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肝硬度值和血小板计数/脾脏厚径比率对肝硬化食管胃底静脉曲张程度的预测价值

封爽 冯慧芬 徐晶 余功超 郑珊

引用本文:
Citation:

肝硬度值和血小板计数/脾脏厚径比率对肝硬化食管胃底静脉曲张程度的预测价值

DOI: 10.3969/j.issn.1001-5256.2021.12.018
基金项目: 

中国肝炎防治基金会王宝恩肝纤维化研究基金 (2020006)

详细信息
    通信作者:

    冯慧芬,huifen.Feng@163.com

  • 中图分类号: R575.2

Value of FibroScan and platelet count-to-spleen thickness ratio in predicting the degree of esophageal and gastric varices in liver cirrhosis

Research funding: 

Wang Baoen Liver Fibrosis Research Foundation of China Hepatitis Prevention Foundation (2020006)

  • 摘要:   目的  探讨瞬时弹性成像技术(FibroScan)和血小板计数与脾脏厚径比率(PC/ST)对肝硬化食管胃底静脉曲张(EGV)程度的预测价值。  方法  选取2017年1月—2020年9月于郑州大学第五附属医院入院3 d内接受FibroScan、彩色多普勒超声、电子胃镜及血生化检查的肝硬化患者210例,以电子胃镜检查结果为“金标准”分为无、轻度、中度、重度EGV组。计量资料多组间比较采用One-Way ANOVA检验或Kruskal-Wallis H检验,并绘制肝硬度值(LSM)、PC/ST及LSM+PC/ST受试者工作特征曲线(ROC曲线),通过DeLong法比较各指标ROC曲线的诊断性能。  结果  无、轻、中、重度EGV组的LSM(F=32.00,P<0.01)和PC/ST值(H=49.58,P<0.01)组间比较差异均有统计学意义。轻度EGV组LSM、PC/ST、LSM+PC/ST的ROC曲线下面积(AUC)分别为0.762、0.656、0.770,阳性预测值及阴性预测值分别为75.4%、75.0%,60.2%、75.8%,82.5%、65.4%;中度EGV组LSM、PC/ST、LSM+PC/ST的AUC分别为0.841、0.796、0.896,阳性预测值及阴性预测值分别为86.1%、79.7%,68.0%、80.5%,74.1%、90.2%;重度EGV组LSM、PC/ST、LSM+PC/ST的AUC分别为0.834、0.830、0.903,阳性预测值及阴性预测值分别为80.5%、82.5%,71.4%、83.6%,79.5%、85.0%。PC/ST与LSM+PC/ST预测轻、中、重度EGV的AUC组间比较,差异均有统计学意义(Z值分别为2.66、2.71、2.37,P值分别为0.007、0.007、0.018)。  结论  LSM、PC/ST、LSM+PC/ST对肝硬化合并中重度EGV具有较好的预测价值。

     

  • 图  1  LSM、PC/ST、LSM+PC/ST预测不同程度食管静脉曲张的ROC曲线

    注:a,轻度食管静脉曲张;b,中度食管静脉曲张;c,重度食管静脉曲张。

    表  1  LSM、PC/ST与食管静脉曲张程度的关系

    分组 例数 LSM(kPa) PC/ST
    无静脉曲张组 60 16.60±5.03 2.74(1.82~5.01)
    轻度静脉曲张组 61 21.07±4.64 2.06(1.45~2.93)
    中度静脉曲张组 45 25.25±6.791)2) 1.44(0.91~2.00)1)2)
    重度静脉曲张组 44 28.53±9.711)2) 1.07(0.72~1.75)1)2)
    统计值 F=32.00 H=49.58
    P <0.01 <0.01
    注:与无食管静脉曲张组相比,1) P<0.01;与轻度食管静脉曲张组相比,2) P<0.01。
    下载: 导出CSV

    表  2  LSM、PC/ST、LSM+PC/ST对各组食管静脉曲张程度的预测价值

    分组 AUC 截断值 敏感度(%) 特异度(%) 95% CI 阳性预测值(%) 阴性预测值(%)
    轻度静脉曲张组
      LSM 0.762 18.9 75.4 75.0 0.675~0.849 75.4 75.0
      PC/ST 0.656 3.70 86.9 41.7 0.558~0.754 60.2 75.8
      LSM+PC/ST 0.7701) 54.1 88.3 0.687~0.854 82.5 65.4
    中度静脉曲张组
      LSM 0.841 22.5 68.9 91.7 0.762~0.922 86.1 79.7
      PC/ST 0.796 1.95 75.6 73.3 0.711~0.880 68.0 80.5
      LSM+PC/ST 0.8961) 88.9 76.7 0.836~0.956 74.1 90.2
    重度静脉曲张组
      LSM 0.834 21.5 75.0 86.7 0.748~0.920 80.5 82.5
      PC/ST 0.830 1.81 79.5 76.7 0.752~0.909 71.4 83.6
      LSM+PC/ST 0.9031) 79.5 85.0 0.848~0.959 79.5 85.0
    注:与PC/ST相比,1) P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2021-05-29
  • 录用日期:  2021-07-07
  • 出版日期:  2021-12-20
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