肝炎肝硬化患者食管静脉曲张非侵入性预测指标的相关分析

刘文娜; 李蓉; 谢元元; 戴光荣

doi:10.3969/j.issn.1001-5256.2014.01.010

肝炎肝硬化患者食管静脉曲张非侵入性预测指标的相关分析

DOI: 10.3969/j.issn.1001-5256.2014.01.010

1. 延安大学附属医院消化科
2. 西安市第一医院消化科

基金项目:

延安大学附属医院研究生创新基金项目(10YJ11)；

详细信息

中图分类号: R575.21
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出版历程
- 收稿日期: 2013-03-25
- 出版日期: 2014-01-20

Analysis of noninvasive predictive indices of esophageal varices in patients with posthepatitic cirrhosis

Department of Gastroenterology, The Affiliated Hospital of Yan'an University

Research funding:

摘要

摘要: 目的探讨肝炎肝硬化患者食管静脉曲张（EV）非侵入性预测指标的临床意义。方法收集2011年2月-2013年1月延安大学附属医院住院的肝炎肝硬化患者64例,所有患者均行胃镜检查,观察EV情况,腹部B超探测门静脉内径（PV）、脾长径（SL）、脾厚度（ST）及腹水程度,并计算脾脏指数（SI）,实验室检查凝血酶原时间（PT）、血清白蛋白（Alb）等,肝功能分级采用Child-Pugh分级法。用ROC曲线下面积（AUC）值分析比较各指标与EV及重度EV的相关性。正态数据多组间均数比较采用单因素方差分析,非正态数据多组间比较采用Kruskal-Wallis H检验,采用Kendall等级相关分析。结果 64例肝炎肝硬化患者中,48例有不同程度的EV（75%）,其中轻度14例,中度12例,重度22例。不同程度曲张组与无曲张组比较,SI、MELD及MELD-Na评分差异均有统计学意义（P<0.05）。轻、重度组比较,PV及SI差异均有统计学意义（P<0.05）。轻、中度组比较,SI差异有统计学意义（P<0.05）。Alb仅在无曲张组与重度组差异有统计学意义（P<0.01）。中、重...
- 肝炎,病毒性,人 /
- 肝硬化 /
- 食管和胃静脉曲张 /
- 预测指标
Abstract: Objective To investigate the clinical significance of noninvasive predictive indices of esophageal varices ( EV) in patients with posthepatitic cirrhosis. Methods Sixty- four patients with posthepatitic cirrhosis, who were hospitalized in the Affiliated Hospital of Yan'an University from February 2011 to January 2013, were enrolled in this study. All patients underwent gastroscopy to evaluate EV. The diameter of portal vein ( PV) , spleen length ( SL) , spleen thickness ( ST) , and degree of ascites were determined by abdominal ultrasound, and the spleen index ( SI) was calculated. Prothrombin time ( PT) , serum albumin ( Alb) , etc., were measured by laboratory testing. Liver function was assessed by Child- Pugh classification. The correlation between each index and EV or severe EV was analyzed based on area under the receiver operating characteristic curve. For normally distributed data, comparison of means between groups was made by one- way analysis of variance; for non- normally distributed data, comparison between groups was made by Kruskal- Wallis H test; correlation analysis was performed by Kendall's rank correlation test. Results Among the 64 patients, 48 ( 75%) had various degrees of EV, including 14 mild cases, 12 moderate cases, and 22 severe cases. There were significant differences in SI, Model for End- Stage Liver Disease ( MELD) score, MELD- Na score between the patients with EV and those without EV ( P < 0. 05) . PV and SI showed significant differences between the mild cases and severe cases ( P < 0. 05) ; SI showed significant differences between the mild cases and moderate cases and between the moderate cases and severe cases ( P < 0. 05 for both) . Alb showed significant difference only between the patients without EV and severe cases ( P < 0. 01) . No significant difference in PT was found between each two patient groups ( P > 0. 05) . As the severity of EV increases, PV, SI, MELD score, and MELD- Na score tended to increase, Alb showeda downward trend, and PT demonstrated no significant changes. The degree of EV was positively correlated with Child- Pugh score ( t = 0. 483, P < 0. 05) , and there was no correlation between the degrees of ascites and EV ( P > 0. 05) . When SI was higher than 58. 96 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 91. 7%, 100. 0%, 100. 0%, and 80. 1%, respectively. When SI was higher than 70. 56 cm2, its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 86. 4%, 90. 5%, 96. 5%, and 68. 9%, respectively. Conclusion There is a certain correlation between degree of EV and Child-Pugh score. PV, Alb, SI, MELD score, and MELD- Na score have predictive values for EV, and SI may be used as a sensitive noninvasive predictive index for EV and severe EV in patients with posthepatitic cirrhosis.
- hepatitis, viral, human /
- liver cirrhosis /
- esophageal and gastric varices /
- prediction index

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参考文献(21)

[1]BURROUGHS AK, TRIANTOS CK, O'BEIRNE J, et al.Predictors of early rebleeding and mortality after acute variceal hemorrhage in patients with cirrhosis[J].Nat Clin Pract Gastroenterol Hepatol, 2009, 6 (2) :72-73.

[2]Chinese Medical Association of Infections Diseases and Parasites;Chinese Medical Association of Hepatology.The programme of prevention and treatment for viral hepatitis[J].Chin J Hepatol, 2000, 8 (6) :324-329. (in Chinese) 中华医学会传染病与寄生虫病学分会、肝病学会.病毒性肝炎防治方案[J].中华肝脏病杂志, 2000, 8 (6) :324-329.

[3] Chinese Medical Association Digestion of Endoscopic Credits.The pilot programme in gastric esophageal varices endoscopic diagnosis and treatment Norms[J].Chin J Dig Endosc, 2004, 21 (3) :149-151. (in Chinese) 中华医学会消化内镜学分会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案 (2003年) [J].中华消化内镜杂志, 2004, 21 (3) :149-151.

[4]WANG HF, DING T, SHANG ZQ, et al.Efficacy of octreotide in maintenance treatment of esophageal and gastric variceal bleeding in patients with liver cirrhosis:a meta-analysis[J].Chin J Clin Pharmacol Ther, 2012, 17 (7) :768-772. (in Chinese) 王华富, 丁汀, 商振球, 等.奥曲肽对肝硬化食管胃底静脉曲张破裂出血维持治疗的Meta分析[J].中国临床药理学与治疗学, 2012, 17 (7) :768-772.

[5]YANG L, HAN GH.Revising consensus in portal hypertension:report of the Baveno V consensus workshop[J].J Clin Hepatol, 2011, 27 (2) :116-118. (in Chinese) 杨力, 韩国宏.最新门脉高压共识 (Baveno V版) [J].临床肝胆病杂志, 2011, 27 (2) :116-118.

[6]DONG LM, HONG WD, WU JS.The use of artificial neural network in predicting large esophageal varices in patients with cirrhosis[J].J Med Res, 2013, 42 (2) :156-159. (in Chinese) 董乐妹, 洪万东, 吴建胜.人工神经网络在肝硬化食管大静脉曲张预测中的应用[J].医学研究杂志, 2013, 42 (2) :156-159.

[7]SCHEPIS F, CAMMA C, NICEFORO D, et al.Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?[J].Hepatology, 2001, 33 (2) :333-338.

[8]ZAMAN A, BECKER T, LAPIDUS J, et al.Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage[J].Arch Intern Med, 2001, 161 (21) :2564-2570.

[9]LI Q, SU Q, WANG J, et al.Noninvasive parameters for diagnosing esophageal and/or gastric fundus varices in patients with liver cirrhosis[J].J Capit Med Univ, 2011, 32 (3) :426-430. (in Chinese) 李琴, 苏强, 王婧, 等.无创评估肝硬化患者食管和 (或) 胃底静脉曲张因素的分析[J].首都医科大学学报, 2011, 32 (3) :426-430.

[10]JIANG ZL, CHEN XP, FU B, et al.Research on the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh's score in patients with liver cirrhosis[J].West China Med J, 2011, 26 (2) :187-188. (in Chinese) 蒋志凌, 陈旭平, 付冰, 等.肝硬化食管静脉曲张程度门脾静脉内径及Child-Pugh分级的关系[J].华西医学, 2011, 26 (2) :187-188.

[11]YANG F, WANG B, LI XH, et al.Logistic regression analysis on related factors of liver cirrhosis with esophageal-gastric varices bleeding[J].J Clin Hepatol, 2006, 22 (4) :269-270. (in Chinese) 杨方, 王彬彬, 李兴海, 等.Logistic回归分析肝硬化食管胃底静脉曲张破裂出血的相关因素[J].临床肝胆病杂志, 2006, 22 (4) :269-270.

[12]ZHENG S, ZHU WM, LIU H, et al.Clinical significance of model for end-stage liver disease in prognostic assessment on patients with decompensated liver cirrhosis[J].Chin Gen Practi, 2008, 11 (6) :938-939. (in Chinese) 郑盛, 朱为梅, 刘海, 等.终末期肝病模型对失代偿期肝硬化患者预后评估的临床意义[J].中国全科医学, 2008, 11 (6) :938-939.

[13]SUMON SM, SUTRADHAR SR, CHOWDHURY M, et al.Relation of different grades of esophageal varices with child-pugh classes in cirrhosis of liver[J].Mymensingh Med J, 2013, 22 (1) :37-41.

[14]OBSTEIN KL, CAMPBELL MS, REDDY KR, et al.Association between model for end-stage liver disease and spontaneous bacterial peritonitis[J].Am J Gastroenterol, 2007, 102 (12) :2732-2736.

[15]FATTAH SA, EL-HAMSHARY NK, KILANY YF, et al.Prognostic and predictive values of meld score, platelet count and pre albumin in patients with compensated and decompensated liver cirrhosis with acute variceal bleeding[J].J Egypt Soc Parasitol, 2012, 42 (2) :443-452.

[16]ZHAN GQ, TAN HB, LI F, et al.Evaluation of model for end stage liver disease for estimation of short-term prognosis in decompensated cirrhosis[J].J Clin Hepatol, 2011, 27 (3) :280-282. (in Chinese) 占国清, 谭华炳, 李芳, 等.终末期肝病模型评估肝硬化失代偿期患者的短期预后[J].临床肝胆病杂志, 2011, 27 (3) :280-282.

[17]ZHENG XL, WANG LZ, WU BL, et al.Value of model for endstage liver disease in prediction of prognosis in patients with decompensated hepatic cirrhosis[J].J Clin Hepatol, 2011, 27 (7) :738-740. (in Chinese) 郑晓丽, 汪良芝, 吴宝利, 等, 终末期肝病模型对肝硬化失代偿期患者预后的预测价值[J].临床肝胆病杂志, 2011, 27 (7) :738-740.

[18]LUCA A, ANGERMAYR B, BERTOLINI G, et al.An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis[J].Liver Transplant, 2007, 13 (8) :1174-1180.

[19]ZHENG S, YIN F, YAN XH, et al.The short-term prognostic value of the model for end stage liver disease including serum sodium in patients with decompensated liver cirrhosis[J].J Clin Hepatol, 2009, 12 (2) :118-120. (in Chinese) 郑盛, 殷芳, 严晓会, 等, MELD-Na模型评分对评估失代偿期肝硬化患者短期预后的临床价值[J].实用肝脏病杂志, 2009, 12 (2) :118-120.

[20]PANG CM, SHU JC, YANG QH, et al.Non-invasive predictive factors of esophageal varices in patients with liver cirrhosis[J].Chin J Gastroenterol Hepatol, 2005, 14 (3) :283-285. (in Chinese) 庞春梅, 舒建昌, 杨绮红, 等.肝硬化患者食管静脉曲张的无创性预测因素分析[J].胃肠病学和肝病学杂志, 2005, 14 (3) :283-285.

[21]WATANABE S, HOSOMI N, KITADE Y, et al.Assessment of the presence and severity of esophagogastric varices by splenic index in patients with liver cirrhosis[J].J Comput Assist Tomogr, 2000, 24 (5) :788-794.

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