Advances Of Ultrasound In Perdicting Esophagogastric Variceal Hemorrhage In Liver Cirrhosis

Objective: To observe and measure the characteristics of patients with liver cirrhosis, such as portal vein and spleen vein’s diameter, flow velocity and quantity, hepatic artery and spleen artery’s diameter, resistance index and pulsatility index, portal hypertension index, we observe the esophagogastric wall thickness and inner diameter of patients with liver cirrhosis portal hypertension by transabdominal gastrointestinal contrast-enhanced ultrasonography and analys the risk degree of hemorrhage, in order to find out the simple and feasible method of predicting esophagogastric variceal hemorrhage.Methods: 67 patients with liver cirrhosis after hepatitis B and 20 non-cirrhotic controls were studied.They are from Xian Yang center hospital infectious department and digestive department between April 2013 to March 2014 inpatient and outpatient. 37 cases of male, 30 cases of female, age range from 29 to 71 years old, the average age is 47 years old. According to the presence of history of esophagogastric variceal hemorrhage were divided into 35 cases(52.2%) with positive bleeding history, patients with history of one or more esophagus varicosity burst; 32 cases(47.8%) of negative bleeding history. According to the degree of esophageal varices is divided into no, mild, moderate and severe groups. Randomly selected by the clinical, laboratory and imaging examination of 20 healthy volunteers without any liver disease cases, 10 cases of men, 10 cases of female, age range from 18 to 35 years old, the average age is 25 years old.Doppler sonographic machine(PHILIPS i U22) were used to all subjects of abdominal ultrasound examination.The portal vein(PV)、 heptic artery(HA) andsplenic vein(SV)、 splenic artery( SA) was scanned in the fasting state. The portal vein trunk(PV) and right hepatic artery(HA)’s measurement point is apart from the left and right branch of 1 ~ 2 cm in the trunk; The splenic vein(SV) and splenic artery(SA)’s measurement point at 0.5~1.0 cm from the spleen door. In the condition of quiet breathing, the portal vein diameter(Dpv), time average maximum velocity(Vpv), quantity of blood flow(Qpv), hepatic artery diameter(Dha), systolic flow velocity(HAmax), diastolic flow velocity(HAmin), resistance index(HARI), pulse index(HAPI), splenic vein diameter(missing), time average maximum velocity(types), blood flow(Qsv), splenic artery diameter(Dsa), systolic flow velocity(SAmax), diastolic flow velocity(SAmin), resistance index(SARI), pulse index(SAPI) were measured, the above parameters are measured three times, take the average value, and portal hypertension index(PHI) was calculated finally. Then drink gastrointestinal contrast agent 500 ml(produced by huzhou east Asian), patients with right side, on the center of the abdomen showed abdominal aorta to the left and then shows that segment of esophagus and stomach bottom, measuring esophageal gastric wall thickness(Degw) and varicose vein diameter(Degv).The liver function, blood routine, and whether or not with ascites and hepatic encephalopathy of patients with cirrhosis was examined before ultrasound examination. In accordance with its bleeding history and all cirrhosis patients were performed with endoscopy, and divided into three degrees, mild(F1), moderate( F2) and severe(F3). To statistical analysis using SPSS13.0 software package, cirrhosis group and normal control group in the comparison of the measured parameters using independent sample t test, the results was expressed by mean±standard deviation(sx ±), the correlation analysis of parameter and gastroscope degree using Spearman rank correlation, the parameters and ultrasonic to measure the degree of esophageal gastric varices associated with Pearson correlation analysis, the esophagogastric varicose vein diameter cutoff value of each hierarchy and its sensitivity and specificity is obtained by Receiver Operating Characteristic curve(ROC), esophagogastric varices bleeding rate of different degree of group using the chi-square test.Results:1. The parameters of patients with liver cirrhosis Dpv 、 Qpv、 Dsv、 Qsv、Degw 、Degv 、Dha、HARI 、HAPI、 Dsa 、SARI 、SAPI、 PHI are significantly higher than that of normal control group. The parameters of Vpv, HAmin are significantly lower than the normal control group, The parameters of patients with liver cirrhosis Vsv、HAmax, SAmax, SAmin compared with normal control group had no obvious difference. 2. A group of patients with liver cirrhosis Dpv, Dsv has weak correlation between gastroscope classification, Degw, Degv has significant correlation, but Vpv、Qpv、Vsv、Qsv、Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin 、 SARI 、 SAPI 、 Qsv/Qpv 、 PHI had no obvious correlation between gastroscope classification. 3. A group of patients with liver cirrhosis has a weak correlation between Dpv and Degv, there is a significant correlation between Dsv、 Degw and Degv, but there is no obvious correlation between Vpv、 Qpv、 Vsv、 Qsv、 Dha、HAmax、HAmin、HARI、HAPI、Dsa、SAmax、SAmin、SARI、SAPI、Qsv/Qpv、PHI and Degv. 4. In accordance with its bleeding history and all cirrhosis patients were performed with endoscopy, and divided into three degrees, mild(F1), moderate( F2) and severe(F3). the esophagogastric varicose vein diameter cutoff value of each hierarchy and its sensitivity and specificity is obtained by Receiver Operating Characteristic curve(ROC), and the distinction between mild and moderate, moderate and severe varicose vein diameter of cutoff value with 3.00 mm and 5.75 mm, the sensitivity and specificity of 87.5%, 91.7% and 94.9%, 91.7% respectively. On the basis of ultrasonic cutoff value all of the patients can be divided into no, mild, medium and severe four groups, the results compared with endoscopic degree, it is concluded that ultrasonic diagnosis of esophagogastric varices coincidence rate is respectively: 66.7%, 71.4%, 78.6%, 92.5%. 5. The hemorrhage incidence of patients with liver cirrhosis of severe esophagogastric varicose vein was 72.5%, significantly higher than that of mild and moderate groups.Conclusion: 1. The parameters of Dpv, Qpv, Dsv, Qsv, Degw, Degv, Dha, HARI, HAPI, Dsa, SARI, SAPI, PHI can obviously increase on the patients with liver cirrhosis,Vpv, HAmin can obviously reduce, Vsv,HAmax,SAmax, SAmin has no obvious change. The parameters of Degv on the patients with liver cirrhosis has obvious correlation between with gastroscope grading, Dpv, Dsv, Degw has weak correlation between with gastroscope grading. 2. Contrast-enhanced ultrasound in the diagnosis of esophagogastric varices, with 3.00 mm and 5.75 mm respectively as a cutoff value divided into mild and moderate, moderate and severe of varicose vein diameter, the sensitivity and specificity are 87.5%, 91.7% and 94.9%, 91.7% respectively. 3. Abdominal stomach filling contrast-enhanced ultrasound diagnosis of esophagogastric varices total coincidence rate: 85.1%. For the diagnosis of severe esophagogastric varices accuracy is as high as 92.5%, and the hemorrhage rate( 72.5%) of severe group is significantly higher than the other two groups, so the abdominal stomach filling contrast-enhanced ultrasound in predicting esophagogastric varicosity hemorrhage has certain clinical value, and can reduce upper gastrointestinal endoscopic examination, worthy of clinical popularization and application.