肝硬化患者食管静脉曲张及曲张程度的早期诊断方法分析

目的 对乙肝后肝硬化门脉高压症患者胃镜、B超、血液检验等进行分析，探讨这些检查在肝硬化门脉高压症患者食管静脉曲张诊断中的意义。方法 148例乙肝后肝硬化患者（合并或无门脉高压者）进行电子胃镜、腹部B超、血液检验，观察食管胃底静脉曲张的情况，测量门静脉主干内径、脾静脉内径及脾脏长径之间的差异，并分析这些指标与食管静脉曲张的关系。结果 食管静脉曲张发生率为61％，食管静脉曲张程度越重，伴胃底静脉曲张比例越高；随食管静脉曲张程度不同，门静脉主干内径、脾静脉主干内径及脾脏长径之间存在差异。血小板记数、脾脏长径、血小板记数／脾脏长径、Child—Pugh分级在合并有食管静脉曲张与未合并食管静脉曲张两组中存在明显差异。多因素分析发现，血小板记数／脾脏长径指数与食管静脉曲张的发生密切相关，独立性强。结论 门静脉主十内径、脾静脉内径、脾脏厚度可为判断门静脉高压提供参考，综合上述3点并结合胃镜检查结果可较准确判断有无食管静脉曲张及程度；血小板记数／脾脏长径指数能够较为准确地预测肝硬化门脉高压症食管静脉曲张的发生。

Analysis of methods for early diagnosis of oesophageal varices and its degree in cirrhosis patients

Objective To analyze clinical value of gastroscopy, B ultrasonography and biochemical parameters in the diagnosis of oesophageal varices（OV） in post hepatitis cirrhosis patients with or without portal hypertension. Methods All 148 patients were examined with gastroscipy, uhrasonographic measurement of portal vein and spleen and splenic vein diameter. Platelet count/spleen diameter ratio was also calculated for all patients. Results The prevalence rate of OV was 61%. The severer the degree of esophageal varices was the higher incidence of gastric varices was observed. The diameter of portal vein, spleen diameter, the diameter of splenic vein were different in different degrees of esophageal varices. Platelet count, spleen diameter, platelet count/spleen diameter radio, and Child-Pugh class were significantly different among patients with or without OV. By a multivariate analysis, the platelet count/spleen diameter radio was one independently parameter associated with the presence of OV. Conclusion Diameter of portal and splenic vein, spleen diameter by B ultrasonography can provide valuable suggestion in diagnosis of portal hypertention. But the diagnosis should be confirmed by gastroscopy detection. The platelet count/spleen diameter radio is one of the independently parameters associated with the presence of OV.