.收集患者上消化道出血史、采用瞬时弹性扫描仪检测患者肝脏和脾脏硬度,采用电子胃镜检查食管、胃底曲张静脉,以Child-Pugh分级评估患者肝脏储备功能.分别比较不同出血史、不同静脉曲张、不同Child-Pugh分级患者的肝、脾硬度值.结果 3种不同Child-Pugh分级患者肝、脾硬度值差异均有统计学意义(P<0.05),且随着Child-Pugh分级等级的升高,肝、脾硬度值均明显升高(P<0.05).不同静脉曲张程度患者肝、脾硬度值差异均有统计学意义(P<0.05),且随着静脉曲张严重程度的增加,肝、脾硬度值均明显升高(P<0.05).不同出血史的患者肝、脾硬度值差异有统计学意义(P<0.05),且无出血患者明显低于单次出血和2次以上出血的患者,差异有统计学意义(P<0.05).结论 T E可有效预测肝硬化程度、食管静脉曲张严重程度与出血风险,具有较高的临床价值,操作简便、重复性佳,值得推广使用.

The Predictive Value of Transient Elastography on Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis

Objective To investigate the predictive value of transient elastography (TE)on upper gastrointestinal bleeding in patients with liver cirrhosis.Methods The data of 50 patients with liver cirrhosis diagnosed with liver cirrhosis complicated with upper gastrointestinal bleeding and receiving the measurement of liver elasticity in Chengdu Second People 's Hospital from October of 2016 to October of 2017 were analyzed retrospectively.Those patients'histories of upper gastrointestinal bleeding were collected,the hardness of liver and spleen was detected by Fibroscan,the esophageal and gastric varices were examined by the electronic gastroscope, and their liver function was evaluated by Child-Pugh grading.The hardness of liver and spleen was compared between different bleeding histories,varices and Child-Pugh grading respectively.Results The liver cirrhosis values and spleen hardness values were significantly different among patients with three Child-Pugh grading values(P<0.05)and they were significantly increased with the increase of Child-Pugh grading(P<0.05).The values of liver hardness and spleen hardness among patients with different degree of varices were significantly different(P<0.05), and they were significantly increased with the growing severity of varicose veins(P<0.05).The values of liver and spleen hardness were significantly different between patients with different bleeding histories(P<0.05)and they were significantly lower in the no-bleeding group than the bleeding groups of one time or more than one time(P<0.05).Conclusion TE can effectively predict the degree of cirrhosis,the severity of esophageal varices and the risk of bleeding with high clinical value,easy operation and good repeatability,so it is worth to be popularized.