신장동맥 저항 지수의 의의: 알코올성 간경변 환자에서 식도정맥류 파열과의 연관성 = The Value of Renal Artery Resistive Indices: Association with Esophageal Variceal Bleeding in Patients with Alcoholic Cirrhosis

다국어 초록 (Multilingual Abstract)

Purpose: To determine whether resistive indices of the renal artery (RIR) or the splenic artery (RIS) can be used as predictors of bleeding in patients with alcoholic liver cirrhosis.
Materials and Methods: According to esophageal variceal bleeding episodes, 33 patients with cirrhosis were divided into two groups, a bleeder group (n=17) and a nonbleeder group (n=16). These two groups were compared with respect to five variables (age, spleen size, Child's score, RIS, and RIR). Sensitivity, specificity, and accuracy for the detection of bleeders were calculated using a cutoff value of 0.7 for RIR.
Results: The mean values of variables were higher for bleeders than for non-bleeders. With the exception of age, four variables were significantly correlated with bleeding (r=0.43 for spleen size; r=0.36 for Child's score; r=0.37 for RIS; p<0.05, respectively; r=0.63 for RIR, p<0.01). Only RIR was found to be significantly a predictive variable for bleeders (adjusted Odds ratio=19.9; 95% confidence interval: 1.3-306, p<0.05) when the RIR was more than 0.7. RIR had a sensitivity of 88.3% and a specificity of 75% with an accuracy of 81.8% at a cutoff value of 0.7 for identifying bleeders.
Conclusion: A high RIR value will be useful in predicating esophageal variceal bleeding in patients with alcoholic liver cirrhosis.

국문 초록 (Abstract)

목적: 신장 동맥 및 비장 동맥 저항 지수가 알코올성 간경변 환자에서 출혈의 지표로 사용될 수 있는지 알아보고자 하였다.
대상과 방법: 식도정맥류 출혈력에 따라 33명의 간경변 환자를 출혈군(17명)과 비출혈군(16명)으로 분류하였다. 이들 두 군에서 나이, 비장 크기, Child 수치, 신장 동맥 저항 지수, 비장 동맥 저항 지수를 비교하였다. 식도 정맥류 출혈을 발견하는 민감도, 특이도, 정확도를 기준점(cutoff value)을 통해 계산하였다.
결과: 변수들의 평균값은 출혈군에서 높았다. 나이를 제외하고 4개의 변수는 출혈과 의미 있는 연관성을 보였다(비장크기: r=0.43, Child 수치: r=0.36, 비장 동맥 저항 지수: r=0.37, 각각 p < 0.05, 신장 동맥 저항 지수: r=0.63, p < 0.01). 이중 신장 동맥 저항 지수는 0.7보다 클 때, 출혈의 높은 예측 인자로 확인되었다(교정 확률비=19.9; 95% 신뢰구간: 1.3-306, p < 0.05). 이때 출혈에 대한 민감도는 88.3%, 특이도는 75%, 정확도는 81.8%였다.
결론: 높은 신장 동맥 저항지수는 알코올성 간경변 환자에서 식도정맥파열을 예측하는데 도움이 된다.

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