Quantitative Analysis of Real-time Ultrasound Elastography in Elderly Patients with Advanced Malignant Obstructive Jaundice in Assessing the Prognosis of PTCD
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摘要:
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（PTCD）预后的关系。 方法 回顾性选取2017年5月至2021年5月间，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前后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 2组梗阻部位、总胆红素水平、Child-Pugh评分差异有统计学意义（P < 0.05）；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诊断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。 Abstract:Objective To explore the relationship between quantitative analysis of real-time ultrasound elastography and the prognosis of percutaneous transbiliary drainage （PTCD） in elderly patients with advanced malignant obstructive jaundice. Methods Retrospectively selected 112 elderly patients with advanced malignant obstructive jaundice who underwent PTCD treatment in our hospital between May 2017 and May 2021 were divided into poor prognosis （n = 42） and good prognosis groups （n = 70） according to their prognosis. We compared the clinical data of the two groups, the quantitative indexes of real-time ultrasound elastography before and after PTCD, analyzed the correlation between the quantitative indexes of real-time ultrasound elastography and Child-Pugh score, the quantitative indexes of real-time ultrasound elastography after PTCD and the prognosis of PTCD in elderly patients with advanced malignant obstructive jaundice, and drew the receiver operating characteristic （ROC） curve, and evaluated the value of real-time ultrasound elastography quantitative indicators for the prognosis of elderly patients with advanced malignant obstructive jaundice after PTCD. Results There were statistically significant differences in the site of obstruction, Child-Pugh score, and total bilirubin level between the two groups （P < 0.05）. The mean value of strain of real-time postoperative ultrasound elastography quantitative index of PTCD in the poor prognosis group was lower than that in the good prognosis group, and the percentage of blue field was higher than that in the good prognosis group （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. Conclusions 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. -
Key words:
- Malignant obstructive jaundice /
- Old age /
- Advanced /
- Real-time ultrasound elastography /
- PTCD /
- Prognosis
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表 1 2组临床资料比较[n（%）]
Table 1. Comparison of clinical data between two groups [n （%）]
临床资料 预后不良组（n = 42） 预后良好组（n = 70） χ2 P 性别 男 24（57.14） 39（55.71） 0.022 0.883 女 18（42.86） 31（44.29） 年龄（岁） 60～70 20（47.62） 45（64.29） 2.994 0.084 >70 22（52.38） 25（35.71） 体质量指数（kg/m2） < 24 27（64.29） 47（67.14） 0.096 0.757 ≥24 15（35.71） 23（32.86） 梗阻长度（cm） < 2.5 24（57.14） 42（60.00） 0.089 0.766 ≥2.5 18（42.86） 28（40.00） 梗阻部位 胆总管上段 23（54.76） 18（25.71） 10.890 0.004* 胆总管中段 12（28.57） 24（34.29） 胆总管下段 7（16.67） 28（40.00） 梗阻时间（d） < 30 27（64.29） 55（78.57） 2.732 0.098 ≥30 15（35.71） 15（21.43） Child-Pugh评分 < 10 25（59.52） 63（90.00） 14.481 <0.001* ≥10 17（40.48） 7（10.00） 总胆红素水平（μmol/L） < 170 6（14.29） 27（38.57） 9.073 0.011* 170～340 26（61.90） 36（51.43） >340 10（23.81） 7（10.00） *P < 0.05。 
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表 2 2组实时超声弹性成像定量指标比较（
$\bar x \pm s $ ）Table 2. Comparison of quantitative indexes of real-time ultrasonic elastography between two groups （
$\bar x \pm s $ ）组别 n 应变均值 蓝色领域百分比（%） PTCD术前 PTCD术后 PTCD术前 PTCD术后 预后不良组 42 103.28 ± 15.69 107.74 ± 17.29 21.82 ± 4.96 25.84 ± 8.06 预后良好组 70 105.84 ± 20.31 119.31 ± 20.45 22.39 ± 5.07 17.26 ± 5.24 t 0.701 3.066 0.581 6.829 P 0.485 0.003* 0.563 < 0.001* *P < 0.05。
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表 3 实时超声弹性成像定量指标与Child-Pugh评分的相关性
Table 3. Correlation between quantitative indexes of real-time ultrasonic elastography and child-pugh scores
项目 应变均值 蓝色领域百分比 Child-Pugh评分 r −0.392 0.303 P < 0.001 < 0.001
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表 4 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
Table 4. Relationship between quantitative indexes of real-time ultrasonic elastography and prognosis
因素 β S.E. Waldχ2 P OR 95%CI 应变均值 −0.701 0.175 16.025 < 0.05 0.496 0.315～0.782 蓝色领域百分比 2.736 0.502 29.696 < 0.05 15.419 12.111～19.631 注：因变量赋值：实时超声弹性成像定量指标以平均值为界，≤ 平均值 = 1，﹥平均值 = 2。
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表 5 实时超声弹性成像定量对老年晚期恶性梗阻性黄疸患者PTCD预后的诊断价值
Table 5. Quantitative diagnostic value of real-time ultrasonic elastography in assessing the prognosis of PTCD
指标 AUC 95%CI Z统计 P 截断值 敏感度 特异度 应变均值 0.651 0.548～0.753 2.877 < 0.001* 118.77 73.81% 54.29% 蓝色领域百分比 0.830 0.743～0.917 7.413 < 0.001* 22.31 % 71.43% 85.71% 联合预测 0.862 0.792～0.932 10.148 < 0.001* / 88.10% 71.43% *P < 0.05。
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[1] Rizzo A,Ricci A D,Frega G,et al. How to Choose Between Percutaneous Transhepatic and Endoscopic Biliary Drainage in Malignant Obstructive Jaundice: An Updated Systematic Review and Meta-analysis[J]. In Vivo,2020,34(4):1701-1714. doi: 10.21873/invivo.11964 [2] 韩山山,赵君会,叶军,等. NRS-2002与MNA-SF营养评估对恶性梗阻性黄疸患者术后生存期的预测价值[J]. 临床肝胆病杂志,2019,35(8):1755-1759. [3] Dhaliwal A,McKeown J,Bhat I. Malignant Melanoma: A Rare Cause of Obstructive Jaundice[J]. J Gastrointest Surg,2021,25(4):1076-1077. doi: 10.1007/s11605-020-04805-1 [4] Shan Q Y,Jiang H,Chen S L,et al. Postsurgical Management of Dilated Biliary Tract in Children: Ultrasound-Guided Percutaneous Transhepatic Cholangial Drainage and Subsequent Percutaneous Ultrasound Cholangiography[J]. Am J Roentgenol,2020,214(6):1377-1383. doi: 10.2214/AJR.19.22225 [5] Qi S,Yan H. Effect of percutaneous transhepatic cholangial drainag+radiofrequency ablation combined with biliary stent implantation on the liver function of patients with cholangiocarcinoma complicated with malignant obstructive jaundice[J]. Am J Transl Res,2021,13(3):1817-1824. [6] 张雪惠,陈达丰,陈月凤. 高龄恶性梗阻性黄疸支架治疗的预后影响因素分析[J]. 肝脏,2017,22(4):345-348. doi: 10.3969/j.issn.1008-1704.2017.04.019 [7] 樊文莉,邢艳丽,刘晓晖. 实时超声弹性成像及其参数对宫颈癌的诊断价值[J]. 实用癌症杂志,2020,35(3):468-471. doi: 10.3969/j.issn.1001-5930.2020.03.034 [8] 孙建明,郑媛媛,王谷一,等. 实时超声弹性成像技术诊疗梗阻性黄疸的应用价值研究[J]. 中国现代医学杂志,2017,27(9):95-98. doi: 10.3969/j.issn.1005-8982.2017.09.020 [9] 李刚,毛谅,凡银银,等. 低位恶性梗阻性黄疸患者术前减黄临床疗效观察[J]. 肝胆外科杂志,2019,27(1):27-30. [10] 滕才钧,邓燕云,韦建林. 18F-FDG PET/CT联合MR胰胆管造影多模态显像诊断良恶性梗阻性黄疸[J]. 中国医学影像技术,2019,35(3):390-394. [11] Varadarajulu S. Endoscopic ultrasound-guided biliary drainage for palliation of malignant obstructive jaundice[J]. Gastroenterol Hepatol (N Y),2019,15(2):105-107. [12] 陈伟伟,黄坤,刘锐,等. 经皮肝穿刺胆管引流术联合胆道支架植入术治疗高位恶性梗阻性黄疸的效果及预后影响因素分析[J]. 临床肝胆病杂志,2019,35(3):559-564. doi: 10.3969/j.issn.1001-5256.2019.03.021 [13] Yang H C,Huang S Y,Wu C C,et al. Delayed repair of post-hepatectomy bile duct injury by ducto-jejunostomy directly through a percutaneous transhepatic cholangial drainage tract: An easy alternative[J]. Asian J Surg,2021,44(6):926-927. doi: 10.1016/j.asjsur.2021.04.007 [14] 迟长昆,张坤. PTCD术与ERCP术治疗高位恶性梗阻性黄疸的临床效果及对肝功能的影响对比[J]. 肝胆外科杂志,2019,27(4):285-288. doi: 10.3969/j.issn.1006-4761.2019.04.014 [15] 张晓彤,尹丽,郭丽苹. 超声组织弥散定量分析技术评估乳腺癌术前TAC化疗者肝脏损伤的价值研究[J]. 临床超声医学杂志,2019,21(1):33-36. doi: 10.3969/j.issn.1008-6978.2019.01.015 [16] 崔海珺,黄清华,罗文. 实时超声弹性成像技术在肝纤维化程度评估中的应用[J]. 深圳中西医结合杂志,2019,29(22):65-66. doi: 10.16458/j.cnki.1007-0893.2019.22.032 [17] 赵佳琦,章建全,赵璐璐,等. 实时超声弹性成像技术评价不同功率微波消融致兔骨骼肌急性损伤后修复的动态变化[J]. 第二军医大学学报,2019,40(9):970-976. doi: 10.16781/j.0258-879x.2019.09.0970 [18] 叶蕾,王立平,王心宇,等. 实时剪切波弹性成像对乳腺小肿块的各向异性与良恶性的评估价值[J]. 放射学实践,2019,34(3):337-341. doi: 10.13609/j.cnki.1000-0313.2019.03.019 [19] 于慧敏,唐缨,赵静雯,等. 组织弥散定量分析技术评价脑死亡所致供肝损伤的研究[J]. 中华超声影像学杂志,2019,28(1):55-59. doi: 10.3760/cma.j.issn.1004-4477.2019.01.012 [20] 段海珊,蒋黎,刘慧敏,等. 实时超声弹性成像在诊断慢性乙肝肝纤维化程度中的应用价值[J]. 西部医学,2019,31(11):1757-1761. doi: 10.3969/j.issn.1672-3511.2019.11.025 [21] 郭佳. 实时超声弹性成像技术对梗阻性黄疸定量化的初步研究[D]. 上海: 第二军医大学, 2013. -
