摘要
目的总结原发性胆汁性肝硬化(PBC)患者食管静脉曲张特点,探索食管静脉曲张发生的无创预测指标。方法研究对象为首都医科大学附属北京佑安医院肝病消化中心2010年1月至2014年12月期间住院治疗的122例PBC患者,常规电子胃镜检查明确食管静脉曲张程度;应用Logistic回归分析血常规、肝功能、凝血功能、自身抗体、免疫球蛋白、腹部增强CT血管重建、腹部彩色多普勒超声检查测量门静脉(PV)、脾静脉(SV)直径以及Child-Pugh评分、MELD评分以及Mayo评分共18项指标对预测PBC患者食管静脉曲张发生的价值。结果 122例PBC患者中,13%(16/122)无食管静脉曲张,87%(106/122)具有不同程度的食管静脉曲张。PBC患者有食管静脉曲张和无食管静脉曲张两组患者中,Mayo评分、白蛋白、胆碱酯酶、血小板计数、门静脉和脾静脉直径具有统计学差异;多因素分析显示,脾静脉直径在两组之间具有统计学差异,P=0.016。ROC曲线下面积为0.843,当取截断值为SV=8.5 mm时,灵敏度72%、特异度92.9%、阳性预测值98.6%、阴性预测值31.7%。结论脾静脉内径可较好的预测PBC患者食管静脉曲张发生的风险;而既往国外报道的具有预测价值的血小板计数、Mayo评分在本研究中未显示出预测价值。
Objective To summarize the characteristics and to explore the non-invasive predictors of esophageal varices in patients with primary biliary cirrhosis （PBC）. Methods A total of 122 hospitalized PBC patients in department of Gastroenterology and Hepatology, Beijing You＇ an Hospital, Capital Medical University were retrospectively enrolled in our study. The degree of esophageal varices was judged by endoscopy. Eighteen indications including Blood routine examination, liver function, coagulation function, autoantibody, Immunoglobulin, the diameters of portal vein and splenic vein measured by abdominal enhanced CT vascular remolding or abdominal color doppler sonography, Child-Pugh score, model of end stage of liver disease （MELD） score and Mayo score were analyzed by logistic regression to identify the predictors of esophageal varices in PBC patients. Results Of the 122 PBC patients, 13% （16/122）were found no esophageal varices and 87% （106/122）were found with mild to severe degree esophageal varices. Mayo score, Albumin, Cholinesterase, Platelet count and the diameters of Portal vein and Splenic vein（SV） were found with statistical difference in univariate analysis, but only the diameter of SV was found with statistical difference in the further multivariate analysis. When the cut-off value of SV was 8.5 millimeter,the area under ROC was 0. 843 and the sensitivity, specificity, positive predictive value and negative predictive value were 72%, 92.9% , 98.6% and 31.7% respectively. Conclusions The diameter of SV could be a good predictor of esophageal varices in patients with PBC. Platelet count and Mayo score had not indicated predication value reported by foreign countries in previous years.
出处
《中华胃肠内镜电子杂志》
2016年第4期156-160,共5页
Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)
基金
北京市医院管理局临床医学发展专项(ZYLX201610)
首都医科大学附属北京佑安医院肝病艾滋病基金(YNKT20160010)
北京市属医院科研培育计划(PX2016054)
关键词
原发性胆汁性肝硬化
食管静脉曲张
脾静脉
预测
无创
Primary biliary cirrhosis
Esophageal varices
Splenic vein
Predictor, Non-invasive
