血小板计数/脾面积及血小板计数/脾长径比值诊断乙肝肝硬化患者食管静脉曲张的价值

目的 探索血小板计数/脾面积(PC/SA)及血小板计数/脾长径(PC/SD)比值诊断乙肝肝硬化患者食管静脉曲张(EV)的价值。方法 连续纳入2019年4月至2020年2月北京地坛医院诊治的172例乙肝肝硬化患者,均经胃镜、血常规及腹部超声检查,采集血小板计数(PC)、脾长径、脾厚径等数据,计算PC/SA、PC/SD,根据胃镜分为EV组及无EV组,应用受试者工作特征(ROC)曲线评价PC/SA、PC/SD诊断EV的价值,并比较两者的诊断准确性。结果 EV组患者121例,无EV组51例,EV组脾长径、脾厚径显著大于无EV组(P <0.001),EV组PC、PC/SA、PC/SD显著小于无EV组(P<0.001)。PC/SA诊断EV的曲线下面积(AUC)为0.846(95%CI:0.784～0.897),取最优截断值10.29时,敏感性(Se)、特异性(Sp)、阳性预测值(PPV)及阴性预测值(NPV)分别为79.4%、76.5%、88.9%、60.9%,P<0.001；PC/SD的AUC为0.816(95%CI:0.750～0.871),取最优截断值629.65时,Se、Sp、PPV、NPV分别为87.6%、64.7%、85.5%、68.7%,P<0.001。PC/SA诊断准确性优于PC/SD(Z=2.954,P=0.003)。结论 无创模型PC/SA、PC/SD可用于筛查乙肝肝硬化患者EV,PC/SA具有更高的准确性,值得临床关注、推广应用。

Value of platelet count/spleen area and platelet count/spleen diameter ratio for diagnosing esophageal varices in hepatitis B cirrhosis patients

ABSTRACT Objective To explore the value of platelet count/spleen area and platelet count/spleen diameter ratio for diagnosing esophageal varices(EV) in patients with hepatitis B cirrhosis. Methods A total of 172 consecutive patients with hepatitis B cirrhosis from April 2019 to February 2020 at Beijing Ditan hospital were enrolled. All of them were performed by gastroscope, Blood routine examination and abdominal ultrasonography. Platelet count, spleen length diameter and spleen thickness diameter were collected. PC/SA and PC/SD were calculated. According to gastroscope, the patients were divided into EV group and no EV group. Evaluating the value of PC/SA and PC/SD for diagnosing EV by ROC curve. The diagnostic accuracy of two methods was compared. Results There were 121 patients with EV and 51 patients with no EV. The spleen length diameter and spleen thickness diameter in EV group were significantly larger than those in no EV group (P< 0.001). PC, PC/SA and PC/SD in EV group were significantly lower than those in no EV group (P< 0.001).The AUC of PC/SA for diagnosising EV was 0.846(95%CI: 0.784-0.897). When the optimal cutoff value was 10.29, the sensitivity(Se), specificity(Sp), positive predictive value(PPV) and negative predictive value(NPV) were 79.4%, 76.5%, 88.9% and 60.9% respectively, P<0.001.The AUC of PC/SD was 0.816(95%CI: 0.750-0.871). When the optimal cutoff value was 629.65, Se, Sp, PPV and NPV were 87.6%, 64.7%, 85.5% and 68.7% respectively, P<0.001. The diagnostic accuracy of PC/SA was better than that of PC/SD(Z=2.954, P=0.003). Conclusion PC/SA and PC/SD can be used to screen EV in patients with hepatitis B cirrhosis. PC/SA, with higher accuracy, is worthy of clinical attention and application.