脾体积对肝硬化门静脉高压性胃病及其严重程度的预测价值  

Value of spleen volume in predicting portal hypertensive gastropathy and its severity in patients with liver cirrhosis

作　　者：张志强 陈伟 刘波 ZHANG Zhiqiang;CHEN Wei;LIU Bo(Department of Gastroenterology,Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine,Xiangyang,Hubei 441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院消化内科,湖北襄阳441000

出　　处：《临床肝胆病杂志》2023年第4期826-833,共8页Journal of Clinical Hepatology

基　　金：湖北省自然科学基金(2018CFB619)。

摘　　要：目的探讨脾体积(SV)对肝硬化患者门静脉高压性胃病(PHG)及重度PHG的预测价值。方法回顾性分析2018年1月—2022年8月湖北医药学院附属襄阳市第一人民医院收治的168例肝硬化患者临床资料,以胃镜检查结果为“金标准”,将患者分为无PHG组(n=115)和PHG组(n=53),轻度PHG组(n=26)和重度PHG组(n=27),所有患者均行电子胃镜、腹部磁共振及相关血清学检查,获取相关指标及参数。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验。通过多因素Logistic回归分析筛选出PHG、重度PHG的独立危险因素,利用受试者工作特征曲线(ROC曲线)比较相关指标或参数的预测价值。ROC曲线下面积的比较采用Delong检验。结果单因素分析显示:PHG组和非PHG组性别、有无腹水、Hb、PLT、AST、TBil、Alb、PT、INR、Child-Pugh分级、FIB-4评分、King评分、Lok评分、脾长径(SD)、SV、血小板/脾长径(PSDR)、血小板/脾体积(PSVR)比较,差异均有统计学意义(P值均<0.05);轻度PHG组和重度PHG组Hb、PLT、Alb、SD、SV、PSDR、PSVR比较,差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析显示:FIB-4评分(OR=1.280,95%CI:1.009~1.625)和SV(OR=1.007,95%CI:1.001~1.013)是PHG发生的独立危险因素(P值均<0.05);SV(OR=0.990,95%CI:0.980~1.000)是重度PHG发生的独立影响因素(P<0.05)。ROC曲线分析结果显示:在预测PHG发生时,SV的曲线下面积为0.884,高于FIB-4评分的0.825(P<0.05),其最佳临界值为406.82,敏感度为0.774,特异度为0.870;在预测重度PHG发生时,SV的曲线下面积为0.782,最佳临界值为714.63,敏感度为0.593,特异度为0.962。结论SV对PHG和重度PHG的发生均具有较好的预测价值。Objective To investigate the value of spleen volume(SV)in predicting portal hypertensive gastropathy(PHG)and severe PHG in patients with liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of 168 patients with liver cirrhosis who were admitted to Xiangyang No.1 People’s Hospistal Affiliated to Hubei University of Medicine from January 2018 to August 2022,and with the results of gastroscopy as the gold standard,these patients were divided into non-PHG group with 115 patients and PHG group with 53 patients;the PHG group was further divided into mild PHG group with 26 patients and severe PHG group with 27 patients.All patients underwent electronic gastroscopy,abdominal magnetic resonance imaging,and serological examination to obtain related indices and parameters.The group t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.A multivariate Logistic regression analysis was used to screen out the independent risk factors for PHG and severe PHG,and the receiver operating characteristic(ROC)curve was used to compare the predictive value of related indices or parameters.The area under the Roccurve is compared using Delong test.Results The univariate analysis showed that there were significant differences between the PHG group and the non-PHG group in sex,presence or absence of ascites,hemoglobin(Hb),platelet count(PLT),aspartate aminotransferase,total bilirubin,albumin(Alb),prothrombin time,international normalized ratio,Child-Pugh class,FIB-4 score,King score,Lok score,spleen diameter(SD),SV,platelet count/spleen diameter ratio(PSDR),and platelet count/spleen volume ratio(PSVR)(all P<0.05),and there were significant differences in Hb,PLT,Alb,SD,SV,PSDR,and PSVR between the mild PHG group and the severe PHG group(all P<0.05).The multivariate Logistic regre

关 键 词：肝硬化 门静脉高压性胃病 预测 

分 类 号：R575.2[医药卫生—消化系统] R573[医药卫生—内科学]