摘要
目的探讨乙型肝炎肝硬化患者食管静脉曲张(EV)程度的无创性判断指标。方法临床诊断为乙型肝炎肝硬化的患者118例,以胃镜检查结果为金标准分为无EV、轻度EV、中度EV、重度EV。用非条件Logistic回归模型从性别、年龄、肝功能分级、血小板、凝血酶原时间、血浆清蛋白、总胆红素、肝硬度值(FS值)、门静脉内径、脾脏厚度共10个变量中筛选出与肝硬化EV关系最密切的危险因素。通过受试者工作特征曲线下面积(AUROC)来评估上述有意义的指标预测不同程度EV的准确性。结果多因素非条件Logistic回归分析筛选出的乙型肝炎肝硬化患者并发EV的危险因素有FS值(P<0.01)、脾脏厚度(P<0.01)、门静脉内径(P<0.0 5)。FS值和脾脏厚度判断是否有EV的AUROC分别为0.729、0.733,判断中重度EV的AUROC分别为0.807、0.891,判断重度EV的AUROC分别为0.863、0.961,其对应界值分别为17.5 kPa和40.5 mm、26.8 kPa和45.5 mm、31.5 kPa和52.5mm。结论 FS值、脾脏厚度既能判断乙型肝炎肝硬化患者有无EV,又能很好地判断EV程度。FS值和脾脏厚度联合应用可以更好地判断EV的程度。
Objective To investigate the noninvasive indicators for diagnosing the size of esophageal varices （EV） in patients with HBV-related cirrhosis.Methods The clinical data of 118 patients with HBV-related cirrhosis were retrospectively studied.The patients were divided into no EV group,mild EV group,moderate EV group and severe EV group according to the Gastroscopy results which were used as the gold standard.Unconditional Logistic regression model was used to screen the most closely risk factor for EV from 10 variables which were the gender,age,Child-Pugh grades,platelets,prothrombin time,plasma albumin,total bilirubin,liver stiffness values （liver stiffness measurement by Fibroscan,FS value）,portal vein diameter and thickness of spleen.The area under the receiver operating characteristic curve （AUROC） was used to assess the diagnostic abilities of these risk factors.Results The risk factors were as follows：FS value （P ＜0.01）,thickness of spleen （P ＜ 0.01） and portal vein diameter （P ＜ 0.05）.The AUROCs for predicting the presence of EV with FS and thickness of spleen were 0.729 and 0.733,respectively.The AUROCs for predicting the presence of moderate and severe EV were respectively 0.807 and 0.891.The AUROCs for predicting the presence of moderate and severe EV were separately 0.863 and 0.961.The cut-off value of FS and thickness of spleen were 17.5kPa and 40.5 mm,26.8 kPa and 45.5 mm,and 31.5 kPa and 52.5 rnm,respectively.Conclusions FS value and thickness of spleen could be used to determine the presence of EV as well as determine the degree of EV in patients with HBV-related cirrhosis.Esophageal varices＇degree could be better evaluated when both FS value and thickness of spleen are used together.
出处
《山东医药》
CAS
2013年第43期15-17,共3页
Shandong Medical Journal
基金
国家自然科学基金资助项目(81271845
30800974)
关键词
乙型肝炎
肝硬变
食管静脉曲张
肝硬度值
门静脉内径
脾脏厚度
受试者工作特征曲线下面积
hepatitis B
liver cirrhosis
esophageal varices
liver stiffness values
portal vein diameter
thickness of spleen
area under the receiver operating charateristic curve
