肝硬化高危食管曲张静脉出血无创性预测指标的临床研究  

Clinical study of the non-invasive predictors for cirrhotic patients with high risk esophageal varices bleeding

作　　者：张倩倩[1] 王敏[1] 许建明[1] 

机构地区：[1]安徽医科大学第一附属医院消化内科,安徽合肥230022

出　　处：《胃肠病学和肝病学杂志》2012年第3期247-249,共3页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金资助项目(81070337)

摘　　要：目的分析血小板计数、脾脏直径、血小板计数/脾脏直径比值与肝硬化高危食管曲张静脉的关系及其临床价值。方法连续收集近3年肝硬化合并食管静脉曲张住院患者272例。出血组113例,其中行胃镜检查并明确静脉曲张分级的共94例,非出血组159例,其中101例既往无出血史。以胃镜检查发现重度食管曲张静脉和/或红色征作为高危食管曲张静脉标准,将非出血组分为高危组77例,非高危组24例。分析出血组与非出血组、高危组与非高危组之间血小板计数、脾脏直径和血小板计数/脾脏直径比值,并通过绘制受试者工作特征(ROC)曲线计算脾脏直径,预测肝硬化合并高危食管曲张静脉的敏感度、特异度、阳性预测值和阴性预测值。结果出血组与非出血组之间血小板计数、脾脏直径、血小板计数/脾脏直径比较差异均无统计学意义(P>0.05)。高危组脾脏直径大于非高危组(161.96±33.64 vs 139.15±24.29,P=0.024);经ROC曲线分析,脾脏直径预测肝硬化患者合并高危食管曲张静脉的灵敏度为87.9%,特异度为53.8%,阳性预测值为85.9%,阴性预测值为58.1%,ROC曲线下面积为0.71。结论脾脏直径可以作为预测肝硬化高危食管曲张静脉的指标,其灵敏度较好,诊断效率较高,但特异度欠佳。Objective To identify the clinical value of blood platelet count,spleen diameter and platelet count/spleen diameter for the high risk esophageal in cirrhotic patients. Methods A cohort of 272 inpatients with liver cirrhosis and esophageal varices within the latest three years in our hospital was studied,including bleeding group 113 patients and,non-bleeding group 159 patients.By endoscopic screening in non-bleeding group,77 patients with large esophageal varices and（or） varices with red wale signs were considered as high risk esophageal varices,and 24 patients as non-high risk group.The platelet count,spleen diameter and ratio of platelet count/spleen diameter were observed.Receiver operating characteristic curve was constrcuted to find the best sensitivety,specificity,positive predictive value and negative predictive value cut off value of spleen diameter for presence of high risk esophageal varices. Results There were no obvious differences for platelet count,spleen diameter and ratio of platelet count/spleen diameter between bleeding group and non-bleeding group.Larger speen diameter was observed in high risk group compared with no-high risk group（161.96 ± 33.64 vs 139.15±24.29,P=0.024）.Through ROC curve,the spleen diameter cut-off value under 128.5 predicted high risk esophageal with 87.9% sensitivity,53.8% specificity,85.9%positive predictive value,58.1% negative predictive value（ROC curve area： 0.71）. Conclusion The spleen diameter can be used as a non-invasive predictor for high risk esophageal varices with good sensitivity and diagnostic efficiency but suboptimal specificity.

关 键 词：食管曲张静脉 门脉高压 肝硬化 无创性预测指标 

分 类 号：R575.2[医药卫生—消化系统]