老年晚期恶性梗阻性黄疸患者实时超声弹性成像定量分析对PTCD预后的预测价值

  目的   探究老年晚期恶性梗阻性黄疸患者实时超声弹性成像定量分析与经皮经胆道穿刺引流术（percutaneous transhepatic cholangio drainage，PTCD）预后的关系。  方法   回顾性选取2017年5月至2021年5月昆明市第一人民医院112例行PTCD治疗的老年晚期恶性梗阻性黄疸患者，根据患者预后情况分为预后不良（n = 42）与预后良好组（n = 70）。比较2组临床资料、PTCD术前（入院时）、PTCD术后（术后1周）实时超声弹性成像定量指标，分析实时超声弹性成像定量指标与Child-Pugh评分的相关性、PTCD术后实时超声弹性成像定量指标与老年晚期恶性梗阻性黄疸患者PTCD预后的关系，绘制受试者工作特征（ROC）曲线，评价PTCD术后实时超声弹性成像定量指标对老年晚期恶性梗阻性黄疸患者PTCD预后的诊断价值。  结果   预后不良组PTCD术后实时超声弹性成像定量指标应变均值较预后良好组低，蓝色领域百分比较预后良好组高（P < 0.05）；老年晚期恶性梗阻性黄疸患者应变均值、蓝色领域百分比与Child-Pugh评分有关（P < 0.05）；应变均值、蓝色领域百分比均为老年晚期恶性梗阻性黄疸患者PTCD预后患者独立影响因素（P < 0.05）；应变均值、蓝色领域百分比联合预测老年晚期恶性梗阻性黄疸患者PTCD预后的AUC为0.862。  结论   老年晚期恶性梗阻性黄疸患者实时超声弹性成像定量测量应变均值、蓝色领域百分比与患者肝功能及预后有关，PTCD术后进行实时超声弹性成像定量，有助于疾病预后预测，在临床工作中具有重要意义。

Quantitative Analysis of Real-time Ultrasound Elastography in Elderly Patients with Advanced Malignant Obstructive Jaundice and the Assessment of Prognostic Value of PTCD

  Objective  To explore the relationship between the quantitative analysis of real-time ultrasound elastography and the prognosis of percutaneous transbiliary drainage （PTCD） in elderly patients with advanced malignant obstructive jaundice.   Methods  A retrospective selection of 112 elderly patients with advanced malignant obstructive jaundice who underwent PTCD treatment in Kunming First People’s Hospital between May 2017 and May 2021 were divided into poor prognosis （n = 42） and good prognosis groups （n = 70） according to their prognosis. The clinical data, quantitative real-time ultrasound elastography before PTCD （at admission） and after PTCD （1 week after surgery） between the two groups were compared so as to analyse the correlation between quantitative real-time ultrasound elastography and Child-Pugh score, the relationship between quantitative real-time ultrasound elastography after PTCD and the prognosis of PTCD in elderly patients with advanced malignant obstructive jaundice. The subject work characteristic （ROC） curve was plotted to evaluate the diagnostic value of quantitative real-time ultrasound elastography after PTCD on the prognosis of PTCD in elderly patients with advanced malignant obstructive jaundice.   Results  The mean strain values were lower and the percentage of blue fields was higher in the poor prognosis group compared to those of the good prognosis group for quantitative indicators of real-time ultrasound elastography after PTCD （P < 0.05）; The mean value of strain and blue field percentage were associated with Child-Pugh score （P < 0.05）; Strain mean value and blue field percentage were independent factors influencing PTCD prognosis in elderly patients with advanced malignant obstructive jaundice （P < 0.05）; The AUC for the combined diagnosis of strain mean value and blue field percentage in elderly patients with advanced malignant obstructive jaundice for PTCD prognosis was 0.862.   Conclusion  Real-time ultrasound elastography quantitative measurement of mean strain and percentage of blue area in elderly patients with advanced malignant obstructive jaundice are related to the liver function and prognosis. Real-time ultrasound elastography quantification after PTCD can help predict the prognosis of the disease. It is of great significance in clinical work.