血小板计数/胆囊壁厚度对肝硬化食管静脉曲张的预测价值

段志辉; 周胜云; 李增魁; 翟栋材; 周克柔; 孙小芳; 王艳红; 吴义娟; 李素荣; 王继涛

doi:10.3969/j.issn.1001-5256.2019.12.015

血小板计数/胆囊壁厚度对肝硬化食管静脉曲张的预测价值

DOI: 10.3969/j.issn.1001-5256.2019.12.015

1. 邢台市人民医院内镜中心
2. 邢台市人民医院超声科
3. 邢台市人民医院麻醉科
4. 邢台市人民医院肝胆外科

基金项目:

河北省卫生厅重点科技研究计划；

详细信息

中图分类号: R575.2;R446.1
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出版历程
- 收稿日期: 2019-07-15
- 出版日期: 2019-12-20

Value of platelet count and gallbladder wall thickness in predicting esophageal varices in patients with liver cirrhosis

Center of Endoscopy,Xingtai People's Hospital

Research funding:

摘要

摘要: 目的探讨PLT联合胆囊壁厚度（GBWT）对肝硬化食管静脉曲张的预测价值。方法回顾性分析2018年1月-2019年1月于邢台市人民医院临床确诊为乙型肝炎肝硬化患者100例,以胃镜做为判断食管静脉曲张（EV）的金标准,分成非EV组（n=50）和EV组（n=50）。所有患者行腹部超声（包括GBWT、门静脉直径、脾长径）及胃镜检查,以及血清学指标检查。正态分布的计量资料2组间比较采用独立样本t检验;非正态分布的计量资料2组间比较采用Mann Whitney U非参数检验。采用多因素logistic回归分析筛选预测肝硬化EV的无创指标。采用受试者工作特征曲线对比单指标及联合指标对EV的诊断效能。结果 EV组GBWT、门静脉直径、脾长径均高于非EV组（Z值分别为-6. 251、-2. 611,t=-3. 657,P值均<0. 01）,EV组PLT、PGR、PSR均低于非EV组（Z值分别为-5. 403、-7. 018、-6. 015,P值均<0. 001）。GBWT诊断乙型肝炎肝硬化EV的受试者工作特征曲线下面积（AUC）及95%可信区间为0. 861（0. 784～0. 938）,临...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 诊断
Abstract: Objective To investigate the value of platelet count( PLT) and gallbladder wall thickness( GBWT) in predicting esophageal varices( EV) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical data of 100 patients who were diagnosed with hepatitis B cirrhosis in Xingtai People's Hospital from January 2018 to January 2019,and according to the results of gastroscopy as the gold standard for EV,these patients were divided into non-EV group with 50 patients and EV group with 50 patients. All patients underwent abdominal ultrasound( including GBWT,portal vein diameter,and spleen length),gastroscopy,and serological examination. The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. A multivariate logistic regression analysis was used to screen out the noninvasive indices for predicting EV in liver cirrhosis. The receiver operating characteristic( ROC) curve was used to compare the diagnostic efficiency of a single index and combined indices. Results Compared with the non-EV group,the EV group had significantly higher GBWT,portal vein diameter,and spleen length( Z =-6. 251 and-2. 611,t =-3. 657,all P < 0. 01) and significantly lower PLT,PGR,and PLT-to-spleen length ratio( Z =-5. 403,-7. 018,and-6. 015,all P < 0. 001). At the optimal cut-off value of 0. 44 cm,GBWT had an area under the ROC curve( AUC) of 0. 861( 95% confidence interval: 0. 784-0. 938),a sensitivity of 0. 76,a specificity of 0. 86,a positive predictive value of 0. 86,and a negative predictive value of 0. 78 in the diagnosis of EV in hepatitis B cirrhosis. In the diagnosis of EV,PGR had an AUC of 0. 907,a sensitivity of 0. 90,a specificity of 0. 82,a positive predictive value of 0. 91,and a negative predictive value of 0. 84; in the diagnosis of high-risk EV,PGR had an AUC of 0. 823,a sensitivity of0. 68,a specificity of 0. 88,a positive predictive value of 0. 89,and a negative predictive value of 0. 86. With the criteria of GBWT < 0. 47 cm and PLT≥83 × 109/L,46% of all patients( 46/100) had no need for gastroscopy at the moment. Conclusion GBWT is expected to become a new index for predicting EV. Hepatitis B cirrhosis patients with GBWT < 0. 47 cm and PLT≥83 × 109/L have a low probability ofEV,and thus it is recommended to postpone gastroscopy. The combination of these two noninvasive indices can provide a simple preliminary screening tool for clinicians to rule out esophageal varices in cirrhosis.
- liver cirrhosis /
- esophageal and gastric varices /
- diagnosis

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参考文献(16)

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