肝硬度×脾脏直径/血小板评分对肝硬化食管静脉曲张的预测价值

周佳美; 班志超; 李艳; 张晓娟; 张咏华; 王明蕾

doi:10.3969/j.issn.1001-5256.2018.11.014

肝硬度×脾脏直径/血小板评分对肝硬化食管静脉曲张的预测价值

DOI: 10.3969/j.issn.1001-5256.2018.11.014

保定市第二中心医院消化内科

基金项目:

保定市科技支撑计划项目(17ZF132)；

详细信息

中图分类号: R575.2
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出版历程
- 出版日期: 2018-11-20

Value of liver stiffness-spleen diameter-to-platelet ratio score in predicting esophageal varices in patients with liver cirrhosis

Research funding:

摘要

摘要:
目的探讨肝硬度×脾脏直径/血小板评分（LSPS）预测肝硬化食管静脉曲张（EV）的临床价值。方法收集2012年10月-2017年8月于保定市第二中心医院就诊的肝硬化患者76例,分为EV组（n=32）和非EV组（n=44）。所有患者行肝功能、血常规、凝血象检查,行胃镜检查有无静脉曲张及程度,行肝硬度检查,并计算肝脏血清学纤维化指标AST与PLT比值（APRI）、FIB-4、LSPS。计量资料2组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ2检验,相关性分析采用Spearman相关分析。绘制受试者工作特征曲线,选取敏感度和特异度之和最大值对应的LSPS为最佳界值。结果 EV组PLT值低于非EV组（Z=-6. 932,P <0. 01）,EV组脾脏直径、肝硬度、LSPS明显高于非EV组（Z值分别为-4. 566、-6. 575、-7. 323,P值均<0. 01）;脾脏直径、肝硬度和LSPS与EV的rs分别为0. 537、0. 759、0. 775,P值均<0. 001;中度EV患者LSPS明显高于轻度患者[6. 50（5. 71<...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 诊断
Abstract:
Objective To investigate the value of liver stiffness-spleen diameter-to-platelet ratio score ( LSPS) in predicting esophageal varices ( EV) in patients with liver cirrhosis. Methods A total of 76 patients with liver cirrhosis who visited The Second Central Hospital of Baoding from October 2012 to August 2017 were enrolled and divided into EV group with 32 patients and non-EV group with 44 patients.Blood samples were collected from all patients for liver function test, routine blood test, and coagulation test. Gastroscopy was performed to evaluate the presence or absence of EV and the degree of EV. Liver stiffness was measured, and aspartate aminotransferase-to-platelet ratio index, fibrosis-4, and LSPS were calculated. The Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Spearman correlation analysis was also performed. The receiver operating characteristic ( ROC) curve was plotted to select LSPS corresponding to the maximum sum of sensitivity and specificity as the optimal cut-off value. Results Compared with the non-EV group, the EV group had a significantly lower platelet count ( Z =-6. 932, P < 0. 01) and significantly higher spleen diameter, liver stiffness, and LSPS ( Z =-4. 566, -6. 575, and-7. 323, all P < 0. 01) .Spleen diameter, liver stiffness, and LSPS were positively correlated with EV ( rs= 0. 537, 0. 759, and 0. 775, all P < 0. 001) . The patients with moderate EV had a significantly higher LSPS than those with mild EV [6. 50 ( 5. 71-9. 20) vs 4. 63 ( 2. 12-6. 13) , Z =-2. 010, P = 0. 044]. At the optimal cut-off value of 1. 59, LSPS had a sensitivity of 100%, a specificity of 93. 2%, a positive predictive value of91. 4%, and a negative predictive value of 100% in the diagnosis of EV, with an accuracy of 96. 1%, a Youden index of 93. 2%, and an area under the ROC curve of 0. 994 ( 95% confidence interval: 0. 985-1. 004) , suggesting that LSPS > 1. 59 showed the possibility of EV in cirrhotic patients and gastroscopy was unnecessary for patients with LSPS < 1. 59. Conclusion LSPS has a certain value in predicting the presence or absence of EV in patients with liver cirrhosis.
- liver cirrhosis /
- esophageal and gastric varices /
- diagnosis

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参考文献(9)

[1] BERZIGOTTI A, SEIJO S, ARENA U, et al. Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis[J]. Gastroenterology, 2013, 144 (1) :102-111.

[2] KIM BK, HAN KH, PARK JY, et al. A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis[J]. Am J Gastroenterol, 2010, 105 (6) :1382-1390.

[3] SHIBATA S, UMEMURA T, YAMAZAKI T, et al. Liver stiffness-spleen size-to-platelet ratio risk score identifies esophageal varices in Japanese patients with chronic hepatitis C[J]. Hepatol Res, 2016, 46 (9) :884-889.

[4] Chinese Society of Hepatology and Chinese Society of Infectious Diseases Chinese, Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[5] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Endoscopy, Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol, 2016, 32 (2) :203-219. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志, 2016, 32 (2) :203-219.

[6] ROULOT D, CZERNICHOW S, LE CLESIAU H, et al. Liver stiffness values in apparently healthy subjects:influence of gender and metabolic syndrome[J]. J Hepatol, 2008, 48 (4) :606-613.

[7] DENG H, QI X, PENG Y, et al. Diagnostic accuracy of APRI, AAR, FIB-4, FI, and King Scores for diagnosis of esophageal varices in liver cirrhosis:A retrospective study[J]. Med Sci Monit, 2015, 21 (42) :3961-3977.

[8] XU XD, XU CF, DAI JJ, et al. Ratio of platelet count/spleen diameter predicted the presence of esophageal varices in patients with schistosomiasis liver cirrhosis[J]. Eur J Gastroenterol Hepatol, 2016, 28 (5) :588-591..

[9] ZHANG DK, CHEN M, GAO YJ, et al. Clinical value of spleen acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index, and aspartate aminotransferase/alanine aminotransferase ratio in predicting esophageal varices in patients with liver cirrhosis[J]. J Clin Hepatol, 2018, 34 (3) :508-512. (in Chinese) 张大鹍, 陈敏, 皋月娟, 等.脾脏ARFI弹性值与APRI及AAR指数对肝硬化食管静脉曲张的预测价值[J].临床肝胆病杂志, 2018, 34 (3) :508-512.

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11.	买买提·瓦司力，高旭升，司俊杰，徐峰. 经皮肝穿引流和支架植入在恶性梗阻性黄疸患者治疗的疗效评价. 新疆医学. 2022(07): 770-772+809 . 百度学术
12.	王颖. 彩超引导经皮穿刺肝胆管引流术治疗梗阻性黄疸的临床研究. 中国医疗器械信息. 2022(15): 123-125 . 百度学术
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22.	傅建英. 内镜介入治疗急性梗阻性黄疸的疗效及对患者炎症因子的影响. 中外医疗. 2021(33): 57-60 . 百度学术
23.	李蔚，王锡斌，崔卫东，杨青，刘会苗，杨金雨，王锡斌. 超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析. 实用肝脏病杂志. 2020(03): 447-450 . 百度学术
24.	李磊. 胆道支架联合经皮肝穿刺胆管引流术对晚期恶性梗阻性黄疸的临床应用价值. 名医. 2020(08): 85-86 . 百度学术
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27.	姜磊，都晓英，孙医学，张大坤，周凯，徐建中，陈芳芳. PTBS术治疗恶性梗阻性黄疸的临床价值及预后因素分析. 蚌埠医学院学报. 2019(09): 1202-1205+1209 . 百度学术
28.	江新华. 64层螺旋CT3D成像与MRCP成像技术对胆道梗阻性疾病的诊断价值. 江西医药. 2019(11): 1336-1340 . 百度学术
29.	吴子鑫，吴申伟. 经皮肝穿刺胆道支架植入治疗对恶性梗阻性黄疸患者肝功能指标、炎症指标的影响. 齐齐哈尔医学院学报. 2019(24): 3098-3099 . 百度学术
30.	武飞. 经皮肝穿刺胆管引流术与Roux-en-Y胆肠吻合术治疗恶性梗阻性黄疸患者的对比研究. 中国药物与临床. 2019(23): 4098-4100 . 百度学术