肝脾超声波指标预测乙肝肝硬化食管静脉曲张

[摘要] 目的 遴选肝硬化食管静脉曲张(EV)的无创性诊断指标并建立相应诊断模型。方法 回顾性分析203例乙肝肝硬化患者资料，统计学分析人口学及血液常规、生化指标、超声波指标，初步建立诊断模型。结果 患者年龄、肝脏超声评分、脾脏厚度（脾厚）、血清ALT、Alb、血小板/脾脏比值相关性较大，在轻度和显著EV患者中差异有显著性；门脉内径、脾肋下长度、Plt、GGT、AST及WBC也有相关性；Logistic回归分析表明肝脏超声、脾厚及年龄预测EV状态，ROC曲线下面积0.799，食管静脉曲张指数（EVI）－0.42适合作为筛选诊断截断值，灵敏度80.2%、特异度73.5%；26.6％患者EVI < -1.31，阴性预告值 87.0％，无重度EV患者；29.1%患者EVI > 0.45，阳性预告值78.0％，无EV患者13.6%。应用脾厚预测EV，超过1/3患者免除内窥镜检查，脾厚<39mm的NPV 90.2%, 仅2.4%患者有重度EV，89.7%脾厚>58mm患者存在不同程度EV。结论 肝脏超声评分、脾厚及年龄联合诊断模型可有效筛选、预测EV状态，脾厚<39mm可基本排除食管静脉曲张可能性。

Ultrasonic Indexes of Liver and Spleen Effectively Screening and Predicting Esophageal Varices in Patients with Hepatitis B Virus-Related Cirrhosis.

Objective: To screen non-invasive indexes and establish a diagnosis model for screening and predicting EV. Methods: Two hundreds and three HBV-C patients were retrospectively investigated. Patients’ hematologies, serum biochemical index, scores of ultrasonic examination were statistically analyzed. A novel model was established by Stepwise Logistic Regression Analysis. Results: Patients’ age，liver ultrasonic score, spleen thickness between ribs, alanine aminotransferase, albumin and ratio of blood platelet/spleen thickness were correlated with EV stages significantly, and also statistically different between patients with mild and significant EV. Other related indexes included diameter of Portal Vein, spleen length below ribs, blood platelet, prothrombin time, γ-glutamyltransferase, aspartate aminotransferase and white blood cell. Logistic regression analysis showed age, liver ultrasonic score and spleen thickness as indexes for predicting EV stages. Area under receiver operation curve of Model was 0.799. EV index (EVI) of -0.42 for model was suitable for screening, with specificity 73.5%, sensitivity 80.2%. Nearly 27% of patients’ EVI were lower than -1.31, with 87.0% negative predictive value (NPV), no severe EV in missed diagnosis patients. About 29.1% of patients’ EVI were upper than 0.45, with positive predictive value 78%, and 13.6% without EV in misdiagnosis patients. With single spleen thickness predicted, about one third patients would be free from endoscopy. Patients with spleen thickness lower than 39mm predicted EV with NPV 90.2%, and only 2.4% patients with severe EV. Nearly 90% of patients with spleen thickness upper than 54mm were confirmed with different degree of EV. Conclusions: Model consisted of age, liver ultrasonic scores and spleen thickness effectively screened and predicted EV stages. Patients with spleen thickness lower than 39mm could be excluded from EV.