消化性溃疡血管深度与出血的相关性研究

目的探讨消化性溃疡底部血管深度与溃疡出血的关系,确定一个血管深度临界点作为内镜多普勒阳性标准。方法胃镜检查时发现的急性期消化性溃疡患者178例,立即用16MHz内镜多普勒超声探头经内镜活检道插入检测溃疡底部血流。对不同血管深度的出血性溃疡发生率作CochranArmitage趋势检验,计算各血管深度判别溃疡出血的敏感性、特异性和准确性,绘制ROC曲线,确定多普勒阳性的血管深度标准。结果 178例患者急性出血和无出血者分别有74例和104例,溃疡底部测及血流信号分别为66例(89.2%)和72例(69.2%),差异有统计学意义(P0.01)。两组测及的血管深度中位数分别为0.5mm和0.9mm,差异有统计学意义(P0.001)。对不同血管深度的出血性溃疡发生率作CochranArmitage趋势检验,差异有统计学意义(P0.001)。ROC曲线分析显示,溃疡底部血管深度0.7mm作为临界点最佳,其敏感性、特异性和准确性非别为79.7%、83.7%和82.0%。结论消化性溃疡底部血管深度与出血相关。血管深度≤0.7mm可作为内镜多普勒阳性标准。其对再出血的预测价值需进一步研究。

Correlation between hemorrhage and vessel depth of peptic ulcer

Objective To investigate correlation between depth of vessels in the bottom of peptic ulcer and hemorrhage from ulcer,so as to determine a critical point of vessel depth as positive standard of endoscopic Doppler ultrasound.Methods A 16 MHz ultrasonic Doppler transducer was used through the accessory channel of an endoscope,if an acute peptic ulcer was found during gastroscopy,to assess the blood flow in the bottom of ulcer.Cochran Armitage trend test was performed for occurrence rate of hemorrhagic ulcer in different blood vessel depths.We calculated the sensitivity,specificity and accuracy of different blood vessel depths for ulcerative hemorrhage and drew receiver operator characteristic （ROC） curves to determine the standard of blood vessel depth for positive Doppler signal.Results In the 178 patients,66 of the 74 hemorrhagic patients （89.2%） had blood flow signal detected at the bottom of the ulcer,while 72 （69.2%） of the 104 non-hemorrhagic did （P 0.01）.The median values of the detected blood vessel depths of the two groups were 0.5mm and 0.9mm respectively （P 0.001）.The incidence rates of hemorrhagic ulcer in different blood vessel depths were significantly different （P 0.001）.ROC curve analysis showed 0.7mm was the best critical point of blood vessel depth,with sensitivity,specificity and accuracy as 79.7%,83.7% and 82.0% respectively.Conclusion Depth of blood vessel in the bottom of peptic ulcer is correlated with hemorrhage.Blood vessel depth below 0.7mm could be used as the positive standard for endoscopic Doppler ultrasound assessment.Further investigation is needed for its value in predicting rehaemorrhagia.