血清腹水清蛋白梯度与门静脉高压症食管胃底曲张静脉破裂出血的相关性研究

目的探讨血清腹水清蛋白梯度（SAAG）与门静脉高压症食管胃底静脉破裂出血的关系。方法对2009∽2011年冀中能源峰峰集团总医院门静脉高压症并发食管胃底静脉曲张破裂患者36例行选择性断流手术（观察组）,另选取同期40例食管胃底静脉曲张未出血患者作为对照组,2组患者的年龄、门静脉宽度、总胆红素、SAAG、部分凝血活酶时间（APTT）值进行比较,同时对出血手术患者SAAG和门静脉压力梯度（PPG）变化值行直线相关性分析。通过受试者工作特征（ROC）曲线确定血清SAAG对门静脉高压症食管胃底静脉破裂出血的预测值。结果观察组患者SAAG为（24.2±7.1）g/L,对照组患者SAAG为（15.2±6.0）g/L,2组比较差异有统计学意义（P〈0.05）。观察组患者SAAG与PPG变化值两者之间存在正相关（r=0.84,P〈0.01）,利用ROC曲线确定SAAG并预测门静脉高压症食管胃底静脉破裂出血的最佳诊断切点为18.3g/L,敏感度和特异度分别为95.1%和66.1%。结论血清SAAG是预测门静脉高压症食管胃底静脉破裂出血的良好指标。

Correlation study of serum-ascites albumin gradient and esophageal-gastric fundus variceal bleeding of portal hyperten-sion

Objective To investigate the relationship between the serum-ascites albumin gradient（SAAG） and portal hypertension esophageal and gastric fundus variceal bleeding .Methods A cases of 36 esophageal gastric fun-dus variceal bleeding of portal hypertension under going selective devascularization and splenectomy were enrolled from 2009 to 2011 at General Hospital of Fengfeng Jizhong energy group ,at the same time ,40 cases of esophageal and gastric varices without hemorrhage were selected as control group .Age ,portal vein width ,total bilirubin ,SAAG , activated partial thromboplastin time（APTT） were contrasted between two groups .measured preoperative and post-operative SAAG and portal vein pressure gradient （PPG） .The correlation between PPG and SAAG was explored . The value of SAAG predicting esophageal-gastric fundus varices rupture was confirmed by receiver operating charac-teristic curve（ROC） .Results SAAG of bleeding patients was （24 .2 ＆#177; 7 .1）g/L ,SAAG of non bleeding was （15 .2 ＆#177; 6 .0）g/L .The difference of SAAG and APTT in two groups was significant .The changes of SAAG were positive cor-relation with PPG changes （r=0 .84 ,P〈0 .01） .Using receiver operating characteristic curves （ROC） ,the SAAG val-ue predicting esophageal and gastric variceal bleeding was 18 .30 g/L ,sensitivity and specificity were 95 .1% and 66 .1% .Conclusion serum-ascites albumin gradient is a good indicator predicting esophageal and gastric variceal bleeding .