乙肝后肝硬化患者食管静脉曲张无创性预测因素分析

                                     作者：于江泳 刘晓娜 王东 崔景晶

【摘要】  目的 探讨乙肝后肝硬化患者食管静脉曲张发生及其程度的无创性预测因素及临床价值。方法 将住院的89例乙肝后肝硬化患者按照有无食管静脉曲张及其程度随机分为无曲张组(22例)、轻度曲张组(24例)、中度曲张组(17例)及重度曲张组(26例)。对比分析四组患者外周血小板(PLT)计数、脾脏长径、脾脏厚度、脾脏指数(SI)、门静脉内径、脾静脉内径、PLT/脾脏长径比值、PLT/脾脏厚度比值、白蛋白(ALB)、胆红素、凝血酶原时间 (PT)等指标，按Child?Pugh分级法对患者肝功能进行评估和分级，并用Logistic回归分析比较各指标与食管静脉曲张发生及其程度的相关性。结果 曲张组与无曲张组比较，外周PLT计数、脾长径及二者比值、SI有显著性差异（P＜0.05或P＜0.01）。轻、重度曲张组间比较，PLT计数及与脾长径比值有显著性差异（P＜0.05）。四组患者之间的脾厚度、ALB、PT、胆红素、Child?Pugh值、门静脉内径、脾静脉内径等均无显著性差异（P＞0.05）。Logistic回归分析显示，PLT计数/脾长径比值与有无重度食管静脉曲张组有明显相关（P＜0.01），其OR值为1.028，当PLT计数/脾长径比值≤909，判断重度食管静脉曲张的敏感性为89％，特异性为83％，阳性预测值为93％，阴性预测值为100％。结论 PLT计数/脾脏长径比值可作为非侵入性预测有无重度食管静脉曲张的指标。 
【关键词】  肝硬化；食管静脉曲张；预测因素
    【Abstract】  Objective  To retrospectively investigate the non?invasive predictive factors of esophageal varices(EV) in patients with post?hepatitis B cirrhosis.Methods  Eighty nine patients with post?hepatitis B cirrhosis were included. Twenty?six patients had severe EV, twenty?four patients had mild EV, seventeen patients had moderate EV and twenty?two patients had no EV. Platelet count, spleen diameter, the thickness of spleen (SPT), spleen vein(SV), portal vein(PV), spleen index(SI), platelet count/spleen diameter ratio, platelet count/ thickness of spleen ratio, liver biochemistry such as bilirubin and albumin, and Child?Pugh score, etc, were recorded and compared statistically.Results  There were significantly difference of platelet count, spleen diameter, SI, platelet count/spleen diameter ratio between groups of EV and the group of no EV (P＜0.05 or P＜0.01). The platelet count/spleen diameter ratio was the only predictive factor for the presence of severe EV (P＜0.01). When the platelet count/spleen diameter ratio≤909, it had a sensitivity and specificity of 89% and 83% respectively, and positive and negative predictive value of 93% and 100% respectively.Conclusion  The platelet count/spleen diameter ratio was the  non?invasive predictive index for the presence of severe EV.
    【Key words】  liver cirrhosis，esophageal varices，predictive factor
    食管静脉曲张是肝硬化门脉高压的严重并发症，发生率为60%～80%，有30%～40%的肝硬化患者发生静脉曲张破裂出血［1］。由此产生的上消化道大出血及肝性脑病等并发症可严重危及患者生命，病死率高达30%～50%［2］。导致出血的机制是曲张静脉内压力增高, 而血流动力学研究表明曲张静脉壁张力与血管内外压力差及血管内径成正比，因此破裂出血多见于重度静脉曲张，尤其是表面伴有红色征者。内镜检查由于其侵入性及患者耐受性差等因素，临床上推广受到限制。采用非侵入性方法预测食管静脉曲张及其程度受到人们重视。本研究回顾性分析89例乙肝后肝硬化患者的相关资料，探讨肝硬化患者食管静脉曲张发生及其程度的无创性预测因素及其临床价值。

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