目的 筛选获得诊断肝硬化食管静脉曲张(EV)无创性诊断指数.方法 回顾性分析经我院临床确诊的202例乙型、丙型肝炎以及酒精性肝病引起的肝硬化患者临床资料,以胃镜确诊EV和高风险EV(HREV),彩色多普勒超声诊断仪测量肝、胆囊、脾及其血管参数,结合临床血液常规和生化指标,进行统计学分析,评价单指标、多指标序贯或同步联合模型对EV、HREV的无创性诊断效能.结果 脾厚径(SPT)诊断EV、HREV的受试者工作特征曲线下面积分别为0.827、0.766,联合指数1(超声评分、SPT、白细胞计数及白蛋白)的诊断EV工作特征曲线下面积为0.873,联合指数2(SPT、白蛋白)的诊断HREV工作特征曲线下面积为0.777.SPT与联合指数1或血小板/脾厚径比值的同步联合可完全排除EV可能,SPT与联合指数1或血小板的序贯联合可完全确定EV诊断,约半数患者可完全明确EV状态.SPT与联合指数2联合诊断可明确10%患者HREV状态.结论 SPT联合基于SPT的指数或血小板可使部分患者完全确定有或无EV,是有效的肝硬化EV无创诊断手段.%Objective To explore the noninvasive indicators for predicting the occurrence of esophageal varices(EV)in patients with liver cirrhosis.Methods A total of 202 patients with liver cirrhosis caused by hepatitis B or C or alcoholic hepatic disease were enrolled in this study.EV and high-risk esophageal varices(HREV)were confirmed in these patients by gastroscopy.The hematological,serum biochemical and ultrasonic parameters of the patients were analyzed,and a model for predicting EV was established by stepwise logistic regression analysis.Results The areas under receiver-operating characteristics curve(AUROC) of splenic thickness(SPT)for detecting EV and HREV were 0.827 and 0.766,respectively.The combined index USWA(SPT,US, WBC and albumin[ALB])showed an AUROC of 0.873 for detecting EV,and the index SPA(combining SPT and ALB)showed an AUROC of 0.777 for detecting HREV. The direct combination of SPT with USWA or with platelet/splenic thickness ratio (PSA)was capable of completely excluding a definite diagnosis of EV,while the sequential combination of SPT with USWA or with platelet was capable of a diagnosis of EV and clarifying the condition of EV in approximately half of the cirrhotic patients in the absence of gastroscopic findings.The combination of SPT and SPA allowed for a definite diagnosis of the condition of HREV in 10% of the cirrhotic patients. Conclusion SPT combined with SPT-derived indexes or platelet status allows for a definite diagnosis of EV in patients with liver cirrhosis to offer a noninvasive option for diagnosis.
展开▼
