肝功能评级指标预测肝硬化患者食管静脉曲张程度价值分析  

Noninvasive indexes of liver function in prediction of esophageal varices in patients with liver cirrhosis

作　　者：戴光荣[1] 刘文娜[2] 李蓉[3] 

机构地区：[1]延安大学附属医院消化内科二病区,陕西省延安市716000 [2]延安大学附属医院 [3]西安市第一医院消化内科

出　　处：《实用肝脏病杂志》2013年第3期217-219,共3页Journal of Practical Hepatology

基　　金：延安大学附属医院研究生创新基金项目(编号:10YJ11)

摘　　要：目的探讨门静脉内径(PV)、血清钠(Na+)水平、凝血酶原时间(PT)、Child-Pugh评分(CPS)、终末期肝病模型(MELD)及MELD-Na评分对预测食管静脉曲张(EV)程度的意义。方法回顾性分析96例肝硬化患者的临床资料,计算Child-Pugh分级、CPS、MELD及MELD-Na评分。根据胃镜检查结果将EV程度分为轻、中、重度三组,分析以上各指标与EV程度的关系,并运用受试者工作特征曲线下面积(AUC)评价上述无创性指标预测中重度EV的能力。结果 EV程度与Child-Pugh分级或评分、PV、MELD评分及MELD-Na评分均呈正相关(r值分别为0.281、0.371、0.302、0.500、0.537,P均<0.05);与血清钠呈负相关(r=-0.574,P<0.05)。Na+水平的AUC为0.780,当Na+水平<133.25mmol/L时预测中重度EV的敏感度为97.7%,特异度为76.9%。结论 Child-Pugh分级和评分、PV、Na+水平、MELD及MELD-Na评分均能较好地反映EV程度;Na+水平是预测中重度EV较敏感的无创性指标。Objective To investigate the diameter of portal vein（PV）,serum sodium（Na＋） level,prothrombin time（PT）,Child-Pugh score（CPS）,model of end-stage liver disease（MELD） and MELD-Na score in prediction of esophageal varices in cirrhotic patients.Methods A retrospective analysis on clinical features in 96 cirrhotic patients was performed,including the liver function indexes such as CPS,PV,serum Na＋,MELD and MELD-Na score,and the degree of esophageal varices（i.e.mild,moderate and severe） determined by endoscopy.The correlations between liver function indexes and esophageal varices were analyzed.The ability of liver function indexes in predicting EV was evaluated by the area under the receiver operating characteristic（ROC）curves（AUC）.Results The degree of EV was positively correlated to Child-Pugh class,portal vein diameter,Child-Pugh score,MELD and MELD-Na score（r were 0.281,0.371,0.302,0.500 and 0.537,respectively,P0.05）,but was negatively correlated to serum sodium（r=-0.574,P0.05）;The AUC of Na＋ level was 0.780.When Na＋ level was less then 133.25mmol/L as the cut-off value,its sensitivity（97.7%） and specificity（76.9%）were both the highest in predicting moderate or severe EV.Conclusion The Child-Pugh class and score,portal vein diameter,Na＋ level,MELD and MELD-Na score are useful in reflecting the degree of esophageal varices.Furthermore,Na＋ level is much effective in predicting the presence of moderate or severe EV.

关 键 词：肝硬化 食管静脉曲张 CHILD-PUGH评分 终末期肝病模型 

分 类 号：R575.2[医药卫生—消化系统]