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肝硬化食管胃静脉曲张破裂出血(esophagogastric variceal bleeding, EVB)是肝硬化病人最为严重的并发症,发生率为30%~40%,死亡率高达40%,每年5%~10%的肝硬化病人发展为食管静脉曲张(esophageal varices, EV)[1]。电子胃镜是诊断EV的最直观及有效的检查,但该检查为侵入性检查,很多病人耐受性及依从性差,且指南推荐肝硬化病人定期复查胃镜[2],这无疑给病人带来了巨大的精神压力,因此探索发现非侵入性检查方法尤为迫切。本研究通过对血小板计数(platelet count, PC)、脾长径(spleen longitudinal diameter, SD)、血小板计数与脾长径比值(platelet count/spleen longitudinal diameter ratio,PC/SD)、FIB-4指数四项指标的综合评估,旨在探讨各指标对EV的诊断价值。现作报道。
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EV组PC、WBC、PC/SD均低于非EV组,SD、FIB-4、Child-Pugh评分、PT均高于非EV组,差异有统计学意义(P < 0.05~P < 0.01)(见表 1)。
指标 非EV组(n=38) EV组(n=96) t P ALT/(U/L) 94.87±176.78 39.56±26.96 1.92* >0.05 AST/(U/L) 82.39±113.31 53.70±35.06 1.53* >0.05 ALB/(g/L) 34.08±7.22 31.95±6.25 1.70 >0.05 CR/(mmol/L) 64.32±14.77 66.05±28.74 0.46* >0.05 PC/(×109/L) 122.00±53.80 70.39±45.53 5.61 < 0.01 WBC/(×109/L) 4.50±1.52 3.65±2.49 2.41* < 0.05 PT/s 14.36±2.39 15.50±2.92 2.06 < 0.05 INR 1.31±0.24 1.39±0.28 1.43 >0.05 SD/mm 117.58±26.20 154.50±35.11 6.64* < 0.01 Child-Pugh评分/分 7.19±2.05 7.96±1.98 1.99 < 0.05 FIB-4 4.73±3.41 8.88±9.49 3.73* < 0.01 PC/SD 1.15±0.63 0.51±0.43 5.74* < 0.01 *示t′值 表 1 临床指标的比较(x±s)
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ROC曲线分析显示,PC、SD、PC/SD、FIB-4对EV预测的AUC均>0.7, PT、ALT对EV预测的AUC均 < 0.7。提示PC、SD、PC/SD、FIB-4对EV均有一定的诊断价值,PT、ALT对EV诊断的准确性较低;且SD、PC/SD值对预测EV具有相似的诊断效能(见表 2)。
指标 AUC 临界值 95%CI SE P 灵敏度 特异度 PC 0.781 96.50 0.692~0.871 0.046 < 0.01 0.833 0.711 SD 0.811 140.50 0.734~0.889 0.040 < 0.01 0.667 0.816 PC/SD 0.811 0.85 0.726~0.897 0.044 < 0.01 0.875 0.658 FIB-4 0.715 4.05 0.613~0.817 0.052 < 0.01 0.781 0.632 PT 0.611 14.75 0.497~0.725 0.058 >0.05 0.568 0.676 ALT 0.611 40.50 0.500~0.722 0.057 < 0.05 0.646 0.605 表 2 PC、SD、PC/SD、FIB-4单独预测EV的比较
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PC/SD与SD联合对EV预测的AUC为0.822,灵敏度85.4%,特异度71.1%;PC/SD与PC联合对EV预测的AUC为0.811,灵敏度87.5%,特异度65.8%;PC/SD比值与FIB-4对EV预测的AUC为0.811,灵敏度87.5%,特异度65.8%(见表 3)。
指标 AUC 95%CI SE P 灵敏度 特异度 PC/SD+SD 0.822 0.743~0.900 0.040 < 0.01 0.854 0.711 PC/SD+PC 0.811 0.726~0.897 0.044 < 0.01 0.875 0.658 PC/SD+FIB-4 0.811 0.726~0.897 0.044 < 0.01 0.875 0.658 表 3 PC/SD分别与SD、PC、FIB-4联合预测EV的比较
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EV组按是否合并RC分为RC(+)及RC(-)组,比较2组病人的临床资料,结果显示,RC(+)组年龄小于RC(-)组,SD大于RC(-)组,差异有统计学意义(P < 0.05和P < 0.01)(见表 4)。SD对预测EV组病人中RC(+)的AUC为0.705,临界值为151 min,灵敏度为66.1%,特异度为64.5%。SD对EV病人RC的预测有一定的准确性(见图 1)。
指标 RC(-)(n=59) RC(+)(n=37) t P 年龄/岁 55.14±9.97 50.78±10.54 2.04 < 0.05 ALT/(U/L) 45.22±36.39 36.02±18.31 1.64* >0.05 AST/(U/L) 60.19±38.38 49.63±32.48 1.44 >0.05 ALB/(g/L) 31.56±6.12 32.19±6.37 -0.47 >0.05 CR/(mmol/L) 62.81±11.76 68.10±35.48 -0.87 >0.05 PC/(×109/L) 71.11±43.91 69.93±46.88 0.12 >0.05 WBC/(×109/L) 3.13±1.35 3.97±2.96 -1.60 >0.05 PT/s 12.27±2.87 15.65±2.97 -0.61 >0.05 INR 1.38±0.28 1.39±0.29 -0.25 >0.05 SD/mm 139.22±29.98 164.08±34.91 -3.58 < 0.01 Child评分/分 8.00±2.32 7.93±1.76 0.16 >0.05 FIB-4 9.83±8.65 8.29±10.00 0.78 >0.05 PC/SD 0.56±0.41 0.48±0.45 0.95 >0.05 *示t′值 表 4 EV组病人有无RC的临床特征分析(x±s)
PC、SD、PC/SD、FIB-4对肝硬化食管静脉曲张的诊断价值
Diagnostic value of PC, SD, PC/SD and FIB-4 in cirrhotic esophageal varices
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摘要:
目的评估脾长径(SD)、血小板计数(PC)、血小板计数/脾长径比值(PC/SD)、FIB-4指数预测肝硬化食管静脉曲张(esophageal varices,EV)的临床价值。 方法收集134例肝硬化病人的临床资料,均行胃镜检查明确食管胃底静脉曲张情况,按有无EV分为EV组及非EV组,EV组病人按照是否合并红色征(RC)分为RC(+)组及RC(-)组,评价PC、SD、PC/SD、FIB-4等四项指标对EV的诊断效能及分析RC的影响因素。 结果EV组PC、白细胞计数、PC/SD均低于非EV组,SD、FIB-4、Child-Pugh评分、凝血酶原时间均高于非EV组,差异有统计学意义(P < 0.05~P < 0.01);PC、SD、PC/SD、FIB-4对EV预测的受试者工作曲线下面积分别为0.781、0.811、0.811、0.715;SD、PC/SD联合对于EV预测的曲线下面积为0.822,灵敏度为85.4%,特异度为71.1%;RC(+)组年龄小于RC(-)组,SD大于RC(-)组,差异有统计学意义(P < 0.05和P < 0.01);SD对预测EV组病人中RC的曲线下面积为0.705,临界值151,灵敏度66.1%,特异度64.5%。 结论PC、SD、PC/SD、FIB-4对EV的预测均有一定的临床价值,PC/SD、SD联合能较好地预测EV;SD是肝硬化EV病人RC的独立危险因素。 Abstract:ObjectiveTo investigate the clinical value of spleen longitudinal diameter(SD), platelet count(PC), PC/SD and FIB-4 index in predicting the cirrhotic esophageal varices(EV). MethodsThe clinical data of 134 patients with cirrhosis were collected.The esophageal varices in all patients were examined using gastroscopy.According to the presence or absence of EV, the patients were divided into the EV group and non-EV group, and the EV group was subdivided into the RC (+) group and RC (-) group according to the red color sign(RC) The diagnostic efficacy of PC, SD, PC/SD and FIB-4 in EV were evaluated, and the influencing factors of RC was analyzed. ResultsThe PC, WBC and PC/SD in EV group were lower than those in non-EV group, and the SD, FIB-4, Child-Pugh score and PT in EV group were higher than those in non-EV group(P < 0.05 to P < 0.01).The areas under the curve predicted by PC, SD, PC/SD and FIB-4 for EV were 0.781, 0.811, 0.811 and 0.715, respectively.The area under the curve predicted by SD and PC/SD for EV was 0.822, the sensitivity was 85.4%, and the specificity was 71.1%.The age in RC (+) group was less than that in RC (-) group, and the SD in RC (+) group was greater than that in RC (-) group(P < 0.05 and P < 0.01).The area under the curve of SD for predicting RC in EV group was 0.705, the cutoff value was 151, the sensitivity was 66.1% and the specificity was 64.5%. ConclusionsThe PC, SD, PC/SD and FIB-4 have certain clinical value in predicting EV.The combination of PC/SD and SD can better predict.The SD is an independent risk factor for RC in patients with cirrhotic EV. -
Key words:
- cirrhosis /
- esophageal varices /
- spleen longitudinal diameter /
- platelet count /
- FIB-4
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表 1 临床指标的比较(x±s)
指标 非EV组(n=38) EV组(n=96) t P ALT/(U/L) 94.87±176.78 39.56±26.96 1.92* >0.05 AST/(U/L) 82.39±113.31 53.70±35.06 1.53* >0.05 ALB/(g/L) 34.08±7.22 31.95±6.25 1.70 >0.05 CR/(mmol/L) 64.32±14.77 66.05±28.74 0.46* >0.05 PC/(×109/L) 122.00±53.80 70.39±45.53 5.61 < 0.01 WBC/(×109/L) 4.50±1.52 3.65±2.49 2.41* < 0.05 PT/s 14.36±2.39 15.50±2.92 2.06 < 0.05 INR 1.31±0.24 1.39±0.28 1.43 >0.05 SD/mm 117.58±26.20 154.50±35.11 6.64* < 0.01 Child-Pugh评分/分 7.19±2.05 7.96±1.98 1.99 < 0.05 FIB-4 4.73±3.41 8.88±9.49 3.73* < 0.01 PC/SD 1.15±0.63 0.51±0.43 5.74* < 0.01 *示t′值 表 2 PC、SD、PC/SD、FIB-4单独预测EV的比较
指标 AUC 临界值 95%CI SE P 灵敏度 特异度 PC 0.781 96.50 0.692~0.871 0.046 < 0.01 0.833 0.711 SD 0.811 140.50 0.734~0.889 0.040 < 0.01 0.667 0.816 PC/SD 0.811 0.85 0.726~0.897 0.044 < 0.01 0.875 0.658 FIB-4 0.715 4.05 0.613~0.817 0.052 < 0.01 0.781 0.632 PT 0.611 14.75 0.497~0.725 0.058 >0.05 0.568 0.676 ALT 0.611 40.50 0.500~0.722 0.057 < 0.05 0.646 0.605 表 3 PC/SD分别与SD、PC、FIB-4联合预测EV的比较
指标 AUC 95%CI SE P 灵敏度 特异度 PC/SD+SD 0.822 0.743~0.900 0.040 < 0.01 0.854 0.711 PC/SD+PC 0.811 0.726~0.897 0.044 < 0.01 0.875 0.658 PC/SD+FIB-4 0.811 0.726~0.897 0.044 < 0.01 0.875 0.658 表 4 EV组病人有无RC的临床特征分析(x±s)
指标 RC(-)(n=59) RC(+)(n=37) t P 年龄/岁 55.14±9.97 50.78±10.54 2.04 < 0.05 ALT/(U/L) 45.22±36.39 36.02±18.31 1.64* >0.05 AST/(U/L) 60.19±38.38 49.63±32.48 1.44 >0.05 ALB/(g/L) 31.56±6.12 32.19±6.37 -0.47 >0.05 CR/(mmol/L) 62.81±11.76 68.10±35.48 -0.87 >0.05 PC/(×109/L) 71.11±43.91 69.93±46.88 0.12 >0.05 WBC/(×109/L) 3.13±1.35 3.97±2.96 -1.60 >0.05 PT/s 12.27±2.87 15.65±2.97 -0.61 >0.05 INR 1.38±0.28 1.39±0.29 -0.25 >0.05 SD/mm 139.22±29.98 164.08±34.91 -3.58 < 0.01 Child评分/分 8.00±2.32 7.93±1.76 0.16 >0.05 FIB-4 9.83±8.65 8.29±10.00 0.78 >0.05 PC/SD 0.56±0.41 0.48±0.45 0.95 >0.05 *示t′值 -
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