肝炎肝硬化患者食管静脉曲张非侵入性预测指标的相关分析

目的探讨肝炎肝硬化患者食管静脉曲张(EV)非侵入性预测指标的临床意义。方法收集2011年2月-2013年1月延安大学附属医院住院的肝炎肝硬化患者64例,所有患者均行胃镜检查,观察EV情况,腹部B超探测门静脉内径(PV)、脾长径(SL)、脾厚度(ST)及腹水程度,并计算脾脏指数(SI),实验室检查凝血酶原时间(PT)、血清白蛋白(Alb)等,肝功能分级采用Child-Pugh分级法。用ROC曲线下面积(AUC)值分析比较各指标与EV及重度EV的相关性。正态数据多组间均数比较采用单因素方差分析,非正态数据多组间比较采用Kruskal-Wallis H检验,采用Kendall等级相关分析。结果 64例肝炎肝硬化患者中,48例有不同程度的EV(75%),其中轻度14例,中度12例,重度22例。不同程度曲张组与无曲张组比较,SI、MELD及MELD-Na评分差异均有统计学意义(P0.05)。轻、重度组比较,PV及SI差异均有统计学意义(P0.05)。轻、中度组比较,SI差异有统计学意义(P0.05)。Alb仅在无曲张组与重度组差异有统计学意义(P0.01)。中、重度组比较,SI差异有统计学意义(P0.05)。PT各组间差异均无统计学意义(P0.05)。随着EV的加重,PV、SI、MELD及MELD-Na评分呈升高趋势,Alb呈下降趋势,而PT无明显变化。EV的程度与Child-Pugh分级呈正相关(t=0.483,P0.05),腹水程度与EV的程度无相关性(P0.05)。SI58.96 cm2时;预测EV的敏感度为91.7%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为80.1%。SI70.56 cm2时,预测重度EV的敏感度为86.4%,特异度为90.5%,阳性预测值为96.5%,阴性预测值为68.9%。结论 EV张的程度与Child-Pugh分级有一定的相关性,PV、Alb、SI、MELD及MELD-Na评分对EV有一定预测价值,但是SI可能做为肝炎肝硬化患者EV及重度EV较敏感的非侵入性预测指标。

Analysis of noninvasive predictive indices of esophageal varices in patients with posthepatitic cirrhosis

Objective To investigate the clinical significance of noninvasive predictive indices of esophageal varices （EV） in patients with posthepatitic cirrhosis. Methods Sixty -four patients with posthepatitie cirrhosis, who were hospitalized in the Affiliated Hospital of Yan＇an Uni- versity from February 2011 to January 2013, were enrolled in this study. All patients underwent gastroseopy to evaluate EV. The diameter of portal vein （PV）, spleen length （SL）, spleen thickness （ST）, and degree of aseites were determined by abdominal ultrasound, and the spleen index （S[） was calculated. Prothrombin time （FF）, serum albumin （Alb）, etc., were measured by laboratory testing. Liver function was assessed by Child - Pugh classification. The correlation between each index and EV or severe EV was analyzed based on area under the receiver operating char- acteristic curve. For normally distributed data, comparison of means between groups was made by one - way analysis of variance ; for non - normally distributed data, comparison between groups was made by Kruskal -Wallis H test; correlation analysis was performed by Kendall＇s rank correlation test. Results Among the 64 patients, 48 （75%） had various degrees of EV, including 14 mild cases, 12 moderate cases, and 22 severe cases. There were significant differences in SI, Model for End -Stage Liver Disease （MELD） score, MELD -Na score between the patients with EV and those without EV （P 〈 0.05）. PV and SI showed significant differences between the mild cases and severe cases （P 〈0.05） ; SI showed significant differences between the mild cases and moderate cases and between the moderate cases and severe cases （ P 〈 0.05 for both）. Alb showed signifi- cant difference only between the patients without EV and severe cases （P 〈 0.01 ）. No significant difference in PT was found between each two patient groups （P 〉0.05）. As the severity of EV increases, PV, SI, MELD score, and MELD - Na score tended to increase, Alb showed a downward trend, and PT demonstrated no significant changes. The degree of EV was positively correlated with Child - Pugh score （ t = 0. 483, P 〈 0.05 ） , and there was no correlation between the degrees of ascites and EV （P 〉 0. 05 ）. When SI was higher than 58.96 cm2 , its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 91.7%, 100.0% , 100.0%, and 80.1% , respectively. When SI was higher than 70.56 cm2 , its sensitivity, specificity, positive predictive value, and negative predictive value for EV were 86.4%, 90.5%, 96.5%, and 68.9%, respectively. Conclusion There is a certain correlation between degree of EV and Child - Pugh score. PV, Alb, SI, MELD score, and MELD - Na score have predictive values for EV, and SI may be used as a sensitive noninvasive predictive index for EV and severe EV in patients with posthepatitic cirrhosis.