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影响肝硬化合并食管胃底静脉曲张破裂出血的血流动力学分析
引用本文:胡华华,刘俊,关丽愉,许捷鸿,易宏,李中专,覃树芬,邓翔宇. 影响肝硬化合并食管胃底静脉曲张破裂出血的血流动力学分析[J]. 肝脏, 2020, 0(4): 369-371
作者姓名:胡华华  刘俊  关丽愉  许捷鸿  易宏  李中专  覃树芬  邓翔宇
作者单位:广西医科大学附属第四医院
基金项目:广西壮族自治区卫生和计划生育委员会科研项目(136704)。
摘    要:目的分析影响肝硬化合并食管胃底静脉曲张破裂出血的血流动力学指标。方法回顾性分析2017年10月至2018年4月间在柳州市工人医院肝硬化合并食管胃底静脉曲张的86例患者的临床资料。随访半年按照是否出现静脉破裂出血分成出血组(30例)和未出血组(56例),比较两组患者性别、年龄、病程、Child-pugh评分、血小板计数、经超声测算出的食管壁内外及交通支曲张静脉的平均内径、平均血流速度等指标的均值差异,评估所得指标与静脉破裂出血结果的相关性,分析影响肝硬化合并食管胃底静脉曲张破裂出血的血流动力学指标,ROC曲线分析其敏感度和特异性。结果性别、年龄、病程、肝功能Child-Pugh评分(8.97±3.04)、血小板计数[(142.60±38.66)×109/L]、经超声测算出的食管壁内外及交通支曲张静脉的平均内径[(1.54±0.62)mm]、平均血流速度[(15.79±4.17)mm/s]等指标中,只有食管壁内外及交通支曲张静脉的平均内径、平均血流速度与胃底静脉曲张破裂出血结局密切相关(r=-0.294、-0.451,均P<0.01),其余指标无关(P>0.05);ROC曲线分析表明:食管壁内外及交通支曲张静脉的平均内径、平均血流速度与胃底静脉曲张破裂出血结局呈正关系,其特异性与敏感度有统计学意义(P<0.05),当食管壁内外曲张静脉的内径>1.875 mm,平均血流速度超过13.75mm/s时,胃底静脉曲张破裂出血的可能性更大,其敏感度分别为0.533、0.833;特异度分别为0.125、0.589。结论食管壁内外曲张静脉的平均内径、平均血流速度与胃底静脉曲张破裂出血结局正相关。

关 键 词:超声内镜  肝硬化  食管胃底静脉曲张  血流动力学

Hemodynamic analysis of liver cirrhosis complicated with esophageal and gastric varices rupture
HU Hua-hua,LIU Jun,GUAN Li-yu,XU Jie-hong,YI Hong,LI Zhong-zhuan,QIN Shu-fen,DENG Xiang-yu. Hemodynamic analysis of liver cirrhosis complicated with esophageal and gastric varices rupture[J]. Chinese Hepatology, 2020, 0(4): 369-371
Authors:HU Hua-hua  LIU Jun  GUAN Li-yu  XU Jie-hong  YI Hong  LI Zhong-zhuan  QIN Shu-fen  DENG Xiang-yu
Affiliation:(Department of Gastroenterology,Fourth Affiliated Hospital of Guangxi Medical University(Liuzhou Worker’s Hospital),Guangxi 545000,China)
Abstract:Objective To analyze the hemodynamic parameters from esophageal and gastric varices bleeding in cirrhosis.Methods The clinical data of 68 patients with liver cirrhosis complicated with esophagogastric varices diagnosed by Fujineng ultrasound gastroscopy in our hospital from October 2017 to April 2018 were retrospectively analyzed.Following up for half a year,the patients were divided into hemorrhage group and non-hemorrhage group according to whether there was venous rupture or not.There were 30 cases in hemorrhage group and 38 cases in non-hemorrhage group.The differences of sex,age,course of disease,the child-pugh score of liver function,platelet count,average diameter,average blood flow velocity measured by ultrasonography were compared between the two groups.Hemodynamic parameters affecting bleeding from esophageal and gastric varices in cirrhosis were analyzed.For closely related indicators,ROC curve was used to analyze the sensitivity and specificity.Results Eighty-six patients were followed up for half a year.30 patients had venous rupture and bleeding,56 patients had no bleeding.The bleeding rate of liver cirrhosis complicated with esophageal and gastric varices was 34.88%.The indexes of sex,age,course of disease,the Child-Pugh score of liver function(8.97±3.04),platelet count[(142.60±38.66)×109/mL],average diameter[(1.54±0.62)mm],average blood flow velocity[(15.79±4.17)mm/s]were measured by ultrasound.Only the mean internal diameter,average blood flow velocity were closely related to the bleeding outcomes of gastric varices rupture(r=-0.294,-0.451,P<0.05).The other indicators were not related(P>0.05).ROC curve analysis showed that the internal diameter,average blood flow velocity were positively correlated with the bleeding outcome of gastric varices rupture,and the specificity and sensitivity has significant statistical significance(P<0.05).When the inner diameter of the varicose vein inside and outside the esophageal wall is larger than 1.875 mm,the average blood flow velocity exceeds 13.75mm/s,the gastric varices are more likely to rupture and bleed.Conclusion The internal diameter and blood flow velocity of esophageal varices are positively correlated with the bleeding outcomes of gastric varices rupture.Close monitoring of the internal diameter and blood flow velocity of esophageal varices should be carried out clinically,which is of great significance in preventing bleeding outcomes of gastric varices rupture and is worthy of clinical promotion.
Keywords:Endoscopic ultrasonography  Liver cirrhosis  Esophageal and gastric varices  Hemodynamic parameters
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