无创评估肝硬化患者食管和(或)胃底静脉曲张因素的分析  

Noninvasive parameters for diagnosing esophageal and/or gastric fundus varices in patients with liver cirrhosis

作　　者：李琴[1] 苏强[1] 王婧[1] 李卉慧[1] 马颖杰[1] 赵志海[1] 钱林学[1] 曹邦伟[1] 贾继东[1] 王宝恩[1] 

机构地区：[1]首都医科大学附属北京友谊医院肿瘤科,北京100050

出　　处：《首都医科大学学报》2011年第3期426-430,共5页Journal of Capital Medical University

摘　　要：目的探讨无创评估肝硬化患者有无食管和(或)胃底静脉曲张的指标或模式。方法收集乙型病毒性肝炎肝硬化患者58例,有食管和(或)胃底静脉曲张的患者34例。检测血常规、肝功能全套项目、凝血因子,同时行B超与胃镜的检查。结果肝硬化患者静脉曲张组与无静脉曲张组比较:血小板,凝血酶原活动度(prothrombin time activity,PTA),活化部分凝血活酶时间,凝血因子Ⅱ、Ⅴ、Ⅶ、Ⅷ、Ⅸ、Ⅹ,纤维蛋白原,D-二聚体,肝功能指标(前白蛋白、白蛋白、总胆红素、总胆汁酸、胆碱酯酶),门脉宽度,脾脏厚度差异均有统计学意义(P<0.05);Logistic回归分析,LogitP=12.280×门脉宽度+2.901×脾脏厚度-0.145×PTA-17.746,P为预测肝硬化患者发生静脉曲张的概率,预测准确率为68.0%,敏感度为69.2%,特异度为66.6%。Child-PughA级患者静脉曲张组与无静脉曲张组比较:PTA,D-二聚体,凝血因子Ⅱ、Ⅸ,血小板,脾脏厚度,门脉宽度差异有统计学意义(P<0.05)。结论 PTA、脾脏厚度、门脉宽度可能有助于预测乙肝肝硬化患者有无食管和(或)胃底静脉曲张。Objective To investigate noninvasive parameters or model for diagnosing esophageal and/or gastric fundus varices in patients with liver cirrhosis.Methods Data of 58 patients with liver cirrhosis caused by hepatitis B were collected,34 patients had esophageal and/or gastric varices.All patients were classified according to Child-Pugh grade（32 Child-Pugh-A,13 Child-Pugh-B,13 Child-Pugh-C）.The laboratory Variables including coagulation factors and liver function tests were performed.Spleen thickness and portal vein width were measured on ultrasonography.Endoscopy was used to detect the esophageal and/or gastric fundus varices.Results Patients with liver cirrhosis were divided into varices group and non-varices group,differences in platelet,prothrombin time activity（PTA）,activated partial thromboplastin time,coagulation Factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ,fibrinogen,D-dimer,liver function factors（prealbumin,albumin,total bilirubin,total bile acid,cholinesterase）,spleen thickness,and portal vein width between two groups were statistically significant（P0.05）.Through Logistic regression analysis,PTA,portal vein width,spleen thickness were the factors which help discriminating esophageal and/or gastric fundus varices existing or not in patients with liver cirrhosis,Logit P=12.280×portal vein width＋2.901×spleen thickness-0.145×PTA-17.746,predicting accuracy was 68.0%,sensitivity was 69.2%,specificity was 66.6%.Patients classified into Child-Pugh A were also divided into varices group and non-varices group,differences in PTA,D-dimer,coagulation factor Ⅱ,Ⅸ,platelet,spleen thickness,portal vein width between two group were statistically significant（P0.05）.Conclusion PTA,portal vein width,and spleen thickness may help discriminate presence or absence of esophageal and/or gastric fundus varices in patients with liver cirrhosis.

关 键 词：肝硬化 凝血因子 食管静脉曲张 胃底静脉曲张 

分 类 号：R575.2[医药卫生—消化系统]