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肝硬度×脾脏直径/血小板评分对肝硬化食管静脉曲张的预测价值
Value of liver stiffness-spleen diameter-to-platelet ratio score in predicting esophageal varices in patients with liver cirrhosis
文章发布日期:2018年09月30日  来源:  作者:周佳美,班志超,李艳,等  点击次数:266次  下载次数:31次

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【摘要】:目的探讨肝硬度×脾脏直径/血小板评分(LSPS)预测肝硬化食管静脉曲张(EV)的临床价值。方法收集2012年10月-2017年8月于保定市第二中心医院就诊的肝硬化患者76例,分为EV组(n=32)和非EV组(n=44)。所有患者行肝功能、血常规、凝血象检查,行胃镜检查有无静脉曲张及程度,行肝硬度检查,并计算肝脏血清学纤维化指标AST与PLT比值(APRI)、FIB-4、LSPS。计量资料2组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验,相关性分析采用Spearman相关分析。绘制受试者工作特征曲线,选取敏感度和特异度之和最大值对应的LSPS为最佳界值。结果EV组PLT值低于非EV组(Z=-6.932,P<0.01),EV组脾脏直径、肝硬度、LSPS明显高于非EV组(Z值分别为-4.566、-6.575 、-7.323 ,P值均<0.01);脾脏直径、肝硬度和LSPS与EV的rs分别为0.537、0.759、0.775,P值均<0.001;中度EV患者LSPS明显高于轻度患者[6.50(5.71~920) vs 4.63(2.12~6.13), Z=-2.010, P=0.044];LSPS诊断EV的灵敏度为100%,特异度为93.2%,阳性预测值为91.4%,阴性预测值为100%,正确率为96.1%,Youden指数为93.2%,受试者工作特征曲线下面积及95%可信区间为0.994(0.985~1004),阈值为1.59,提示LSPS>1.59考虑为肝硬化患者有食管静脉曲张,如<1.59可暂时不必胃镜检查。结论LSPS对肝硬化患者有无EV可以提供一定的预测价值。
【Abstract】:ObjectiveTo investigate the value of liver stiffness-spleen diameter-to-platelet ratio score (LSPS) in predicting esophageal varices (EV) in patients with liver cirrhosis. MethodsA total of 76 patients with liver cirrhosis who visited The Second Central Hospital of Baoding from October 2012 to August 2017 were enrolled and divided into EV group with 32 patients and non-EV group with 44 patients. Blood samples were collected from all patients for liver function test, routine blood test, and coagulation test. Gastroscopy was performed to evaluate the presence or absence of EV and the degree of EV. Liver stiffness was measured, and aspartate aminotransferase-to-platelet ratio index, fibrosis-4, and LSPS were calculated. The Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was also performed. The receiver operating characteristic (ROC) curve was plotted to select LSPS corresponding to the maximum sum of sensitivity and specificity as the optimal cut-off value. ResultsCompared with the non-EV group, the EV group had a significantly lower platelet count (Z=-6.932, P<0.01) and significantly higher spleen diameter, liver stiffness, and LSPS (Z=-4.566, -6.575, and -7.323, all P<0.01). Spleen diameter, liver stiffness, and LSPS were positively correlated with EV (rs=0.537, 0.759, and 0.775, all P<0.001). The patients with moderate EV had a significantly higher LSPS than those with mild EV [6.50 (5.71-9.20) vs 4.63(2.12-6.13), Z=-2.010, P=0.044]. At the optimal cut-off value of 1.59, LSPS had a sensitivity of 100%, a specificity of 93.2%, a positive predictive value of 91.4%, and a negative predictive value of 100% in the diagnosis of EV, with an accuracy of 96.1%, a Youden index of 93.2%, and an area under the ROC curve of 0.994 (95% confidence interval: 0.985-1.004), suggesting that LSPS >1.59 showed the possibility of EV in cirrhotic patients and gastroscopy was unnecessary for patients with LSPS <1.59. ConclusionLSPS has a certain value in predicting the presence or absence of EV in patients with liver cirrhosis.
【关键字】:肝硬化; 食管和胃静脉曲张;诊断
【Key words】:liver cirrhosis; esophageal and gastric varices; diagnosis
【引证本文】:ZHOU JM, BAN ZC, LI Y, et al. Value of liver stiffness-spleen diameter-to-platelet ratio score in predicting esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol, 2018, 34(11): 2341-2344. (in Chinese) 周佳美, 班志超, 李艳, 等. 肝硬度×脾脏直径/血小板评分对肝硬化食管静脉曲张的预测价值[J]. 临床肝胆病杂志, 2018, 34(11): 2341-2344.

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