摘要
目的评估无创检测指标与食道静脉曲张的相关性,通过无创检测指标判断肝硬化患者是否须要进行胃镜检查。方法251例肝硬化患者分为食道静脉曲张组和无食道静脉曲张组。采用多因素Logistic回归分析法评估Child-Pugh评分、凝血酶原活动度(prothrombin activity,PTA)、血小板(platelet,PLT)计数、脾厚、门静脉直径(portal vein diameter,PVD)等无创检测指标与食道静脉曲张的相关性。应用受试者工作特性曲线分析我们建立的基于PTA与PLT的3分评分系统对食道静脉曲张的灵敏度和特异度的评估。结果PTA、PLT、出现肝性脑病、出现腹水在2组间的差异有统计学意义,而总胆红素、PVD、脾厚、清蛋白及Child-Pugh评分在2组间的差异无统计学意义。多因素Logistic回归分析提示PTA<70%、PLT<100×109/L与存在食道静脉曲张明显相关。我们建立的3分评分系统的曲线下面积为0.73,0分预测出现食道静脉曲张的灵敏度为100%,特异度为0;1分预测出现食道静脉曲张的灵敏度为89.10%,特异度为32.50%;2分预测出现食道静脉曲张的灵敏度为70.60%,特异度65.00%;3分预测出现食道静脉曲张的灵敏度为64.70%,特异度为77.50%。结论对于PTA≥70%,尤其合并PLT≥100×109/L的肝硬化患者可以根据患者的具体情况酌情暂缓胃镜检查。
Objective To evaluate the correlation between non-invasive diagnostic markers and the presence of esophageal variees, and determine the necessity of gastroseopic screening for liver cirrhosis according to non-invasive diagnostic markers. Methods A total of 251 cirrhotic patients were divided into non-esophageal varices group and esophageal varices group. Logistic regression was used to evaluate the correlation between the presence of esophageal varices and non-invasive diagnostic markers, such as Child-Pugh scores, prothrombin activity （PTA）, platelet （PLT） counts, thickness of spleen and portal vein diameter （PVD）. Receiver operating characteristic （ROC） curve was used to analyze the sensitivity and specificity of our 3-score system based on PTA and PLT in evaluating the presence of esophageal varices. Results The differences in PTA, PLT, the occurrence of hepatic encephalopathy and the occurance of ascites were significant between the two groups. There were no significant differences in parameters of total bilirubin, PVD, thickness of spleen, albumin and Child-Pugh scores （P〉0.05） between both groups. Logistic regression showed that PTA≤70% and PLT≤100×10^9/L were significantly correlated with the presence of esophageal variees. The area under the curve of our 3-score system was 0.73. Score 0 suggested that the sensitivity and specificity of predicting the presence of esophageal varices were 100% and 0, score 1 suggested that they were 89.10% and 32.50%, score 2 suggested they were 70.60% and 65.00%, and score 3 suggested they were 64.70% and 77.50%, respectively. Conclusion Gastroscopic screening can be delayed temporarily in cirrhotic patients with PTA ≥70% and PLT ≥100×10^9/L.
出处
《传染病信息》
2009年第3期147-149,162,共4页
Infectious Disease Information
基金
北京市科委重大项目--病毒性肝炎诊治一体化的研究(H020920020690)
国家"十一五"重大科技专项--慢性乙型肝炎临床治疗方案的优化及影响(2008ZX10002-004)
